What is Addiction? What Causes Addiction? A Clinical Psychology Podcast Episode.

Typically when people think of addiction, they imagine someone who can't stop anything. It might be gambling, drugs or something else. Equally, people tend to trivialise addiction by calling someone addicted when they enjoy something like a cup of coffee, so they're "addicted" to caffeine. In reality, there is a lot more to addiction than most people know and addiction can destroy lives. Addiction can ruin families, friendships and relationships. Yet why? Therefore, in this clinical psychology podcast episode, you'll learn what is addiction, what are the signs and symptoms and you'll develop a deeper understanding of what addiction actually is beyond the pop psychology "facts" we hear from the media and friends and family. If you enjoy learning about mental health, addiction and clinical psychology, then this will be a great episode for you.

Today's psychology podcast episode has been sponsored by Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.

What is Addiction?

Addiction is when a person engages in a behaviour or uses a substance with rewarding effects, and it is these rewarding effects that compel the individual to repeat the activity despite the harmful consequences. For example, if we take heroin addiction, it is the high that the drug gives a person that compels them to continue to take heroin despite the negative impact it has on their health, finances and social relationships. Other addictive substances can include cocaine, inhalants, alcohol or nicotine, as well as behaviours like gambling are addictions too.

Despite addictive behaviours or substances being wide ranging, addictive substances are united by the fact that they share key neurobiological features. Such as, all addictive substances are heavily involved in the brain’s reward pathways that use the neurotransmitter dopamine. As well as addictive behaviours and substances lead to the pruning of synapses in the prefrontal cortex, this is the brain region responsible for our higher-level functions, so this means our attention gets more focused on the cues related to the addictive substances or behaviour, and less on the non-addictive cues in our life. This is very similar to what happens in the brain with other highly motivated states.

These neurobiological changes are important to be aware of because these brain changes cannot be undone after the addictive behaviour or substance use is stopped.

Furthermore, to bridge the physical and psychological aspects of addiction, individuals with addictions repeat the addictive behaviour or substance use regardless of the physical or psychological harm that it causes them. And someone’s physical tolerance to a substance increases as the body adapts to its presence. This is a reason why substance abusers take stronger and stronger drugs over time because they need more of the drug to get the same high.

One of the most alarming facts about this is that because addiction changes the brain’s executive functions, people with an addiction might not even be aware that their behaviour is causing problems for themselves and other people around them. This leads to the pursuit of the pleasurable effects of the behaviour or substance being a dominant activity over time.

Personally, this is a good example of why I wanted to deep dive and learn more about addiction. Since I live in an area of poverty and I understand that mental health difficulties and addiction are more common in poverty areas, but as an aspiring psychologist, I don’t know that much about addiction. As well as whenever I see mental health jobs in addictions services, my lack of knowledge is possibly one of the reasons why I don’t get an interview. Therefore, constantly researching and learning things about psychology is important because it allows you to grow your knowledge, you can talk about this knowledge in job applications and in interviews and hopefully, it will help you in the future. As well as learning about addiction will hopefully help develop our understanding, empathy and compassion towards people with addictions.

Also, because after this podcast episode, we’ll understand what addictions actually are and what they involve, we’ll be able to challenge the myths and misconceptions that others have about addiction. For example, we now understand that addiction causes physiological changes in the brain that makes someone focus on the addictive substance even more, so that’s one reason why it’s so difficult to stop.

In addition, substance misuse as well as gambling disorders are complex mental health conditions because they impact the motivation, reward, reinforcement as well as memory systems in the brain. Since these conditions are characterised by social impairment, disruption to everyday activities, cravings, relationships and impaired control over usage. This is one explanation as to why continued usage of addictive behaviours and substances can be harmful to work, school and relationships.

Building upon mental health conditions for a moment, when someone has substance use disorders or shows gambling behaviours, it’s likely that they will also have another mental health condition. Such as, depression or anxiety. This is important to be aware of because depression and anxiety and addiction all use different areas of the brain. Therefore, you cannot use addiction treatments to treat the depression or anxiety and vice versa. You need to treat each condition separately.

Personally, this reminds me of transdiagnostic approaches to mental health. In essence, this is when we recognise that different mental health conditions have similar underlying mechanisms and factors. Like both depression and anxiety disorders impair emotional regulation and so on. Yet like everything in psychology, it’s important to understand that everything also needs to be treated individually as depression and addiction shows us. This is another reason why I really like formulation where you tailor the psychological intervention to the individual. Instead of simply saying because you have depression, this intervention will work for you because it always works for depression. Therefore, this is a useful reminder that whenever we approach our clinical work, we must focus on the individual with their unique challenges, conditions and reasons for engaging and maintaining the addictive substance use or behaviour.

Additionally, all addictions can induce feelings of failure as well as a sense of hopelessness in people, especially as it promotes feelings of shame and guilt. Thankfully, research shows that recovery is the rule rather than an exception and there are a lot of routes to recovery. For example, a person with an addiction can recover on their own through improving their social, psychological and physical functioning without the help of others. This is called so-called natural recovery. Other people with addictions can find it useful to engage with peer-based or community networks, or they can go through clinical-based recovery through addiction services.

Like with all mental health conditions, the road to recovery is never straight. If you want to see a firsthand account of this from a trauma perspective, please check out my book Healing as a Survivor. Since people with addictions will start to recover, then they’ll relapse, then they’ll recover some more for a longer time and then another relapse and so on. As well as recovery isn’t the end of the road, because the person with the former addiction still has to maintain their recovery. Even though research shows that a person who is in remission for their addiction for five years shows no greater likelihood of relapsing than the rest of the general population.

There’s even some research from neuroscientists that’s synaptic density is gradually restored after recovery.

What are the Types of Addiction?

I wanted to include this next section because after writing the majority of this podcast episode, I’ve realised that addiction is more of an umbrella term for a wide range of addictive disorders. As well as throughout the podcast episode, we learn about addictive substances and behaviours, and I think we need to realise that when we talk about addiction we are not only talking about cocaine, heroin and gambling addictions. There is a lot more to addiction than those three addictive substances and behaviour.

For example, when it comes to substance use disorders, there are ten distinct disorders and all of these share the same defining features of addiction. The addictive substance is directly as well as intensely involved in the reward and reinforcement systems of the brain so they stimulate the compulsive use that typically leads to the neglect of normal activity with negative consequences. The only real difference between the ten substance use disorders is that the withdrawal symptoms differ in major ways, and some disorders don’t have withdrawal symptoms.

Some examples of substance use disorders include alcohol use disorder because alcohol is a brain depressant, whereas caffeine intoxication is characterised by restlessness, nervousness, flushed face and muscle twitching. A final type of substance use disorder is sedative, hypnotic or anxiolytic use disorder and this is an addiction to sleeping pills and anti-anxiety medication because these agents are brain depressants.

Whilst there are seven other substance use disorders, I wanted to introduce you to the idea that addiction covers so much more than cocaine, heroin and gambling.

Speaking of gambling, addiction isn’t limited to biochemical substances and they can involve behaviours that provide opportunities for immediate reward. This is because the fast feedback that happens with these activities, like gambling, can cause a hobby to turn into a compulsive pursuit of the reward that can lead a person to neglect life goals, activities and this leads to negative consequences.

Interestingly, whilst gambling addiction is the only “properly” recognised form of addictive behaviour at the moment, there are some behaviours that are being studied as possible behavioural addictions. Such as gaming, pornography, internet gambling and smartphone use. Since these behaviours imply that a person gets an immediate reward from the behaviour, but researchers and practitioners aren’t sure if these behaviours meet all the criteria for addictive behaviours.

What Causes Addiction?

One of the most interesting things about addiction is that it is a multi-faceted condition. This means that there are multiple factors that go into the development and maintenance of addiction for any given person. This also means that it is impossible to predict who will and who will not develop compulsive substance use or gambling behaviour. Of course, we can imply who might be likely but we cannot state it outright. As well as it’s a lot more accurate to consider risk factors for the development of addictions instead of direct causes.

Before we move on to the biological, psychological and social risk factors of addiction, I want to be brutally honest with you wonderful readers or listeners. Even though I have never used drugs in my life, there was a time in August 2023 when I would have happily used drugs and become addicted to them. I’d honestly forgotten about it until I was writing this podcast episode. Since August 2023 was when my mental health started to collapse after a decade of abuse and living in fear for my life. I wanted to end my own life, I was self-harming and I was in so much emotional pain. I just wanted the pain to stop, and when I was filling out the university mental health support referral form, there was a question about drug use.

In the referral form, I wrote very bluntly that if someone offered me drugs in that moment, I would have taken them because I didn’t care what harm they did to me or the long-term consequences. I just wanted to feel something. All I knew in that time because of the extremely negative mental health was emotional pain and numbness. I wanted to feel something else and drugs were an answer for me. Therefore, whilst I never actively looked for or took drugs, I would have seriously considered it.

What are the Biological Risk Factors of Addiction?

In addition, some risk factors for addiction include gender because males are more likely than females to develop substance use disorder and the so-called gender gap might be narrowing for alcohol use disorder. As well as females experience the effects of intoxication at lower doses of alcohol compared to males.

Another biological risk factor for addiction includes physiological factors because the variations between people’s liver enzymes that metabolise substances are known to influence a person’s risk of alcohol use disorder.

A final biological risk factor is genes. Since whilst estimates vary, research suggests that genetic factors contribute to around half of a person’s risk for developing a substance use disorder. This includes the nature of a person’s body’s hormonal response to stress, as well as the brain’s receptors for the neurotransmitter dopamine.

What are the Environmental Risk Factors for Addiction?

In terms of the environmental or social risk factors for developing addiction, the easy accessibility of alcohol or other addictive substances in your home, community, work or school increases the risk of repeated use. This is one of the reasons why I didn’t take drugs back in August 2023 because I didn’t have easy access to drugs, but I am sort of aware that other people in my local community do judging from local stories and official data.

A second environmental risk factor is employment status because if you have a job and you develop the skills for employment then this exerts pressure for stability as well as employment provides psychological and financial rewards that decrease addiction risk. This is another reason why addiction is rather high in my local area because unemployment is high. This means that individuals turn towards addictive substances and behaviours to get the psychological rewards that they desire, because they don’t have access to employment but they have access to drugs.

From a systemic viewpoint, that is a very sad fact about society. That in certain areas, it is easier for people to get illegal drugs than it is for people to get legal employment. Common sense would surely suggest that it should be the other way round, and this is why investing in local communities is so important. It’s important that governments invest in people, local infrastructure and jobs in deprived areas so people don’t have to turn to drugs to get psychological rewards.

In terms of peer groups as a risk factor for addiction, we know that humans are a very social species. This is why we’re strongly influenced by our peer group because we want to fit in, we want to be a group member and we want to protect our social standing. This means that we might adopt addictive behaviours from the ingroup, especially during adolescence. Whereas positive social relationships can be strong protective factors against substance use.

Finally, family factors are a powerful risk factor for addiction because having a sibling or parent with an addictive disorder and a lack of parental support or supervision increases risk of addiction. Also, physical, sexual and emotional abuse can increase the risk. Yet having a strong family relationship, getting married or taking on childcare responsibilities can decrease risk of addiction as well.

What are the Psychological Risk Factors of Addiction?

Whilst a myth about addiction is that there is an “addictive personality” because as we can see addiction is caused by the interaction of a wide range of different risk factors, personality factors can be risk factors. Since sensation-seeking and impulsivity have been linked to gambling and substance use disorders, as well as impulsivity might be related to a person’s risk of relapse in particular.

Additionally, mental health conditions, like anxiety, depression, post-traumatic stress disorder and attention deficit disorder, can increase the risk of addiction. As can difficulties in managing strong emotions.

Finally, when a person experiences abuse and trauma, especially significant adverse experiences in early life, can increase the risk of a person developing addiction, because the trauma overwhelms a person’s ability to cope by adding to the burden of stress and sensitising the brain’s pathways to distress and danger. Drugs and other addictive substances can be seen as an alternative way to cope in the individual’s eyes.

Personally, it is this final psychological risk factor that I am very interested in. Not only because this is one of the reasons why I genuinely considered using drugs in 2023, but because it underlines the needs for compassion and understanding when supporting people with addictions. I’m also a massive fan of comedian Mae Martin who was a drug addict for much of their teenage years and early adulthood. Whenever Mae talks about their addiction experience, they talk about how they just needed some love and support to help them overcome their addiction. As well as they used drugs to overcome the difficulties in their lives.

My point is that sending people to prison for using drugs isn’t going to break the vicious cycle of using addictive substances or behaviours, because going to prison isn’t going to help the person find more adaptive ways to get the psychological rewards associated with addictions. This is another reason why learning about addiction is important because by understanding what addiction actually is and how it works, we can better understand how to treat it. Without falling into the classic traps of listening to media and political sources that don’t know better about addiction so they sprout myths and misconceptions for their own gains.

What are Symptoms of Addiction?

The fundamental core of all addictive disorders is the engagement in an activity or the repeated use of a substance that leads to distress or impairment in daily functioning. That is the core symptom of all addictive disorders. Yet from a diagnostic viewpoint, for someone to be diagnosed with an addiction then they need to have at least two of the following clinical features. For example, their addictive substance or behaviour needs to disrupt their obligations at home, school or work, the substance or activity needs to continue despite the interpersonal and social problems that it causes the person, and there is an unsuccessful effort to cut down even if there is a desire to cut down.

In addition, some other clinical features of addiction include a person using the addictive substance or doing the activity in larger amounts or for a longer time period than was intended. For example, we often hear stories about how people get addicted to pain medication because they only intended to use it until an injury was healed but then they get addicted and they end up using the pain medication after the injury’s healed. This is an example of using an addictive substance longer than intended. Another feature is a person has a strong desire or craving to engage in the activity or use the substance. Also, a significant amount of a person’s time is taken up by the pursuit of the substance or activity.

Some final clinical features of addiction are that the addictive substance or behaviour occurs in situations where it is physically risky, a person’s participation in important work, recreational or social activities decreases or stops because of the addiction, the person continues to use the substance or engage in the activity despite knowing the psychological or physical problems that it’s causing or making worse. Also, withdrawal occurs and this manifests either as the presence of physiological withdrawal symptoms or the person takes another related substance to block the withdrawal effects. As well as tolerance occurs. This is when the person needs a markedly increased amount of the substance to achieve the desired effect or there is a significantly diminished effect for the same amount of the substance.

On the whole, like all mental health conditions, there are different severities of addiction depending on the number of clinical features present. For instance, if someone has two or three symptoms then this suggests that they have a mild addiction, if they have four or five symptoms then they have a moderate addiction and if they have six or more symptoms then they have a severe addiction.

Clinical Psychology Conclusion

In a future podcast episode, we’ll explore how addictions are treated but considering that this was the first time that we’ve covered addiction on the podcast, I am really happy with this episode. It’s been a lot of fun to learn, understand and explore what addiction actually is and how it works.

In addition, now that we know this information, if you’re an aspiring psychologist or someone who wants to work in mental health settings, then this information might help you sound more knowledgeable so you can get your foot in the door to a job. Then you can expand your clinical knowledge of addiction that way. Equally, if you’re a qualified psychologist then I hope this has made you think about your own assumptions and what you thought you knew about addiction, and whether you want to take some Continued Professional Development courses on addiction in the future.

As a brief reminder at the end of this episode, addiction is when a person engages in a behaviour or uses a substance with rewarding effects, and it is these rewarding effects that compel the individual to repeat the activity despite the harmful consequences. For example, if we take heroin addiction, it is the high that the drug gives a person that compels them to continue to take heroin despite the negative impact it has on their health, finances and social relationships. Other addictive substances can include cocaine, inhalants, alcohol or nicotine, as well as behaviours like gambling are addictions too.

I hope you enjoyed today’s clinical psychology podcast episode.

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Clinical Psychology References and Further Reading

Alimoradi, Z., Lotfi, A., Lin, C. Y., Griffiths, M. D., & Pakpour, A. H. (2022). Estimation of behavioral addiction prevalence during COVID-19 pandemic: A systematic review and meta-analysis. Current addiction reports, 9(4), 486-517.

Ceceli, A. O., Bradberry, C. W., & Goldstein, R. Z. (2022). The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex. Neuropsychopharmacology, 47(1), 276-291.

Dang, J., Tao, Q., Niu, X., Zhang, M., Gao, X., Yang, Z., ... & Zhang, Y. (2022). Meta-analysis of structural and functional brain abnormalities in cocaine addiction. Frontiers in Psychiatry, 13, 927075.

Ferrer-Pérez, C., Montagud-Romero, S., & Blanco-Gandía, M. C. (2024). Neurobiological theories of addiction: a comprehensive review. Psychoactives, 3(1), 35-47.

Flannery, J. S., Burnell, K., Kwon, S. J., Jorgensen, N. A., Prinstein, M. J., Lindquist, K. A., & Telzer, E. H. (2024). Developmental changes in brain function linked with addiction-like social media use two years later. Social cognitive and affective neuroscience, 19(1), nsae008.

https://www.psychologytoday.com/us/basics/addiction

Nikolinakou, A., Phua, J., & Kwon, E. S. (2024). What drives addiction on social media sites? The relationships between psychological well-being states, social media addiction, brand addiction and impulse buying on social media. Computers in Human Behavior, 153, 108086.

Pickard, H. (2022). Is addiction a brain disease? A plea for agnosticism and heterogeneity. Psychopharmacology, 239(4), 993-1007.

Robinson, T. E., & Berridge, K. C. (2025). The incentive-sensitization theory of addiction 30 years on. Annual review of psychology, 76(1), 29-58.

Tolomeo, S., & Yu, R. (2022). Brain network dysfunctions in addiction: a meta-analysis of resting-state functional connectivity. Translational psychiatry, 12(1), 41.

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