Have you been so frustrated at the clearly irrational behavior of an addict that you have been tempted to shake some sense into them? Every hypothetical situation you've imagined that ends with them returning to a happy, healthy, successful life involves the simple step of "just stop!" 

Maybe the reason that addiction is so difficult to understand by outsiders is because people use the word "addiction" as casually as they use the word "love". For example: "this pizza is so good, it’s addictive!" The truth about addiction is it involves complex physical and psychological factors that are not easy to stop, even when an addict makes a conscious decision to try.

What is addiction? The medical understanding of addiction is grounded in two other concepts: tolerance and dependence. When a user develops tolerance to a drug, he or she requires higher and/or more frequent doses of the substance in order to achieve the same high that they experienced the first time. Someone whose addiction may have started as recreational use for social reasons may escalate into addiction and dependence when they develop tolerance and start using more often to recreate the high. Dependence is often broken down into physical dependence and psychological dependence. If a person experiences physical withdrawal symptoms when they discontinue a drug, they are considered to be physically dependent on that drug. Not all substances cause physical dependence. Of those that can cause physical dependence, not all individuals who use the substance will develop an addiction or become physically dependent on it like, for example, alcohol. Psychological dependence refers to the ways in which substance use and abuse causes activity in the brain’s reward center. When the addict uses the substance, the brain receives a positive signal of “good”. An addict who is not physically dependent on a substance may become addicted to the reward signal, and develop an obsession over recreating that experience, leading to psychological dependence.

So, why can’t they stop using? Especially in the case of individuals who are physically dependent on a substance, discontinuing use means more than losing out on what you may perceive to be a selfish desire to continually get high. Individuals who are physically dependent will experience withdrawal symptoms when they stop using. These symptoms can range from mild headaches and nausea to seizures, coma, and even death depending on the substance in question and the dosages they were taking. Some addicts are terrified of going through withdrawal because they have experienced mild withdrawal symptoms when they had a hard time acquiring the substance. Withdrawal symptoms can be extremely serious, and it is recommended that addicts who are trying to stop their addiction go through a detox process that is monitored by medical professionals to ensure their safety. Individuals who are psychologically dependent on a substance will not experience physical withdrawal symptoms (unless they are also physically dependent as well). However, psychological dependence can dominate an addict’s thought process and make finding more of the substance the only focus of their thoughts. They cannot imagine or understand a life that does not include the reward signal they experience every time they administer the substance.

How can you help an addict? The first step in helping an addict is to understand how addiction works. Talk to your doctor and theirs – ask questions – do research – join a support group. Next, stop enabling them. You may also want to consider seeking the professional help of an intervention team or a rehabilitation facility. While it is possible to persuade an addict to seek treatment alone, professional assistance can help them avoid the many unpleasant and potentially dangerous effects of going through detox alone. Rehab facilities may be better able to give your loved one the time, resources, and skills necessary to get them on the path to recovery than you can alone. Whatever path you choose, you will achieve much more success if you stop trying to argue with the addict and educate yourself on how to fight the addiction.

See also:

• Al-Anon: Support for Loved Ones of Addicts
• The Brain on Drugs
• Who Becomes an Addict?

This article is not an attempt to excuse or justify the poor decisions or lapses in judgment that are often the catalysts of addiction; nor is it an attempt to minimize the many hurtful and destructive consequences of those decisions, which affect both the addict and their family, friends, and community. This article aspires to give the families and friends of those who are suffering from an addiction more awareness of the physical and psychological mechanisms behind addictive behavior. Regardless of how addiction begins or what stage it is in, it is a troubling reality that is complicated by lack of understanding.