Addiction is a complex issue, shaped by a combination of physical, emotional, and psychological factors. While physical dependence and withdrawal are the most commonly discussed aspects of addiction, the psychological dimension of addiction is equally important and often more difficult to treat. Hence the importance of studying the psychological processes, models, and therapies involved in addiction and recovery.
At PCP we believe that understanding the psychology behind addiction is crucial not only for developing effective treatments but also for reducing stigma and supporting lasting recovery.
Unraveling the Features of Substance Abuse and Addiction
Addiction is traditionally defined as compulsive drug-seeking behaviour despite the negative consequences. Although this definition still covers the vast majority of addictions, several refinements arose as our understanding of the psychology of addiction grew.
One of these advancements was the recognition of addiction as a chronic, relapsing condition. This affected the way addiction treatment was approached, with greater emphasis being placed on maintaining long-term sobriety in the community through aftercare services. Addiction affects not only the individual’s physical health but also their mental well-being, relationships, and overall functioning.
Another significant shift was a better understanding of the concept of behavioural addictions such as compulsive gambling, shopping addiction, and weight loss addiction. Behavioural addiction refers to compulsive engagement in rewarding non-substance-related activities that can lead to similar patterns as substance addiction. For example, gambling behaviour can become addictive when individuals are unable to control their impulses despite negative outcomes. This demonstrated that some of the psychological features and brain chemistry changes which occurred in addiction were possible even without drug use. The recognition of new forms of addiction has also highlighted how certain personality traits and psychological factors can increase the risk of developing addiction, leading to the emergence of new addictive patterns.
Because the scope of what could be considered an addiction has widened considerably, perhaps it is best to simplify addiction through the five C’s:
● Chronic disease
● Impaired control
● Compulsive use
● Cravings
● Continued use despite negative consequences
Addictive behaviour is characterised by compulsive engagement in activities or substance use, even when individuals are aware of the risks and negative outcomes. These harmful consequences can include financial loss, relationship disruption, and serious personal or social issues, highlighting the severity of outcomes from addictive behaviours.
Understanding Key Concepts in Addictive Behaviors and Addiction
To further understand addiction, it is also important to define key terms that are associated with the condition.
● Physical Dependence: This occurs when the body adapts to the long-term use of an addictive substance. If drug use is reduced or stopped suddenly, it may lead to unpleasant physical symptoms like headaches, nausea, tremors, and sweating, as well as other unpleasant symptoms that make cessation difficult.
● Psychological Dependence: Psychological dependence deals more with the emotional and mental processes associated with long-term substance use. This involves cravings, compulsive drug-seeking behaviour, anxiety, depression, difficulty concentrating, and obsessive thoughts about drug use.
● Tolerance: Tolerance occurs when the body becomes less responsive to a drug due to long-term use. As a result, the user often takes increasingly larger or more frequent doses to achieve the same effects. With repeated drug use, brain receptors, including dopamine receptors, become less sensitive, requiring more of the substance to achieve the same effect. Tolerance is an important factor in understanding the progression of dependence and addiction and can often lead to overdose. The neurotransmitter dopamine plays a key role in this process, as addictive substances increase dopamine activity in the brain’s reward pathways, contributing to the development of dependence and withdrawal.
● Withdrawal: This refers to the symptoms that occur when a person who is physically or psychologically dependent on a drug stops or reduces drug use. Individuals often experience withdrawal symptoms, which can include both physical and psychological effects. A person addicted to a substance is most likely to experience these symptoms. It could involve physical symptoms or psychological symptoms. The severity and duration of withdrawal can vary significantly based on individual factors, the particular drug being abused, and how long this substance was used.
Risk Factors for Addiction
Addiction does not develop in a vacuum—there are multiple risk factors that can make some individuals more vulnerable than others. Genetics play a significant role; people with a family history of addiction are at a higher risk of developing substance use disorders themselves. This genetic predisposition can affect how the brain responds to addictive substances, making it easier for some individuals to become dependent.
Environmental factors are equally important. Growing up in an environment where addictive substances are readily available or where substance use is normalised can increase the likelihood of experimenting with and becoming addicted to drugs or alcohol. Stressful life circumstances, exposure to trauma, or living in communities with high rates of substance abuse can also contribute to the risk.
Psychological factors, such as co-occurring mental health disorders like depression, anxiety, or PTSD, further elevate the risk of addiction. Individuals may turn to addictive substances as a way to self-medicate or cope with emotional pain. Recognising these risk factors is crucial for both preventing and treating addiction, as it allows for early intervention and tailored support that addresses the unique needs of each person.
Family and Social Influences
The influence of family and social circles on the development of addiction cannot be overstated. Family members, especially parents, shape attitudes and beliefs about addictive substances and behaviours from an early age. If parents or carers model addictive behaviours or express approval—either directly or indirectly—children may be more likely to view substance use as acceptable.
Social learning theory explains that people often learn behaviours by observing those around them. This means that if a young person sees family members or peers engaging in substance use or other addictive behaviours, they are more likely to imitate these actions. Peer influence becomes particularly powerful during adolescence and young adulthood, when the desire for acceptance and belonging is strong. Friends who use addictive substances or engage in risky behaviours can increase the pressure to do the same.
Perceived parental approval also plays a significant role. When young people believe their parents are tolerant of substance use, they are more likely to experiment with drugs or alcohol. Understanding these family and social dynamics is essential for preventing addiction and supporting recovery, as positive role models and supportive relationships can be powerful protective factors.
Popular Psychological Models of Addiction
The first step to understanding the psychology of addiction is examining how it develops. Different theories exist to explain the progression to compulsive drug-seeking behaviour, how the brain becomes rewired in a negative feedback loop and the factors that can trigger this change, including other factors such as environmental and social influences.
Here are some popular models for understanding the psychology of addiction:
● The Addiction Cycle Model: The addiction cycle model divides addiction into three key phases – binge/intoxication, withdrawal, and preoccupation/anticipation. During the binge phase, a person consumes a psychoactive substance and feels certain pleasurable effects like euphoria or anxiety relief. When taken long enough this leads to important changes in the reward system of the brain, particularly in regions such as the nucleus accumbens and the cerebral cortex, which are central to the brain’s reward pathway. Repeated exposure to addictive substances strengthens reward related learning, making the motivation to seek out these substances more powerful over time.
These changes then lead to the withdrawal or negative effect phase. This occurs when the individual attempts to discontinue drug use and develops unpleasant physical and psychological symptoms. At this point, they may also lose the ability to enjoy other pleasurable activities due to changes in brain chemistry associated with long-term drug use, including alterations in the prefrontal cortex that impair decision-making and impulse control.
Once withdrawal has set in the person enters the preoccupation/anticipation stage where they experience cravings and feel compelled to continue drug use to avoid the unpleasant effects of withdrawal. This motivates compulsive drug-seeking behaviour despite the negative effects associated with the addiction.
● Psychoanalytic/Psychodynamic Model: This model was based on research by the famed founder of psychoanalysis, Sigmund Freud. While discussions about the Freudian concepts of ego, superego and id are beyond the scope of this article, this theory attributes addiction to an imbalance between the three levels of consciousness caused by unresolved inner conflicts. It emphasizes how early relationships, unresolved trauma, and underdeveloped ego functions can lead individuals to use psychoactive substances as maladaptive coping mechanisms.
● Personality Model of Addiction: This psychological model for addiction suggests that certain personality traits make individuals more likely to develop drug and behavioural addictions. This includes traits such as impulsivity, low self-esteem, nonconformity, poor stress tolerance, sensation seeking, and manipulativeness. The personality model of addiction has been particularly useful in explaining behavioural addictions like pornography addiction, where changes in brain chemistry are not as prominent as drug addiction.
Interestingly, research into the personality model of addiction has even identified certain personality traits associated with distinct types of addiction. For example, heroin users were found to be higher in neuroticism and lower in extraversion, users of party drugs like LSD and ecstasy were found to be more extroverted, while Internet addiction was associated with higher scores in neuroticism and low scores in extraversion and conscientiousness.
Also, certain personality combinations were found to be more likely to participate in risky behaviour such as drug use. Some examples included individuals high in neuroticism but low in conscientiousness (called the insecures), as well as individuals high in extraversion and low in conscientiousness (impulsives or hedonists). Based on this theory some researchers suggest that personality restructuring through techniques like CBT and DBT are necessary for long-term recovery. Traits related to poor impulse control are also linked to a higher risk of addiction, and addiction is recognized as one of the mental disorders in the DSM 5.
● Incentive-Sensitization Theory: The Incentive-Sensitization Theory describes the disconnect that often occurs between “wanting” a drug (motivation and craving) and the actual pleasure associated with drug use. In simple terms, initial drug use is often associated with strong pleasurable effects which leads to continued use. As tolerance builds, users need more of the substance to feel the same effects, driving the cycle of addiction.
As the effects of tolerance continue the pleasure associated with drug use drops steadily but the cravings only intensify due to the rewiring of reward circuits within the brain. This eventually leads to the cycle of compulsive drug-seeking behaviour, attempted abstinence, withdrawal and relapse, even though the pleasurable effects of the drug have long since diminished. In simple terms, this is a disconnect between wanting the drug and liking it. The brain involved in these changes, often referred to as the addicted brain, undergoes neural adaptations in nerve cells within key reward regions, making relapse more likely.
● Cognitive-Behavioural/Learning Model: The Behavioural Model of addiction suggests that addiction is a learned behaviour which occurs over time as a result of external environmental cues which modify and reinforce certain cognitive processes and eventually model behaviour. For years many experts believed that the primary motivation behind addiction was the avoidance of withdrawal. However, this did not fully explain many other types of addictions, particularly behavioural addictions.
The Cognitive-Behavioural model of addiction is based on the Thought-Feeling-Behaviour Triad. This suggests that maladaptive thinking processes lead to negative feelings which then trigger addictive behaviours possibly in an attempt to reduce the unpleasant emotions associated with these negative thoughts.
This model also suggests that addiction is associated with strong environmental influences. For example, the person may learn to associate certain situations, people or emotions with substance use, a key factor contributing to cravings and relapse. For instance, smoking related cues such as the smell of cigarettes or seeing parents smoking can powerfully trigger cravings and reinforce addictive behaviour.
● Self-Medication Model: This approach suggests that individuals use psychoactive substances to cope with psychological distress, such as anxiety, depression, or trauma, using drugs or behaviours as a form of self-soothing. Therefore, the pursuit of pleasure is not the initiating factor in this model for addiction, but rather the relief of psychological distress.
For example, individuals with intense feelings of anger or anxiety may be drawn more to sedating drugs like opioids and alcohol. On the other hand, people who are depressed, introverted, or having trouble concentrating are typically drawn to stimulants such as amphetamines or cocaine.
It is important to note that this model does not suggest that a person chooses a drug based on its properties, but rather explains why people gravitate to certain types of drugs while experimenting with drug use. The Self-Medication model has been used to explain why drug addiction is highly prevalent in people struggling with depression and anxiety. Experiences of psychological harm, such as those resulting from sexual abuse, can significantly increase vulnerability to addiction as a means of coping with emotional distress.
Types of Addiction
Addiction can take many forms, and understanding the different types is key to effective prevention and treatment. Substance use disorders are among the most well-known, involving the misuse of addictive substances such as alcohol, nicotine, or other drugs. Conditions like alcohol use disorder and drug addiction are characterised by a pattern of compulsive substance use despite negative consequences, such as health problems, relationship issues, or legal troubles.
However, addiction is not limited to substances. Behavioural addictions, such as gambling addiction, internet addiction, and compulsive shopping, involve repeated engagement in rewarding behaviours that become difficult to control. These behaviours can trigger the brain’s reward system in much the same way as addictive drugs, leading to similar cycles of craving, loss of control, and negative consequences.
Recognising the wide range of addictive disorders—including both substance use and behavioural addictions—helps ensure that individuals receive the right support and treatment for their specific challenges.
Psychological Treatment and Psychotherapeutic Approaches to Addiction
Treating addiction involves a combination of medications, counselling, and aftercare services such as housing, legal aid, and financial services. Psychotherapeutic approaches are designed to treat addiction by addressing the psychological and behavioural factors that contribute to substance use. As our understanding of the psychology of addiction has grown so has our approach addressing the root problems associated with addiction through psychotherapy. Here are some popular forms of psychotherapy used in addiction treatment.
Cognitive-Behavioural Therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviours that contribute to substance use. CBT focuses on developing healthy coping skills, recognizing triggers, and preventing relapse by teaching practical strategies to manage cravings and high-risk situations. The approach emphasizes present challenges rather than past experiences, making it more solution-focused
Dialectical Behaviour Therapy (DBT): DBT is effective for individuals struggling with emotional regulation and co-occurring mental health issues. It teaches skills in mindfulness, emotional regulation, and interpersonal relationships. While CBT focuses on thought patterns, DBT helps those in recovery manage intense emotions and urges. This reduces the likelihood of relapse by providing tools to cope with stress and cravings without resorting to substance use.
Motivational Interviewing: This is a patient-centered approach designed to enhance motivation for change. Therapists use nonjudgmental, empathetic communication to help individuals take dedicated steps towards quitting substance use. MI is effective in increasing engagement in treatment and supporting those recovering from substance abuse as they move through various stages of readiness to change their addictive behaviours.
In the case of behavioural addictions, such as gambling, specific interventions are used to treat gambling addiction, including pharmacological treatments like naltrexone and behavioural therapies such as aversion therapy.
Psychodynamic Therapy: This approach explores the unconscious roots of addictive behaviours, focusing on unresolved conflicts, past experiences, and emotional pain that drive substance use. Psychodynamic therapy aims to increase self-awareness, improve emotional regulation, and address relationship patterns. The primary goal of this form of therapy is to help individuals understand and resolve the psychological factors underlying their addiction.
Family Therapy: Family therapy involves the participation of family members in the treatment process to address dysfunctional family dynamics and improve communication. It educates families about addiction, helps resolve conflicts, and builds a supportive environment for recovery. Research shows that family therapy can improve treatment outcomes and reduce relapse rates.
Medications are also used as part of drug therapy to treat addiction, targeting neurochemical pathways to reduce withdrawal symptoms and cravings.
Treatment goals can vary, with some individuals aiming for complete abstinence, while others focus on harm reduction and gradual improvement.
Relapse Prevention
Relapse is a common and often discouraging part of the recovery journey, but it does not mean failure. Preventing relapse requires a proactive and comprehensive approach. One of the first steps is identifying personal triggers—situations, emotions, or people that increase the urge to use addictive substances or engage in addictive behaviors. By recognizing these triggers, individuals can develop strategies to avoid or cope with them.
Building strong coping skills is essential for managing stress, negative emotions, and cravings. Psychological treatment, such as cognitive-behavioral therapy (CBT), can help individuals change unhelpful thought patterns and develop healthier responses to challenges. Group support, family involvement, and ongoing counseling also provide valuable encouragement and accountability.
For some, medication may be necessary to manage withdrawal symptoms and reduce cravings, especially in cases of opioid or alcohol addiction. Medications like methadone or buprenorphine can support recovery by stabilizing brain chemistry and making it easier to focus on psychological healing.
Ultimately, relapse prevention is about creating a supportive environment, building resilience, and equipping individuals with the tools they need to maintain long-term recovery from addiction.
Seek Help Today for Treating Addiction
Addiction is more than a physical struggle – it is a psychological condition rooted in dysfunctional patterns of thought, emotion, and behaviour. By examining key psychological models of addiction we can gain a clearer picture of how addiction takes hold and why it is so difficult to treat.
Effective treatment must go beyond detox and medication; it requires addressing the underlying mental and emotional drivers of addiction through psychotherapy, support networks, and personal transformation. By combining both the science and the human experience of addiction, we can offer more compassionate, effective, and lasting paths to recovery.
If you or someone you love is struggling with addiction, PCP is here to help – because healing begins with understanding.
Reach out today!
