Addiction: Is it a matter of choice?

Rohit began smoking when he joined college. He was friends with a group of teenagers, all of whom smoked. Rohit wanted to fit in, and tentatively picked up the habit by smoking one or two cigarettes a day. Six months down the line, Rohit was smoking a pack a day. He lost interest in classes, assignments and grades. When he went home for the vacations, he couldn’t smoke as much as he wanted to. He began feeling irritated, nauseous and restless. He would pace around, unable to concentrate on simple tasks. He would try to sneak out of the house to smoke, just so he could avoid feeling out of sorts. He couldn’t enjoy his vacations or the time with his family – all he would think about was how he could leave the house to smoke, how he could smoke at home without getting caught, and how he could go back to college, just so that he could smoke without restrictions. His parents had no idea that Rohit was addicted to cigarettes and found out only when the college called them at the end of the year to say that Rohit hadn’t attended classes, and would have to repeat the year.

Addiction is a brain illness with a firm biological basis, and is influenced by social as well as psychological factors.

As the person keeps using the substance, their body’s tolerance to it gets higher, and the withdrawal symptoms make them take it again. They may think that they cannot live without the substance, and that it is as important as food, water or oxygen. The person may increasingly find themselves focusing on the substance and end up neglecting work, responsibilities, family and friends.

According to WHO guidelines, a person is said to have an addiction if:

• they feel compelled to imbibe the substance

• they cannot voluntarily stop using it (or cut down on using it)

• they focus frequently on how to get access to the next dose

Here is a list of the WHO’s diagnostic terms that are used to refer to addiction-related disorders. 

Addiction is a chronic, relapsing condition and is quite similar to other chronic illnesses such as diabetes. It requires treatment in the form of intervention and control. A round of treatment does not guarantee that a person will not be addicted again; there are chances of a relapse. A relapse does not necessarily mean that the person has failed; rather it indicates that the person needs more support to get over the substance.

Common addictive substances

In India, the most common addictive substances can be divided into three categories:

• Legal drugs such as alcohol and tobacco/cigarettes 

• Illicit drugs, which include recreational drugs 

• Pharmaceutical drugs or prescription drugs

Some of the other indicators of an addiction are:

• When the substance takes up a lot of the person’s time and thinking: When will I have my next drink/smoke, what can I substitute it with, where can I get it from, how can I get it?

• Withdrawal symptoms when the person does not use the substance for a period of time: shivering, irritation, severe craving and other psychological and emotional effects

• Loss of control, when the person intends to go a whole day without the substance, but loses the will to do so

• Craving: A strong urge to imbibe the substance

• Continued use of the substance despite knowing that it is causing physical and emotional harm to the person and those around them

In clinical terms, addiction refers to a pattern in which a person becomes dependent on a substance. Addiction is a chronic, relapsing disorder. The usage of the substance causes changes in the brain, which makes it difficult for the user to quit using it.

Both abuse and addiction can be harmful for the individual.

The changes caused in the brain of a person with addiction, occur in the areas of the brain that are related to other mental health disorders such as depression, severe anxiety and schizophrenia. There is a high chance that a person who has an addiction may also develop one of these severe mental disorders.

Doctors say that some people are more vulnerable than others to begin with. “Those who are extremely impulsive, get angry easily, are oppositional or rebellious, or on the other end of the scale – being extremely anxious or having low self-esteem are more likely to get addicted,” says Dr Prathima Murthy, psychiatrist, NIMHANS Centre for Addiction Medicine. Those who are at a genetic risk for addiction (having had a close relative who had addiction issues) are at great risk too.

The environment plays an important role in determining whether a person is likely to get addicted. The availability, accessibility, affordability and social norms regarding the use of addictive substances influence the person’s tendency to develop an addiction.

A person may begin using a substance due to curiosity, peer pressure or environmental influences, without knowing that they are at risk of developing addiction. People who are vulnerable to addiction also cannot understand when they have reached the ‘safe’ limits. They do not have a strong protective mechanism that tells them when to stop, and so the warning signs (like slurring or swaying after a few drinks) may be missing. This makes the person use more of the substance and cause harm to themselves.