Addiction is often explained in simple ways: weak willpower, bad habits or the desire to escape painful feelings.
But decades of research across psychology, neuroscience and behavioural science has transformed what we know about addiction — from the thoughts and feelings that drive it to the traits and mindsets that can help people recover.
Here are 16 psychology studies that shed light on the causes of addiction and the factors that aid recovery.
> Causes
Weakness in the prefrontal cortex
Weakness in an area of the brain called the prefrontal cortex is at the heart of addiction.
The prefrontal cortex lies at the front of the brain, above and behind the eyes.
The area is involved in long-term goal-setting, self-regulation and helps us control our impulses or, in the case of addiction, fails to.
The people most vulnerable to addiction have abnormal functioning in these areas.
Weakness in the prefrontal cortex can be caused by genetic factors, but can also be down to head injury, child abuse or other environmental causes.
Professor Antoine Bechara, the study’s first author, said:
“Addiction is a disease of decision-making.
The majority of people have intact brain mechanisms of decision-making that keep them resilient to succumbing to an addiction.”
Failing to learn the lesson
It is hard for addicts to give up bad habits like drinking, gambling or drugs because they fail to learn the right lessons from the disastrous outcomes.
Most people can connect self-destructive behaviour with its consequences, but for the addict or compulsive the link remains a mystery.
Their failure to form an accurate mental model of their behaviour is partly why addicts find it so hard to quit.
The conclusions come from an intriguing study that had people playing a simple video game sneakily designed to assess whether participants could link certain behaviours with their punishing consequences.
Dr Philip Jean-Richard-dit-Bressel, the study’s first author, explained:
“We already know from previous studies using the same video game that many people—who we call ‘unawares’—fail to realize how their actions lead to negative outcomes.”
More than a habit
The reason that people with addictions and OCD continue to repeat behaviours that are harmful to them is not always down to habit.
Instead, sometimes the cause may paradoxically be too much self-control: after all, it takes considerable effort to keep drinking alcohol when the behaviour is destroying your life.
In fact, people mainly persist because of the reward they get: for the alcoholic, a mood boost and/or relief from withdrawal symptoms.
The worse they feel, the more strongly they value what they know will make them feel better.
Habit may play a part, but perhaps not as large a role as assumed.
The power of sadness
Out of all the negative emotions, sadness plays the strongest role in addictive behaviour.
The sadness that comes from an irrevocable loss predicts people will smoke more and makes people more likely to relapse 20 years later.
In the lab, people feeling sad are more impatient to puff on a cigarette, compared with those experiencing other negative emotions.
It has long been thought that all negative emotions predict addictive behaviour, said Mr Charles A. Dorison, the study’s first author:
“The conventional wisdom in the field was that any type of negative feelings, whether it’s anger, disgust, stress, sadness, fear, or shame, would make individuals more likely to use an addictive drug.
Our work suggests that the reality is much more nuanced than the idea of ‘feel bad, smoke more.’
Specifically, we find that sadness appears to be an especially potent trigger of addictive substance use.”
Pleasure seeking
Alcoholics do not drink in order to dull painful feelings — debunking a long-held myth about addiction.
The same is true for the depressed: alcohol does not reduce their negative emotions appreciably.
In fact, both alcoholics and depressed people get more pleasure from alcohol compared with the non-depressed or unaddicted.
Addicts, then, drink for pleasure, since getting drunk generates high levels of stimulation, but does not reduce painful feelings that much.
Professor Andrea King, the study’s first author, said:
“Currently, the focus of treatment is often on resolving stress and symptoms of depression, but that is only addressing one side of the coin if we don’t also address the heightened stimulation, liking and wanting more alcohol that occur in both depressed and non-depressed people with AUD.”
Related: People who are more sensitive to alcohol’s pleasurable effects are more likely to become alcoholics.
> Risk factors
Deep psychological issues
Young people who get addicted to video games usually have some kind of underlying psychological issue, rather than the games themselves being to blame.
While video games may make existing problems worse, they are often a poor way of coping with largely unrelated mental health problems.
Given that 90 percent of U.S. adolescents engage in gaming for an average of 100 minutes per day, the findings are highly relevant.
Adolescents are particularly sensitive to rewards and find it harder to control themselves, making the ‘buzz’ that gaming offers especially satisfying.
Almost one-in-ten adolescents has a gaming disorder, which can lead to social isolation, distress and severe neglect of responsibilities — for adolescents that means their schoolwork suffers.
Ms Kylie Falcione, the study’s first author, said:
“The kids who were already having depressive symptoms and social issues were more likely to get stuck in a cycle of problematic gaming.
What the study showed, was that the underlying issue started beforehand and that the addictive gaming behaviors were, in a way, a symptom or a manifestation of those preexisting psychopathologies.
For these kids, gaming had become an unhealthy coping mechanism.”
Related: Teenagers who are disagreeable and lacking conscientiousness are at a greater risk of video game addiction.
Gen X and junk food
Members of Generation X — those born between 1965 and 1980 — have the highest odds of being addicted to ultra-processed foods (UPFs) compared to older generations.
The rise of diet-focused processed foods in the 80s may be key to this addiction — which is particularly strong among middle-aged women.
During that decade, low-fat foods and highly refined carbohydrates were marketed as healthy alternatives to full-fat products.
Studies show that UPFs can alter the brain’s reward system leading to a dopamine surge and increased cravings.
Dr Ashley Gearhardt, the study’s senior author, said:
“The percentages we see in these data far outpace the percentages of older adults with problematic use of other addictive substances, such as alcohol and tobacco.”
Neuroticism
Neuroticism is the personality trait often linked to addiction — including shopping addiction.
Shopping can provide a way of escaping the unpleasant thoughts that neurotic people are more likely to experience.
Neuroticism — one of the five major aspects of personality — is a trait that is strongly linked to anxiety, sadness, irritability and self-consciousness.
Many types of addiction have been linked to neuroticism, including alcoholism and other types of substance misuse and problem gambling.
Dr Cecilie Schou Andreassen, the study’s first author, explained the results:
“Our research indicates that people who score high on extroversion and neuroticism are more at risk of developing shopping addiction.
Extroverts, typically being social and sensation seeking, may be using shopping to express their individuality or enhance their social status and personal attractiveness.
Neurotic people, who typically are anxious, depressive, and self-conscious, may use shopping as a means of reducing their negative feelings.”
> Positive mindset
Future focus fights cravings
Learning to focus more on the future helps addicts — and anyone else for that matter — fight their moment-to-moment cravings.
A future orientation reduces impulsivity and enables people to see how their current choices fit into the ‘big picture’.
People thinking more about the future make healthier choices.
Future thinkers are also less likely to fall prey to what psychologists call ‘delay discounting’: choosing small immediate rewards over larger delayed rewards.
Delay discounting is why people prefer to spend rather than save or eat fast food instead of staying healthy.
While the technique is potentially useful to everyone, it is being employed by Professor Stephen LaConte, study co-author and colleagues, to help treat alcoholics:
“…training people to think more about their future changed the extent to which they value immediate rewards over those in the future, and we’re seeing related changes in connectivity in key regions of the brain along with that.”
Hope protects against addiction
Feeling hopeful helps protect people against destructive and addictive behaviours.
Hope is essentially having a positive goal, a way to achieve it and the mental energy to carry it through.
The research helps explain why many people do not turn to things like over-eating, drinking and gambling when they feel deprived in relation to others.
Feeling relative deprivation may set off negative feelings, but a sense of hope is the key to overcoming them.
Dr Piers Fleming, study co-author, explained the results:
“We found that the volunteers who scored high for hope, were much less likely to take risks in the game.
Those who weren’t too hopeful, were a lot more likely to take risks.”
Related: Optimists are less likely to suffer from substance misuse problems.
Life purpose reduces bingeing
Having a sense of purpose in life reduces the desire for binge drinking.
Social drinkers were less likely to binge on the days when they felt guided by personally valuable meanings and goals.
Brain scans also revealed that some people are ‘neurally sensitive’ to alcohol cues — in other words, they find it harder to resist drinking when they are reminded of alcohol.
Purpose in life, though, helped neurally sensitive people resist the urge.
The study’s findings suggest that boosting sense of purpose in life is a useful technique to avoid binge drinking.
People sensitive to the temptations of alcohol could focus on their mission, purpose and values in life — thinking about what really matters.
Growth mindset encourages change
Developing a ‘growth’ mindset is one of the best ways to beat addiction.
People with a growth mindset acknowledge that addiction can be fought in different ways and it has many causes.
Understanding the reasons for addiction can help empower people.
Addiction is not solely dictated by a person’s genes.
Those with a growth mindset are more likely to seek therapy and more confident in their ability to change.
In contrast, thinking of addiction as a disease makes people believe they have less control over it.
Dr Jeni Burnette, the study’s first author, explained:
“The growth mindset message stresses that human attributes are malleable, and we know from previous work that it encourages better self-regulatory strategies such as seeking helping from others.
> Treatment & recovery
Treatment is challenging
Addiction is very difficult to treat in the long-term, a review of thousands of studies conducted over decades finds.
Psychotherapeutic approaches, unfortunately, only have limited success, tending only to work (sometimes) in the short-term, with little evidence that changes will stick.
But that does not mean they are not worth trying.
While research shows treatment effects are modest, there are some therapies that work better than others for each form of addiction:
- Alcohol: CBT has little effect when used alone, but can work modestly when combined with motivational interviewing. Brief psychotherapy can also have a small effect.
- Cannabis: CBT combined with motivational approaches has some moderate effect. Brief psychotherapeutic interventions had little effect.
- Stimulants: Contingency management (using vouchers as rewards) had some small effect, but this was not maintained.
- Opioids: CBT could reduce benzodiazepine use for up to three months, but motivational interviewing was not effective.
Healing as a whole
A holistic approach is the best way to treat drug addiction.
Holistic approaches involve taking into account the social, mental, biological and environmental barriers to overcoming substance misuse.
For example, those with addictions need to be taught to seek social support, to use community services, to live a healthier lifestyle as well as reducing their intake of the drug.
Lifestyle changes tend to be more effective when used in tandem for drug-taking.
Someone trying to quit smoking might also have a target of taking a walk each day and eating more fruits and vegetables.
For alcohol addiction, though, the researchers found that interventions which focused on alcohol abuse worked best.
Professor Dolores Albarracín, the study’s first author, said:
“Many programs treat drug or alcohol use as relatively independent of other related behaviors or contextual factors.
But research reveals that substance use often stems from a variety of biological, psychological and social factors, all working in tandem.”
A natural, mindful high
An 8-week course called ‘Mindfulness-Oriented Recovery Enhancement’ has been shown to reduce opioid misuse by 45 percent.
It works partly because addicts can get a totally safe, legal high from mindfulness meditation that also fights their addictive behaviours.
The key is the production of theta waves: a particular type of electrical activity in the brain that puts the mind into a healthy altered state of consciousness.
Increased theta waves help addicts gain self-control over their addictive behaviours.
Professor Eric Garland, the study’s first author, said:
“Rather than seeking a high from something outside of yourself like a drug, meditation can help you to find an even greater sense of pleasure, peace and fulfilment from within.”
Professor Garland likens this to the 11th step of the popular 12-step addiction treatment program, which involves ‘seeking conscious contact with a higher power through prayer or meditation’.
Related: Mindfulness therapy fights opioid addiction by normalising the brain’s response to pleasure and reducing cravings by half.
Support groups work
The best advice to give an alcoholic is to join Alcoholics Anonymous.
Alcoholics Anonymous, or AA as it is known, is up to 60 percent more effective than other treatments like psychotherapy.
AA is the most effective path to abstinence and also beneficial for those looking to reduce their drinking.
AA works because it is social: members give each other tips on how to stay dry and they provide emotional support to each other.
Professor Keith Humphreys, the study’s first author, said:
“If you want to change your behavior, find some other people who are trying to make the same change.”
