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Signs and Symptoms of Addiction

Reviewed by Psychology Today Staff

Whether the substance involved is crack cocaine or alcohol or a behavior such as gambling, the common denominator of all addictions is continued use despite the development of negative consequences—whether to self, relationships, finances, school or work performance—and the inability to control use. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which shuns the term addiction (but nevertheless, confusingly refers to addictive disorders), instead prefers the term substance use disorder, and categorizes 10 distinct such conditions depending on type of drug involved—for example, Alcohol Use Disorder; Stimulant Use Disorder, including use of cocaine; Opioid Use Disorder, including heroin. The DSM notes that all 10 “produce such an intense activation of the reward system that normal activities may be neglected.”

How each type of drug acts in the body is different, but the behavioral symptoms, including those associated with gambling, all overlap. Another common feature is the persistence of changes in brain circuitry beyond any detoxification period; studies show that it can take months or more after stopping use for the brain to rewire itself to respond to normal rewards.

Signs of Addiction


Substance use is not, by itself, a disorder. According to DSM-5, widely used as a roadmap to diagnosis, it becomes a disorder when use eludes control and interferes with functioning. Substance use disorder is marked by a pattern of pathological behaviors related to use of the substance.

What are common behavioral signs of addiction?

Substance use disorder is marked by a pattern of pathological behaviors related to use of the substance. As listed in the DSM, they include:

• Being unable to stop taking a substance, even when wanting to cut down or regulate use or having tried several times

• Worrying about the next dose or getting a consistent supply of the substance

• Experiencing intense cravings at any time, but especially in places where the drug was once obtained or used

• Devoting considerable time to getting, taking, or recovering from drug

• Neglecting roles and responsibilities such as work, school or home obligations

• Experiencing interpersonal problems as a result of substance use

• Changing social patterns, withdrawing from family, friends and activities in order to use a substance

• Facing risky situations to become intoxicated or maintain a supply of drug

• Using a substance despite knowing it causes physical or psychological harm to oneself

• Developing tolerance, requiring more drug to get an effect; a common but not invariable feature of addiction, sometimes called adaptation

• Developing the unpleasant physiologic symptoms of withdrawal—shakiness, sweating, queasiness or vomiting, headache—when unable to take the substance. Withdrawal is a highly variable sign of addiction; it occurs with use of some drugs (alcohol, for example) but not others (cocaine); however, it often drives continuing use. Withdrawal can require medical treatment when a person abruptly stops heavy substance use.

Along with the diagnostic signposts of addiction, those addicted typically display a number of other behavioral characteristics:

• Secretiveness about activities and relationships as well as private space, to conceal drug use

• Sudden changes in activity patterns, refusing participation in activities once enjoyed

• Lying about whereabouts, absences, consumption habits; making excuses for unusual behavior

• Loss of energy or motivation

• Neglect of appearance

• Stealing to support drug purchases.

What are the psychological signs of addiction?

A cardinal sign of addiction is not being unable to control consumption of alcohol/drug—even when wanting to. In addition, addiction is typically marked by urges or craving—wanting a substance so badly it becomes difficult to think about anything else.

Intoxication has its own distinctive psychological manifestations—from belligerence and mood lability to impaired judgement and “absent presence.” They result from the effects of the substance on the central nervous system. Those who are high also display perceptual disturbances, problems with attention, disrupted thinking patterns and easy confusion, as well as difficulties relating to others. 

In the grand scheme of things, addiction is considered an attempt—a nonproductive attempt—to solve a problem; it offers relief from shyness, relationship difficulties, shortage of opportunities, losses and failures of any kind, and much more. From that perspective, it is a sign of inability to cope with a stressor; behind the psychology of addiction is a sense of powerlessness, and it always a sign that better stress-management skills are needed.

The Experience of Addiction

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At some point, addiction becomes a trap of endless repetition that loses whatever allure it once held. As addiction progresses, the psychological and life problems it causes tend to increase—and the trap can feel too deep to climb out of. However, it is almost always possible to stop use and begin recovery.

Do you have to be addicted to experience problems?

The experience of problems is central to the diagnosis of addiction. As repeated use of a substance accelerates motivation to seek out and use the agent, people typically suffer negative physical and psychological consequences and, in neglecting roles and responsibilities, experience difficulties and disruptions in their family, social, and work lives. They may also face increasingly dangerous situations in pursuit of a substance supply. Independent of the addictive process, problems can also develop from the taking of any chemical substance.

Illegal drugs pose special risks of toxic contamination and/or accidental overdose as a result of substitution with underground agents of unknown potency. The recent rise in opioid deaths, for example, is attributable to a shift from prescription painkillers to the cheaper and often more readily available street drug heroin. Unbeknownst to users, illicit drug manufacturers often adulterate heroin (and the stimulant cocaine, and many other substances of abuse) with the synthetic painkiller fentanyl, which is not only cheaper but 30 to 50 times more potent than heroin, increasing the likelihood of respiratory problems. According to the U.S. Centers for Disease Control and Prevention, fentanyl is the drug most often involved in fatal overdoses in the U.S.

While consumption of any illicit drug can be dangerous from a toxicological perspective, it can also create problems from a behavioral perspective. Intoxication with alcohol is a major cause of traffic accidents and violence to others.

What does physical dependence mean?

There is considerable confusion even among professionals about many of the terms relating to addiction, in part because many terms are used broadly in popular culture but have more specific clinical meaning, and also because, historically, the psychiatric diagnostic bible, the DSM, has used various terms, including dependence, to mean addiction, with the intent to avoid the stigma attached to addiction.

There is an important distinction between drug addiction vs. drug dependence. The term dependence refers to the fact that the brain has adapted physiologically to the substance of abuse. That adaptation, achieved through changes in brain receptor sensitivity and neurotransmitter balance, is manifest in tolerance—requiring larger doses of the agent for effect—and in withdrawal, the onset of any array of unpleasant symptoms when the substance is abruptly discontinued. Dependence specifically refers to the effects of the process of neural adaptation to a psychoactive substance. It is a common feature of addiction, but not the totality of the more complex disorder.

It is possible to be dependent on a substance without being addicted. Physiological dependence can occur with many different kinds of substances, including common medications. It’s also possible to be addicted without being dependent. Tolerance and withdrawal are not universal features of substance use disorder; hallucinogens, for example, do not create tolerance or withdrawal symptoms.

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