Addiction

Help with addictions

Addiction (dependence syndrome) refers to the persistent, compulsive craving for a substance or a certain behavior despite negative consequences. In contrast to occasional use or enjoyment, addiction is characterized by loss of control, tolerance development and withdrawal symptoms. Those affected continue their consumption despite the physical, psychological or social damage caused. Find out more →

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All about addictions

Picture of Fachbeitrag von Mag. Alexander Wieser

Expert contribution by Alexander Wieser

Alexander Wieser is an experienced psychotherapist specializing in Integrative Gestalt Therapy. With over a decade of professional experience in various industries, he brings a diverse perspective to his therapeutic work.

Definition: An addictive disorder is the compulsive craving for a substance or behavior, despite harmful consequences. It is characterized by loss of control, tolerance development and withdrawal symptoms. The causes are biological, psychological and social. The goal of therapy is a stable and addiction-free life.

Adjustment disorder at a glance

Aspect	Short essence
Definition	Reactive disorder (ICD-10 F43.2), develops direct after a stressful event, limited in time & in principle reversible.
Typical triggers	Loss, separation, change of job/place of residence, serious diagnosis, bullying - anything that creates sudden pressure to adapt.
Leading symptoms	Depression, worry circles, irritability, sleep problems, physical tension - always event-related.
Diagnostics	Medical history + temporal context, questionnaires, exclusion of depression/PTSD; physical examination in case of somatic illness.
Treatment	Short-term CBT & crisis intervention; strengthen resources, build coping; medication only short-term for sleep/anxiety.
Forecast	Usually subsides in 3-6 months; good course with early help, otherwise risk of depression/anxiety sequelae.

Introduction: What is an addiction disorder?

The ICD-10 classifies addiction under the chapter groups F10-F19 (mental and behavioral disorders caused by psychotropic substances) and F63 (abnormal habits and impulse control disorders, e.g. pathological gambling). A distinction is made between substance-related addictions (e.g. alcohol, opiates) and non-substance-related behavioral addictions (e.g. gambling, internet use).

2. origin and causes

Addiction arises from a complex interplay of biological, psychological and social factors. This is known as the biopsychosocial model. No single factor can fully explain the development of an addiction. The decisive factor is individual vulnerability, which interacts with environmental conditions and the specific effect of the substance or behavior.

On a biological level, sufferers often have a disorder in the brain's reward system, particularly in the neurotransmitter dopamine in the mesolimbic system. There are changes in the prefrontal control areas, which are important for planning and self-control. The brain also adapts to the substance. This explains why tolerance develops and withdrawal symptoms can occur.

Psychodynamic aspects also play a role. Addictive substances often replace a lack of inner regulation. Many people with an addiction have experienced attachment disorders at an early age or have been emotionally neglected. Consumption often serves to ward off unresolved inner conflicts or unpleasant feelings.

Learning theory concepts show that addiction can be reinforced by positive reinforcement such as intoxication or by negative reinforcement such as stress relief. Operant and classical conditioning, also in the social environment, contribute to the maintenance of addictive behavior.

Finally, social factors are decisive. These include the influence of the peer group, the availability of the substance or medium as well as family and social norms and disruptions.

Diagnostic criteria according to ICD-10 (e.g. F10.2 Alcohol dependence)

At least three of the following characteristics must occur simultaneously within one year in order to be considered a dependency:

There is a strong desire or even a compulsion to consume the substance.
The person concerned has clearly lost control over the start, amount and end of consumption.
Physical withdrawal symptoms occur when the substance is discontinued or reduced.
In addition, tolerance often develops, which means that an increasingly higher dose is required over time to achieve the same effect.
Other interests and activities are neglected because consumption is taking up more and more space.
Nevertheless, the substance continues to be consumed even though harmful effects are already evident.

These criteria apply not only to certain substances, but also to behavioral addictions such as pathological gambling.

Substance-related addictions (ICD-10: F10-F19)

Criterion	Description
Strong desire / compulsion	Urge or inner compulsion to consume the substance.
Reduced control	The start, quantity and end of consumption can no longer be controlled.
Withdrawal syndrome	Physical or psychological withdrawal symptoms when stopping or reducing.
Tolerance development	Increasingly higher doses required to achieve the desired effect.
Neglect of other interests	Other activities are neglected in favor of consumption.
Continued consumption despite damage	Continued use despite harmful consequences that have already occurred.

At least three of these criteria must be present at the same time within one year. The criteria also apply to other substances and to certain behavioral addictions such as pathological gambling.

Each substance has a specific psychotropic effect profile, physical and psychological consequences and typical withdrawal symptoms. What they all have in common is an addiction-like pattern of use with loss of control.

Non-substance-related (behavioral) addictions

These are classified under F63.0 (pathological gambling) or other impulse control disorders. The inclusion of further behavioral addictions is planned in ICD-11.

Behavioral addiction	Typical features
Pathological gambling	Compulsive gambling, debt, loss of control, concealment
Internet addiction / online addiction	Excessive screen time, neglect of social contacts and duties
Shopping addiction	Recurring impulses to buy unnecessarily or excessively
Workaholism	Self-esteem regulation via performance, obsessive striving for control and success
Sex addiction / pornography addiction	Repeated use of sexual content despite social or psychological consequences

These behaviors are based on similar neurobiological mechanisms as substance addictions, particularly in the brain's reward system.

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Progression and prognosis

Addiction is often chronic and is characterized by relapses. Without treatment, the condition usually deteriorates further. This often leads to social isolation, physical illness and mental overload. Those who get help early have a much better chance of recovery.

A relapse is not a personal failure, but part of the disease. It is therefore important to incorporate a relapse management plan into the therapy.

Comorbidities

Addiction often does not occur alone. Many people with an addiction struggle with other mental health problems at the same time. These include depression, anxiety disorders and personality disorders, ADHD or post-traumatic stress disorders. Such additional illnesses are called comorbidities.

These combinations have a strong impact on the course of the addiction and the treatment. The various problems often influence each other. That is why it is usually not enough to tackle the addiction alone. For successful therapy, it is important to treat all existing disorders together. This is referred to as a integrated treatment.

Diagnostics and differential diagnoses

Precise diagnostics are required to reliably identify an addiction and differentiate it from other disorders. Various instruments are used for this purpose. In addition to a discussion with a specialist (clinical interview), standardized questionnaires and laboratory tests are also used. These procedures help to determine the severity and type of addiction. It is equally important to examine other possible causes for the symptoms. Sometimes addictive behavior and other mental disorders such as compulsions, impulse control disorders or simply strong habits are similar. Careful differentiation ensures that the right treatment is chosen.

Instruments	Differentiation from
Clinical interview (e.g. SKID, MINI) Questionnaires: AUDIT (alcohol), DUDIT (drugs), Fagerström test (nicotine), SOGS (gambling) Laboratory tests (liver values, urine screening)	Habitual behavior without addiction criteria Obsessive-compulsive disorder (compulsion ≠ desire) Impulse control disorders (e.g. pyromania, trichotillomania)

Therapy options

Treatment phase	Measures
Acute phase	Detoxification for physical dependence (e.g. inpatient, medication-assisted)
Weaning phase	Psychotherapy (cognitive-behavioral, psychodynamic, systemic) Group therapy, self-help groups (e.g. AA, NA) Drug relapse prophylaxis (e.g. naltrexone, acamprosate for alcohol)
Rehabilitation and aftercare	Social reintegration (housing, work) Relapse prevention Long-term therapeutic support

Special features for children, adolescents and the elderly

Young people:
If young people start using addictive substances at an early age, their risk of developing an addiction later on increases significantly. Alcohol, cannabis and the use of social media are particularly problematic, as these substances are easily accessible and often trivialized. Young people are still developing and their brains are particularly susceptible to the negative consequences of addiction. Preventative measures are therefore important. These include education at school, offers to strengthen the personality and easily accessible advice centers.

Older people:
Addiction is often overlooked in older people. Their consumption behavior is less noticeable in everyday life or is seen as „normal“. Typical substances in this age group are alcohol and tranquilizers such as benzodiazepines. Many older people take medication regularly, which increases the risk of addiction. Loneliness, pain or physical illness can also encourage consumption. It is therefore important to adapt diagnostics and therapy to the life situation of older people. This includes a sensitive approach, age-appropriate advice and special treatment options.

Prevention

Effective prevention starts at various points. It is important to strengthen people's emotional and social skills. Information about the risks of addictive behavior should be provided at an early stage. It helps to promote alternative strategies for coping with stress and problems. Early detection plays a major role in schools, workplaces and medicine. The availability of addictive substances can also be restricted, for example through youth protection laws.

Preventive measure	Brief description
Strengthening emotional and social skills	Promotion of self-confidence, dealing with feelings, ability to deal with conflict
Information about risks	Information about the dangers of addictive substances and behavioral addictions
Promotion of alternative coping strategies	Teaching healthy methods for dealing with stress and strain
Early detection	Early recognition of problems at school, at work or at the doctor's surgery
Restriction of availability	Measures such as youth protection laws to limit access to addictive substances

ICD-11 outlook

In ICD-11, the concept of behavioral addictions is further expanded, including the introduction of „gaming disorder“ as an independent diagnosis. The diagnostic criteria are more clearly focused on loss of control and functional impairment.

Frequently asked questions & answers

When do you become addicted?

Addiction does not begin with daily consumption. Warning signs include loss of control over quantity and frequency, strong cravings, withdrawal from social contacts, development of tolerance (needing more and more) and withdrawal symptoms. If consumption continues despite negative consequences, this is known as dependence.

What types of addiction are there?

A distinction is made between substance-related and non-substance-related (behavioral) addictions. Substance-related addictions include alcohol, nicotine, cannabis, medication, heroin, cocaine and other substances. Non-substance-related addictions include gambling, the internet, social media, shopping, work and sex. Both forms can cause similar symptoms and lead to serious problems.

Is addiction a disease?

Yes, the World Health Organization (WHO) and all medical classification systems (ICD, DSM) recognize addiction as a mental illness requiring treatment - not as a „weakness of will“. It affects the brain, especially the reward center, and alters thinking, feeling and behavior.

How does an addiction develop?

The causes of addiction are manifold. Several factors often come together. These include, for example, genetic predisposition, experiences in early childhood, mental illnesses such as depression or anxiety disorders, severe stress or traumatic experiences. The social environment can also play a role, for example through peer pressure or isolation. Addiction does not usually develop overnight, but over a longer period of time. It arises from the interplay of inner vulnerability and external stress.

Can you become addicted to any substance?

Not every substance has the same addictive potential. Nicotine, heroin and cocaine are considered to be particularly addictive. Medication (e.g. sleeping pills or tranquillizers) can also be addictive if used over a long period of time. In principle, any substance with a rewarding or tension-relieving effect can lead to addiction.

What happens in the event of a relapse?

Relapses are part of the addiction process and not a sign of personal failure. They offer the opportunity to recognize triggers and adapt the therapy plan. It is important to seek help again quickly after a relapse - the sooner the better.

How do you recognize addiction in relatives?

Signs of addiction can include mood swings, irritability or withdrawal. Secrecy, lying and neglecting duties are also common. Financial problems or debts often become apparent. Physical changes such as weight loss or tremors can also be indications.

Can addiction be cured?

Addiction is considered a chronic disease with a risk of relapse - similar to diabetes or high blood pressure. However, with the right treatment and stable support, it is possible to lead an addiction-free, fulfilling life. Many people live permanently abstinent lives or find stable consumption control (in the case of non-substance-related addictions).

Which therapies help with addiction?

There are various proven approaches that can help with addiction. These include motivational interviewing, behavioral therapy and psychodynamic therapies in which, for example, inner conflicts are worked through. Self-help groups such as Alcoholics Anonymous also play an important role. In some cases, drug support can help, especially to prevent relapse.

For severe cases, inpatient treatment is sometimes necessary. Long-term aftercare is also important for lasting success in order to avoid relapses.

How can addiction be prevented?

Prevention begins in childhood. It is important to promote emotional and social skills in children and to create stable relationships and good role models. Healthy ways of dealing with stress and boosting self-esteem also play a role. Measures such as youth protection, which limit access to addictive substances, are also important. An open and trusting atmosphere in families and schools can also help to prevent addiction.