Addiction: alcohol, substance, gambling, and gaming

Clinically-relevant addiction can take the form of alcohol, substances, gambling, and gaming. There are other areas under current investigation, such as social media and internet use, that may be emerging as new areas of clinical addiction. Regardless of the form, addiction is known to cause serious impairment to a person’s normal functioning.

Alcohol and substance use issues 

Alcohol and substance use issues form part of addiction psychiatry. The main classes of drugs include alcohol, cannabis, hallucinogens (like LSD and psylocibin), opioids (like heroin and oxycodone), sedative hypnotics and anxiolytics (like barbiturates and benzodiazepines), stimulants (like cocaine and amphetamine), tobacco, caffeine, and inhalants.

The general theme is that excessive use of drugs in these classes activates the reward system in the brain which in turn reinforces the behaviour to continue taking the drug. This is often at the expense of other activities that would normally be pursued, such as work or personal commitments. The drugs in these classes each work differently but are common in that they cause some form of pleasure which we refer to as a “high”. Those with lower levels of self-control may be more likely to experience issues with addiction.

Treatment of milder forms of substance misuse or dependence can respond well to psychological therapy, particularly groups focused on the concept of recovery, as well as psychoeducation and counselling.

Note: Managing moderate to severe alcohol and sedative hypnotic dependence is a serious medical issue, one that you should contact your GP about. 

Gambling and gaming issues

Gambling addiction works in a similar way to substance addiction, in that the same reward pathway is activated. It is characterised by persistent and recurrent problematic gambling that causes impairment or distress. This is associated with gambling increasing amounts of money, irritability when cutting down, repeated efforts to quit, preoccupation with gambling, lying to conceal losses, and jeopardised relationships, jobs, or education.

Similarly, gaming addiction causes significant impairment or distress to a person’s life. There is a preoccupation with gaming, withdrawal symptoms when the person cannot play, the need to spend increasing time gaming, unsuccessful attempts to reduce, and continuing to game despite problems occurring. Treatment approaches are based on medications, particularly SSRIs and naloxone, and psychological interventions such as CBT.