Addiction: What Is It?
Addiction can be defined in various ways. According to Addiction Switzerland, it is a prolonged loss of control over the use of a psychoactive substance or the engagement in an activity (such as gambling or video games). Addiction causes psychological and even physical distress, leads to a loss of autonomy, and disrupts the ability to function in daily life to varying degrees, both personally and socially.
The use of a psychoactive substance or the engagement in an activity falls along a continuum: on one end, non-problematic use; on the other, addiction. In between lies problematic use, which can have repercussions—of varying intensity—on mental health and physical health, interpersonal relationships, and other essential aspects of daily life. When problematic use reaches a certain intensity, the criteria for addiction may be met.
Not all substance use or engagement in an activity necessarily leads to problematic use, and problematic use does not necessarily lead to addiction. Furthermore, addiction can only be diagnosed based on clinical criteria that are the subject of an international consensus (ICD-11).
Addiction and dependence are two distinct concepts; it is important to differentiate between them. For addictions related to specific activities (known as “behavioral addictions”), the term “dependence” is not used because, based on current understanding, the physiological characteristics of dependence (tolerance, withdrawal) do not apply to these disorders.
Addiction vs. Dependence: What Are the Differences?
Addiction is defined as a prolonged loss of control over the use of a psychoactive substance or the engagement in a particular activity. One of the characteristic symptoms of addiction is “craving,” defined as an intense urge or desire to use the addictive substance.
Dependence occurs when the body physiologically adapts to the regular use of a psychoactive substance. This adaptation has two characteristics: tolerance and withdrawal. Tolerance develops during use: increasingly higher doses are needed to achieve the same initial effect. Withdrawal syndrome, on the other hand, occurs when use of the substance is stopped or reduced. It involves a range of symptoms—both physical (pain, nausea) and psychological (irritability, anxiety, sleep disturbances)—the severity of which varies.
Thus, dependence is one of the most common symptoms that arise during the process leading to addiction. Conversely, dependence does not necessarily lead to addiction.
Addiction and Nicotine
Nicotine is a highly addictive substance, and its use can quickly lead to addiction. Depending on its intensity, this use falls at different points on a continuum ranging from non-problematic use to problematic use and addiction, with varying degrees of impact on mental health and physical health, interpersonal relationships, and other aspects of daily life.
Nicotine’s effect on the brain activates the reward system. In addition, it leads to physical dependence: with regular use, tolerance develops, and the user needs increasingly higher doses to feel the same effect as when they first started using it.
After smoking, nicotine levels drop rapidly, and withdrawal symptoms reappear within a few hours. The next cigarette then immediately relieves these symptoms. This feeling of relief is often interpreted as a relaxing effect unique to nicotine. In reality, it merely soothes the discomfort that it itself has caused. It is this mechanism that perpetuates the belief that nicotine “relaxes” or “helps manage stress.”
Nicotine Withdrawal
The nicotine in tobacco is almost completely eliminated from the body within 24 hours. During withdrawal, certain symptoms appear and then gradually subside: an intense urge to use, anxiety, low mood, difficulty concentrating, irritability, restlessness, increased appetite, and sleep disturbances. The presence and intensity of these symptoms vary from person to person.
Other symptoms, resulting from withdrawal, may also occur, such as tremors, gastrointestinal discomfort, or a sore throat.