addictions

Addictions refer to a group of conditions characterized by compulsive engagement in rewarding stimuli despite negative consequences. They can involve substances, such as alcohol or drugs, or certain behaviors, such as gambling or gaming. Most classifications describe addictions as chronic, relapsing brain disorders in which neural circuits related to reward, motivation, and memory are altered. Core features include cravings, impaired control, tolerance, withdrawal, and continued involvement despite harm.

The neurobiology of addiction involves the brain's reward system, particularly dopamine pathways in the mesolimbic circuit, along with changes in the prefrontal cortex and related learning and memory networks. These neuroadaptations can strengthen cue-driven seeking and diminish voluntary control, contributing to compulsive use or behavior. Changes in stress systems and memory processes also play a role in the persistence of addictive patterns.

Risk factors include genetic vulnerability, early-life stress, psychiatric comorbidity, social environment, and easy access to the substance or activity. Protective factors such as strong social support, coping skills, and access to treatment can reduce risk. Co-occurring mental health disorders are common and influence treatment needs.

Diagnosis and assessment rely on criteria from major classification systems and structured interviews. Clinicians evaluate patterns of use or behavior, functional impairment, cravings, tolerance, withdrawal, and consequences for health and daily life. Screening for other mental health conditions is important for comprehensive care.

Treatment combines medical, psychological, and social approaches. Pharmacotherapies may reduce withdrawal or cravings for certain substances, and medications for alcohol and tobacco use disorders are used as appropriate. Psychosocial therapies such as cognitive-behavioral therapy, motivational interviewing, and contingency management support recovery. Harm-reduction approaches and integrated care with general health services are also used.

Prognosis varies; while chronic, long-term management can improve functioning and quality of life, relapse remains a common challenge. Public health strategies focus on prevention, reducing stigma, and expanding access to evidence-based treatment.