Free Article


by Eric Scalise


Description and Prevalence.

Substance abuse and other addictive problems are prevalent in almost every segment of society today. These problems cross all ethnic, cultural, educational, socioeconomic, gender, and age barriers. There has been an upward trend in elder substance abuse and prescription abuse over the past decade, but adolescent rates have stabilized somewhat. Yet the statistics are staggering (sources include the U.S. Department of Health and Human Services, the U.S. Department of Justice, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the U.S. Bureau of Labor Statistics):

There are an estimated 15 million alcoholics and 10 million drug addicts in the United States, 40% of all family problems brought to domestic court are alcohol related, and 75% of all juvenile delinquents have at least one alcoholic parent. More than 150,000 teens use cocaine, and 500,000 use marijuana once a week or more. In addition, nearly half a million junior and senior high students are weekly binge drinkers. An estimated 10 million to 15 million adolescents need treatment for substance abuse each year.

An estimated 5 million to 7 million people are addicted to prescription drugs.

Every addict directly affects at least 5 other people. In a recent Gallup poll, 41% of those polled indicated that they had suffered physical, psychological, or social harm as a result of someone else’s drinking or drugging (this is double the level reported in 1974).

40 million to 80 million Americans suffer from compulsive overeating, and 5% to 15% will die from its consequences each year. Some $20 billion is spent yearly by Americans seeking to lose weight.

1% to 2% of adolescent girls (close to 100,000 people) and 4% to 5% of college-age women struggle with anorexia and/or bulimia.

There are 2.5 million pathological gamblers and another 3 million compulsive gamblers in the United States. Gambling has become a $500 billion industry. The suicide rate for this population is 20 times higher than the national average. Some 50 million family members are said to be adversely affected.

There are currently more than 300 million pornographic websites with an estimated 6% to 8% of the population diagnosed with some level of sexual addiction.

No one really knows how many workaholics there are because this addiction has received comparatively little attention. One study indicated that more than 10 million adults average 65 to 70 hours of work each week.


The most prevalent debate centers on whether addictive problems are disease-based (primarily genetic/biological) or choice-based (primarily habits/social environment). Major theoretical orientations include moral theory, disease theory, behavioral theory, social-learning theory, and systems theory. People of faith often incorporate the sinful nature of fallen man into the equation. Romans 7:15-25 is a poignant reminder of this. Paul wrote, “But I see another law at work in me, waging war against the law of my mind and making me a prisoner of the law of sin at work within me” (v. 23).

Even though children of alcoholics are four times as likely to become alcoholics as are children of nondrinkers, initial theories of a single alcoholism gene have been disproven. Nevertheless, biological determinants cannot simply be ignored or discarded. Years of qualified research have now clearly demonstrated that addiction is influenced both by multiple genetic traits, called polygenic or addictive inheritance, and by a complex array of psychosocial dynamics. However, it is important to keep in mind that susceptibility does not necessarily imply inevitability. If genetics and biology were all-encompassing and determinative, no one would freely choose to move toward recovery. Alcoholics Anonymous and other 12-step approaches have consistently demonstrated this power of choice.

Recent research continues to explore the neurobiology of addiction. In all brain functioning, neurotransmitters (chemical messengers) are released by the electrical impulses of a neuron and record sensory experiences called imprints. These imprints are encoded, passed along appropriate pathways (across a synapse), and stored (usually at the unconscious level). Dopamine is one of the major agents related to the “pleasure pathway” to/through the limbic system (where the feeling of pleasure is produced and regulated) and plays an important role in the development of addiction. Studies have shown that addictive substances (as well as behaviors) can adversely affect the nucleus accumbens, a circuit of specialized nerve cells within the limbic system. The amygdala—an almond-shaped mass of nuclei that is located deep within the temporal lobe of the brain and that plays a primary role in the processing and memory of emotional reactions—in essence hijacks normal messaging that passes through the neocortex, where cognition is managed and creates new neural pathways that enhance the addictive process. The brain has a natural blood-brain barrier, which normally does not allow water-soluble molecules to pass through capillary walls. A substance is considered to be psychoactive when it can penetrate that barrier and create changes in neurochemistry and subsequent brain functioning.


Most practitioners who work in this field also understand and consider the needs-based aspect of addictive behavior that seems to fuel the dynamic. This can include the need to be insulated from worry and anxiety, the need to reduce manipulative guilt feelings, the need for approval and acceptance, the need to maintain a sense of control and power in one’s environment, the need to avoid pain (physical, emotional, and psychological), and the need to be a perfect person and measure up to the expectations of others. As such, all addictions typically fit into four basic categories:

addictions that stimulate—activities or substances that provide arousal and ecstasy, usually resulting in a release of adrenaline

addictions that tranquilize—activities or substances that calm, comfort, or reduce tension and anxiety, usually resulting in a release of endorphins

addictions that serve some psychological need, such as self-punishment, codependency, and workaholism

addictions that satisfy unique appetites, involving both psychological and physiological components, such as pornography and some fetishes

All addictions share several common identifiers.

They remove people from their true feelings in order to provide a form of escape.

They control people, and the control transcends all logic or reason.

They always involve pleasure.

They involve psychological dependence.

They are ultimately destructive and unhealthy.

They eventually take priority over all of life’s other issues.

All addicts minimize or deny their addiction.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) quantifies the difference between substance abuse and dependency. The latter can be characterized as a maladaptive pattern of substance use leading to clinically significant impairment or distress that can include tolerance, withdrawal symptoms, and increased usage in spite of the fact that doing so is ultimately destructive. Addicts usually do not become dependent on a substance or activity immediately, but only after progressing through a number of distinct stages:

Experimentation. People are motivated by curiosity or a desire for acceptance or escape, they do not go overboard, they learn that the effects are controlled by the level of intake, and they suffer few if any consequences.

Occasional use or doing. People experience periodic disruptions at work/school/home, need more of the substance or activity to get the same effect, have more actual seeking behavior, and are frequently guided by more experienced “users.”

Regular use or doing. People begin obsessing more and are preoccupied with using or doing, begin to do it more on their own, may experience a periodic loss of control, begin to break their own self-imposed rules that regulate the behavior, experience increased shame and guilt, and look for ways to hide the behavior.

Addiction and dependence. These people need the substance or behavior to survive, cope, and get by in daily living/functioning, and they experience a deterioration in mental, emotional, physical, moral, and spiritual health.

However otherwise unique, all addictive behaviors throughout these stages provide short-term gain but lead to long-term pain.