Dependence

Addiction - a chronic illness with many faces

mental disorders worldwide. They not only affect physical health, but also have a profound impact on the psyche, social life and everyday life. Addiction occurs when the consumption of a substance or a certain behavior can no longer be controlled voluntarily - even if negative consequences have already occurred. Find out more →

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All about dependency

Picture of Fachbeitrag von Dr. Katrin Wippersberg

Specialist article by Dr. Katrin Wippersberg

Dr. Katrin Wippersberg is a multi-skilled psychoanalyst and psychotherapist who works with great empathy and extensive experience in the treatment of trauma, anxiety disorders and depression, as well as being a profound couples therapist.

Definition: Addiction is one of the most common mental disorders and puts a strain on the body, mind and social life. It occurs when substance use or behavior can no longer be controlled despite negative consequences. Examples range from alcohol and nicotine to drugs and behavioral addictions such as gambling or excessive internet use. Common to all forms are loss of control, social withdrawal and a fixation on a short-term relieving action.

Dependency at a glance

Aspect	Short essence
What is dependency?	Counts as one of the most common mental disorders; is present when substance use or behavior despite negative consequences is no longer controllable. Affects the body, psyche and social life; ranges from alcohol/nicotine, medication & drugs to behavioral addictions (e.g. gambling, internet/gaming, shopping & work addiction).
Why does it arise?	Multifactorialgenetic disposition & neurobiological characteristics (reward system), plus psychological stress (trauma, emotional instability, low frustration tolerance, depression, ADHD) and social influences (stressful childhood, peer pressure, poverty, isolation, family background).
How do you recognize them?	Loss of control, craving, tolerance development, withdrawal, neglect of other areas and Continue despite damage. Progression: initially „harmless“ consumption → ritualization → withdrawal, irritability, concealment, mood swings as well as sleep disorders, exhaustion, anxiety.
How is it diagnosed?	Clinical interview, standardized questionnaires (e.g. AUDIT, DUDIT), behavioural observation, physical examinations & laboratory tests (e.g. liver values, urine) and family history. ICD-10: within 12 months ≥3 characteristics (including craving, loss of control, withdrawal, tolerance, neglect, use despite harm). DSM-5Substance use disorder with degrees of severity.
How is it treated?	Phase model: medically accompanied Withdrawal (inpatient/outpatient) → psychotherapeutic Weaning (behavioral therapy, group, motivational interviewing) ± drug support (e.g. methadone, naltrexone) → social reintegration & Relapse prevention. Goal: inner freedom & sustainable quality of life.

Diagnostic criteria according to ICD-10 and DSM-5

International classification systems such as ICD-10 and DSM-5 define clear criteria for diagnosing addiction. According to ICD-10, at least three characteristics must occur simultaneously within twelve months: a strong desire or compulsion to use (craving), limited control over starting, quantity or cessation, physical withdrawal symptoms when reducing or stopping, a development of tolerance with increasing dose requirements, increasing neglect of other areas of life and continued use despite harmful consequences.

In the DSM-5, these aspects are summarized under the term „substance use disorder“ and additionally divided into degrees of severity - depending on how many criteria are met.

Forms of addiction - substance-related and behavior-related

The classic substance-related addictions include alcohol and nicotine consumption. Illegal drugs such as cannabis, cocaine or heroin and the misuse of medication, such as tranquilizers or painkillers, are also common. In addition to these substance addictions, there are also non-substance-related Addictions, which follow the same pattern of loss of control, tolerance development and withdrawal. Examples include pathological gambling, internet addiction and gaming disorder, shopping addiction, work addiction and, to a lesser extent, sex or sports addiction. All of these disorders are used for short-term emotional regulation or inner stabilization, but reduce the quality of life in the long term.

Causes - a complex interplay

The development of addiction is multifactorial. Biological components such as genetic predispositions, neurobiological characteristics (for example a dopamine deficiency in the reward system) or an increased tolerance meet psychological stresses such as unprocessed trauma, emotional instability, low frustration tolerance or accompanying disorders such as depression and ADHD. Added to this are social influences, such as stressful childhood experiences, peer pressure, poverty, isolation or a family history of stress. The more of these risk factors that act simultaneously, the greater the likelihood that addictive behavior will develop and become permanently entrenched.

Progression and typical signs

An addiction often begins with seemingly harmless consumption. Over time, the behaviour becomes ritualized and increasingly beyond control. Everyday life increasingly revolves around the substance or the behavior, while school, work and friendships are neglected. Without the usual consumption, those affected experience inner emptiness or strong states of tension, withdraw, react irritably, conceal their behavior or fluctuate in mood. This is accompanied by physical and psychological complaints such as sleep disorders, exhaustion or anxiety. In the further course of the disease, profound damage occurs on a physical, emotional and social level.

Diagnostics - well-founded and differentiated

The diagnosis of addiction is made in a detailed clinical interview and is supplemented by standardized questionnaires such as AUDIT for alcohol or DUDIT for drugs, behavioural observations, physical examinations and laboratory tests such as liver values or urine analyses, as well as assessments by relatives. A precise differential diagnosis is essential, as addiction often overlaps with other mental disorders. Depression, anxiety disorders, personality disorders, eating disorders or attention deficits often occur at the same time. Only a comprehensive diagnosis enables targeted and effective treatment.

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Treatment - steps towards freedom

Treatment for addiction takes place in several phases and is individually tailored. It usually includes medically supervised withdrawal treatment in an inpatient or outpatient setting, followed by psychotherapeutic weaning with methods such as behavioral therapy, group therapy or motivational interviewing and, if necessary, medication support, such as methadone for opiate addiction or Naltrexone for alcohol addiction. Finally, social reintegration with assisted living, relapse prevention groups or professional reintegration promotes long-term stabilization. The aim is not just to give up, but to develop new strategies for dealing with stress, feelings, relationships and self-worth.

Addiction in adolescence - particularly vulnerable

Adolescents are particularly susceptible to addiction-related behaviors because their brains are not yet fully developed, they exhibit higher risk behavior and have a strong need to belong. Typical initiation scenarios are alcohol and nicotine, excessive gaming or social media and the mixed use of cannabis or medication. Parents, schools and other caregivers should look out for warning signs such as social withdrawal, a drop in performance or emotional instability and seek professional support at an early stage.

Social significance - addiction is a collective issue

Addiction not only affects those affected, but also families, businesses, educational institutions and the healthcare system. It causes considerable follow-up costs and often leads to shame, guilt and exclusion. An effective social response therefore relies on prevention, education and early support rather than condemnation. Addiction is not a sign of weakness, but a treatable disease.

Frequently asked questions & answers

What exactly is an addiction?

Addiction occurs when a person can no longer control the use of a substance or behavior, even though they are aware of the negative consequences. Typical characteristics are strong cravings, tolerance development, withdrawal symptoms, loss of control, neglect of everyday duties and continued use despite problems.

What forms of addiction are there?

A distinction is made between substance-related addictions such as alcohol, drugs, medication or nicotine and non-substance-related addictions such as gambling, excessive internet use, shopping addiction, workaholism or sports addiction. What all forms have in common is the loss of control, not the addictive substance itself.

How do I know if I am addicted?

Warning signs are the feeling of needing something to calm down or relax, even though you keep telling yourself not to. Secret consumption, feelings of guilt, conflicts and constantly lying to yourself also indicate a possible addiction.

Can you be addicted even though you only consume a little?

Yes, addiction is less a question of quantity than of the relationship to the substance or behavior. Anyone who regularly thinks about alcohol, drinks in secret or can no longer cope with certain situations without drinking can be addicted, even to small amounts.

Is it an addiction if I drink a glass of wine every evening?

Not necessarily, but it can still be a risk. The decisive factor is the reason: habit, relaxation or dealing with inner turmoil. If alcohol is regularly used as a means of self-regulation, an addiction can gradually develop.

Why can some people quit and others can't?

Addiction is a disease, not just a question of willpower. Biological predisposition, psychological stress and social circumstances influence the ability to stop. It often takes more than good intentions, namely support, therapeutic guidance and, if necessary, medication.

Are you addicted if you only look forward to a certain situation, such as Friday night drinking or smoking weed before going to bed?

Not necessarily, but it can be the beginning of a psychological dependency. If the behavior becomes an emotional fixed point and relaxation is no longer possible without the substance, mindfulness is required.

Is it a real addiction if I have no physical withdrawal symptoms?

Yes, psychological addiction should be taken just as seriously as physical addiction. Many behavioral addictions do not cause classic physical withdrawal symptoms, but create great internal pressure when the behavior is interrupted and significantly impair quality of life.

How does an addiction develop: why me?

Addiction develops from the interaction of several factors. These include genetic predispositions, neurobiological characteristics in the reward system, unprocessed psychological stress, unfavorable learning patterns and social pressure or emotional isolation. No one consciously chooses to become addicted; it often appears as an apparent solution to inner distress.

I do work, can I still be an addict?

Yes, many of those affected maintain a stable outward appearance in their work, family and everyday life for a long time. These functional addictions nevertheless cause suffering, fear of exposure and increasing loss of control. Hidden addictions also require treatment.

Do I always have to stop completely or is controlled consumption also possible?

This depends on the type of addiction, previous history and everyday stability. In the case of substance-related addictions such as alcohol, medication or drugs, permanent abstinence is usually the safest route. For some behavioral addictions, such as heavy internet use, a reduction may be possible, but never without professional support.

What happens when I stop the addiction, who am I then?

Many people ask themselves this question because addiction has often become part of their identity. After quitting, emptiness, fear or disorientation may initially occur. Good therapy helps you to find new roles, recognize real needs and create a life that feels like freedom rather than renunciation.

Can I really be cured by therapy?

Addiction is chronic, but can be treated successfully. Complete recovery in the medical sense is not guaranteed, but stable abstinence, self-efficacy and a fulfilled life are realistic goals. Setbacks are part of the process; the key is to stick with it and make use of help.

Is it a relapse if I drink, gamble or use once?

A relapse is not a personal defeat, but part of many development processes. It is important to seek help, analyze the triggers and develop new strategies. In this way, even a relapse can be a step forward.

What do I tell my environment, do I even have to?

You decide for yourself how openly you want to deal with your illness. During therapy, you can clarify what openness is appropriate, who you want to confide in and what support you can activate in your environment.