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Skip to 0 minutes and 9 secondsHi, my name is Kyle Dyer. I'm the academic lead for education and training on addiction at the Institute of Psychiatry. I'm a psychopharmacologist by training, which means I have a background in both clinical psychology and pharmacology. So what I'm interested in is the effects of drugs on human thoughts, and behaviours, and emotions. In this lecture, we're going to consider three questions about addiction. What is addiction? How does it develop? And what are the key distinguishing features? Addiction is a challenging condition. It can affect anyone. It develops slowly, often without our awareness. It touches all aspects of our lives, and it causes significant harms. Addiction doesn't respect who you are.

Skip to 1 minute and 0 secondsIt doesn't respect your background, whether you're rich or poor, privileged, educated, male, or female. But addiction happens for a reason. It's functional. It serves a purpose. For some people, it's seeking the experience of a good time. For others, it's the means of escape from physical or emotional pain. The first step towards using a drug or developing an addictive behaviour is that it gives us something that we need. It removes our pain, our sadness. It helps us cope, or it just helps us relax and enjoy our spare time. The most obvious and fundamental initial experience is that drug use feels good. No matter what the mechanism of action, all drugs share a common feature.

Skip to 1 minute and 56 secondsAnd that common feature is that it increases activity in the reward centre or the pleasure centre, if you like, of our brain. Drugs of abuse will increase a chemical within our brain called dopamine. Dopamine is a neurotransmitter. Its presence in regions of the brain that regulate emotion, and movement, cognition or thinking, the development of new memories, and most importantly, the feelings of pleasure. So this is known as the dopamine reward pathway of the brain. And this is the pathway that usually becomes activated when we do something that's important for our survival, something like eating, spending time with our children, spending time with our loved ones, and so on.

Skip to 2 minutes and 43 secondsBy engaging in these behaviours, we are rewarded with feelings of pleasure and euphoria. We feel good, so we want to do it again. What drugs do, what drugs of abuse do so very well is that they overstimulate this rewards system. And this makes us want to take drugs again and again. Finally, the journey out of addiction is one of great challenge and effort. It can be really difficult to quit an addiction, to just say no, and it often takes several attempts. But at the end of the day, addiction can be treated successfully.

Skip to 3 minutes and 23 secondsIt's important to remember here that not everyone who uses a drug will become addicted. One of the key questions for addiction science is to determine what is it that makes some people become addicted and others not.

Skip to 3 minutes and 39 secondsUnderstanding addiction and developing effective responses is important personally, socially, and economically. So let's start with asking ourselves a question. What is addiction? Well, this is both a simple and a very complex question. We've all probably got a gut feeling in a broad sense in understanding what addiction is about. But do those of us who drink lots of coffee and get headaches if we miss our morning cup of coffee consider ourselves coffee addicts? Do we only think of the stereotypes of injecting drug users, the stereotypes of criminals or drug fiends? I don't know. My point here is that before we can answer the question what is addiction, we need to question our own beliefs and our own stereotypes.

Skip to 4 minutes and 30 secondsDo we see people with addiction as weak, as poor, as sick, as criminal, as lacking in moral strength?

Skip to 4 minutes and 39 secondsA really useful starting point is to look at how we actually make a diagnosis of addiction.

Skip to 4 minutes and 51 secondsThe Diagnostic and Statistical Manual of Mental Health Disorders is used by many clinicians to identify and diagnose mental health disorders. We call this the DSM. The newly released fifth edition of the DSM combines categories of substance abuse and dependence into a single addictive disorder that we measure on a continuum from mild to severe. Now, this is an interesting development. It highlights how the word addiction is a generic term for a range of drug and non-drug disorders that can span a range of severity. The DSM gives a set of symptoms, key symptoms, for diagnosing addiction.

Skip to 5 minutes and 39 secondsAnd these can include taking the drug in larger amounts or longer than you meant to, wanting to cut down or stop but not being able to, spending more and more time getting a drug, using it, and then recovering from its effects, craving. That's an interesting one. We'll come back to craving throughout this course. Other criteria include not managing to do what you should do at work, at home, or at school, and continuing to use. Continuing to use even when you know that it's causing you problems or it's putting you in danger. Continuing to use even though you know you're experiencing some physical or psychological problems is perhaps the key defining criteria in diagnosing addiction.

Skip to 6 minutes and 31 secondsFinally, the criteria include needing to use more of the drug to get the desired effect, or experiencing symptoms of depression and maybe some physical signs and symptoms that are uncomfortable when you stop using the drug or when the blood levels drop. And these symptoms can only be relieved by taking more of the drug. These criteria are a good starting point for understanding addictions.

What is addiction? Part 1

So let’s start by asking ourselves the question: “What is addiction?”

In the first of two short videos exploring this question, I introduce the key issues around how we define the term ‘addiction’.

After watching the video, please feel free to use the comment facility on this page (click on the pink plus icon) to post your own comments and thoughts on this question.

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This video is from the free online course:

Understanding Drugs and Addiction

King's College London