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Addiction: nurture and nature

Alcohol, illegal drugs and nicotine are the substances which probably come to mind when we think about addiction.

However, addiction is much wider than substance dependency. It can extend to behaviours such as gambling, video gaming and pornography.

Dr Naveen Puri, Medical Director for Bupa UK Insurance, says,

“In simple terms, an addiction is anything which stimulates dopamine reward pathways in the brain. It establishes a craving for something to the point where a want becomes a need.

Compulsive behaviour

More common in men

Substance misuse is more common in men. But the gap is narrowing and there is evidence that women escalate to dependency quicker than men.1 Alcohol is one of the most common problems. The number of people drinking at dependency-level climbed sharply during the pandemic.2

Addictive personality?

At one time, psychologists believed particular traits created an addictive personality. This would mean that some people might be at greater risk of dependency than others.

Multiple drivers

Reward pathways

Another issue is that habits can become habit-forming as the brain’s neural processes and reward systems are rewired. This is because elevated levels of dopamine lead to increased sensitivity to glutamate — a brain chemical associated with learning and cue-related behaviours.8

Dopamine, and this reward pathway, is also the driver for behavioural addictions such as gambling, video gaming, excessive use of pornography and sex-addiction.

Brain scans of cocaine users reveal that erotic images activate the same brain circuits as drug-related images. Similarly, scans show that prolonged exposure to online pornography alters brain signalling and desensitises the viewer.8

ADHD and mental health

Dopamine dysregulation is often a factor in attention deficit hyperactivity disorder (ADHD).9 This may explain why ADHD, conduct disorder and depression in adolescence are associated with an increased risk of alcohol, cannabis and nicotine addiction.10

Providing support

Resources from the Workplace Health and Wellbeing Academy

1 Fonseca, F., Robles-Martínez, M., Tirado-Muñoz, J. et al. A Gender Perspective of Addictive Disorders, 2021, DOI: 10.1007/s40429-021-00357-9

2 Alcohol in England, January 2024.

3 House of commons library, Alcohol Statistics: England, July 2021.

4 NHS, Alcohol units, 2021.

5 Office for National Statistics, December 2022.

6 Global Journal of Addiction & Rehabilitation Medicine, The Myth of ‘Addictive Personality, DOI: 10.19080/GJARM.2017.03.555610 (PDF, 0.3MB)

7 Neuropsychopharmacol, Heilig, M., MacKillop, J., Martinez, D. et al. Addiction as a brain disease revised: why it still matters, and the need for consilience, 2021, DOI: 10.1038/s41386-020-00950-y

8 Journal of Psychosexual Health, Jha A, Banerjee D. Neurobiology of Sex and Pornography Addictions: A Primer, 2022, 4(4):227-236. DOI: 10.1177/26318318221116042

9 National Library of Medicine, Attention-deficit-hyperactivity disorder and reward deficiency syndrome, October 2008, 4(5):893-918. DOI: 10.2147/ndt.s2627

10 National Library of Medicine, Identifying Early Risk Factors for Addiction Later in Life: A Review of Prospective Longitudinal Studies, March 2020, 7(1):89-98. DOI: 10.1007/s40429-019-00282-y.

11 National Institutes on Drug Abuse (US), Common Comorbidities with Substance Use Disorders Research Report, April 2020.

12 National Library of Medicine, the link between schizophrenia and substance use disorder: A unifying hypothesis, April 2018, 194:78-85. DOI: 10.1016/j.schres.2017.04.016

13 National Library of Medicine,The effectiveness of workplace interventions for the prevention of alcohol use: A meta-analysis, November 2023, 118(11):2043-2061. DOI: 10.1111/add.16276.

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