Reward, tolerance and dependence are considered the three components of addiction. People start engaging with mood altering and behaviours to feel good or to become more confident (reward). Over a period of time they need to take more to produce the same affect (tolerance). If they stop using they get the opposite affect to reward and go into withdrawal. They start the drug again to stop withdrawal (dependence). This is the essence of drug addiction.
The reputation of a pleasurable or rewarding action is called positive reinforcement. People drink/take drugs for many different reasons to feel good – confident, relaxed etc. All of these effects constitute a pay off or reward to the user. The Reward system is part of our survival kit, which has evolved to ensure the survival of the species, and makes essential activities such as eating, drinking and sex pleasure. The brain releases natural reinforcers, opioid-like transmitters which raise circulating dopamine levels and create a feeling of satisfaction.
Alcohol and other drugs of abuse are chemical surrogates of natural reinforcers but more powerful and persistently rewarding that the natural reinforcers to which the human brain is accustomed. Continues exposure can initiate increased drug seeking behaviour and set the stage for addiction.
Drugs cause changes in the receptors to which they bind, making them less sensitive. This creates tolerance, the need to take sequentially larger amounts of a substance to produce the same effect/reward. People drink/use for those rewards but they progressively fall short of their reward/pay off. This creates the need to take sequentially larger amounts of a substance to produce the same effect/reward.
Dependence is the need for continued use to avoid withdrawal. If they stop using, they get the opposite effect to reward and go into withdrawal. Severe physical withdrawal symptoms are usually opposite in nature to the drug’s acute affect/reward and include anxiety, emotional agitation/depression, tremors and sweating. These effects are devastating and painful; starting the drug again brings prompt relief.
Cycle of Addiction
The addict now needs to drink/use to function and to satisfy the craving they feel. They no longer experience reward from their using, are tolerant to the affects of their drug of choice but dependent on its use and they are now locked into the Cycle of Addiction.
Author: Nick Kypriotis, Client Relations Manager (MSc, FDAP NCAC) at The Kusnacht Practice