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Dr Trisha Macnair last medically reviewed this article in March 2010.

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There are a lot of misconceptions and a fair bit of uncertainty about the nature of addictions, how they're caused, what course they follow and how best to treat them. This section will shine some light on the key issues.


Impossible to control

If you ask anyone what an addiction is, they'll probably say it's being unable to stop using a substance, for example an illegal drug such as heroin, or maybe legal substances such as alcohol.

Did you know around four million people use illicit drugs each year in England and Wales, and it’s estimated that more than 280,000 have problems because of their drug use?

Perhaps the best example is cigarette smoking. Anyone who has ever smoked will recognise the strong sense of compulsion to light up, particularly in situations where this is not allowed, such as in an plane, restaurant or pub.

These aspects of addiction have a physiological basis related to how the substance acts on the brain (in the case of cigarettes, it’s the effects of nicotine that the person craves) and a psychological aspect relating to the reasons for taking the substance (such as smoking to improve concentration or be part of a social group).



Dependence means feeling that you need a substance in order to carry on doing what you want to do, even if problems result from its use. If you are dependent on a substance then you might be said to be addicted to it.

But overall, we shouldn't view addiction or dependence in simple or absolute terms (that someone is either a hopeless addict or not). People may be dependent on substances in many different ways and to a variety of degrees of intensity.

What happens next depends on the nature of the substance, how someone's using it, the problems that it may be linked with, and the various aspects of the person's psychological make-up, their personal and social relationships.


Stages of addiction

Most addictions take time to develop and almost no one deliberately sets out to become addicted to a substance. What happens is a person's consumption progresses through several stages.

Following initiation (a first try) - maybe to experiment to see what the substance is like - a person may go on to use the substance again, and perhaps begin to use on an occasional then regular basis. Meanwhile, the amount consumed may also begin to increase. For some substances, the body rapidly becomes tolerant of a dose taken and the user will increase the amount to achieve a desired effect.


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