The stages of change model

Adapted from Australian Institute of Professional Counsellors, Institute Inbrief, Edition 359.

Good day readers! How are you? … Shit? Depressed? Anxious? Angry? First of all, if you’re someone who says “I feel shit”, I would encourage you to use a more accurate descriptor instead of shit. Tell your brain what emotion or feeling you are experiencing. Shit can mean a lot of things. When we’re able to identify an emotion, it’s more likely we’ll be able to regulate or manage it. When I was learning Dialectical Behavioural Therapy, they had a saying: Name it to claim it to tame it. They also encouraged us to distance our identity from our feelings e.g., “I’m having the feeling that I’m angry” rather than “I’m angry”. I know it sounds like simple fluff but there is a profound difference between observing the experience of anger, loneliness, fear, guilt etc. and believing we (the self) are the embodiment or a manifestation of an emotion.

Alright, moving along to the subject of the article. The Australian Institute of Professional Counsellors sent me their monthly (I think it’s monthly) Institute Inbrief. If you’re someone who has lived with a mental health disorder or emotional difficulties for a long time, being in nature is not really a new antidote from the field. And it’s not always as simple as just going out into nature. When I was deep in the abyss of my own depression, there wasn’t a lot that would change my mood or perception of life. But, we do these practices anyway – and that’s kind of the point. It’s a practice. It may have to be initiated using a bit of self-force. Oftentimes, motivation comes after we begin the motion.

So, here are some examples from the article that support ‘nature has a therapeutic effect for the mind and body’:

• One study found that women who looked at pictures of nature for two minutes had lower levels of the stress hormone cortisol (Gillespie, et al., 2019).
• Another study showed that people who walked in a forest preserve showed lower levels of hostility, aggression and anxiety than they did before the walk.
• Gregory Bratman, PhD, an assistant professor at the University of Washington, and colleagues shared evidence that contact with nature is associated with increases in happiness, subjective well-being, positive affect, positive social interactions and a sense of meaning and purpose in life, as well as decreases in mental distress (Science Advances, Vol. 5, No. 7, 2019).

How can we most effectively reap the mental health benefits that nature offers?

Why nature?

I’m aware we’re in Covid-19 lockdown and restrictions at the moment (27/09/2021) so you will need to determine for yourself if what proceeds to be written is practical and realistic for you right now.

We need to understand that the psyche of the human-being is linked to the natural world in many important ways. The human brain constantly processes and assimilates incoming information, and it relies on external stimuli for guidance regarding how to think and behave. Not only does incorporating nature into our daily lives help us understand the world better, but it can also contextualise ourselves in accordance with this understanding; humans – as an animal – have evolved in tandem with the natural world, and thus it is able to promote the development of beneficial skills including improved visual–spatial acuity, attentional abilities, and memory (Oddie, 2019). Our world is full of beautiful and intricate natural structures, and even just a simple walk through a park can provide us with moments of joy, awe, and wonder (Fiebert et al., 1980; Lefebvre & Brucker, 2018).

Additionally, the seemingly chaotic stimulus that nature provides us with promotes creativity and abstract thought (Berman, et al., 2012); these qualities have been the cornerstone of our species’ evolutionary development over the past few thousand years, thus illustrating the primacy of our relationship with nature.

Our neurobiology is extremely complex, and as such cannot be reduced to simple terms. However, we can say with some certainty that our brains’ sophisticated processing systems are enhanced by our interactions with nature. Our brain naturally integrates external stimuli into existing mental frameworks—this is referred to as “cognitive recursion” (Oddie, 2019). This means that if we spend our time in environments that were designed and created by the human mind, then we are putting ourselves in an echo chamber of stimulus and will not receive new information to broaden our mental capabilities. If we spend time in nature surrounded by structures and patterns that are born of unfathomably complex and foreign processes, then our minds can assimilate this new content into its existing understanding of reality.

Basically, if you spend your days in a white cube (i.e. a house) then your mental framework will be limited to the creative potential that a white cube suggests. If, however, you spend your days in an ever-changing fractal world of colours and shapes (i.e. natural environments) then your mind will reflect this, and adopt an expanded creative potential in order to perceive and understand its surroundings. This is a powerful reality; understanding how our connection with nature nourishes our minds is where spirituality meets both science and intuition.

What benefits does nature offer?

Perhaps the most important and relevant aspect of an active lifestyle in nature is its ability to reduce stress. Studies have shown that taking a walk in a park could decrease stressful thoughts, and even reduce blood pressure (Bush, et al., 2016; Robins, 2020). This finding demonstrates that simply being exposed to nature can decrease stress levels, and implies that returning to nature may be an effective way of keeping our mental health at its best. And here’s the kicker: any amount of time spent in nature is net-gain for your mental wellbeing (Robins, 2020). There is no threshold or minimum a dosage of nature that will have an effect on you – even just spending a short time sitting in your backyard enjoying nature will likely have a positive impact on your mental health.

Other studies have also shown that exposure to nature has an effect on our emotional outlook; particularly in regards to relieving us from pessimistic and fearful thinking (Lefebvre & Brucker, 2018). Life in the modern world is full of consequential decisions and options, the outcomes of which can dictate the quality of your entire life. Decision making is one of the more neurologically complex and taxing processes that our brains undertake, and research has shown that we make 35,000 choices per day (Huston, 2018).

This process involves assessing each option for its individual merit, sorting each option into a hierarchy in relation to every other option, making predictions about every possible positive and negative outcome of each option, and then weighing each outcome against that of every other option; golly, how exhausting! The fear and pessimism arises because each option invariably comes with the potential for myriad negative outcomes, and we are constantly coerced into assessing these. Thankfully, nature offers respite from all this noise. Spending time in nature relieves us from overthinking by presenting us with very few options, each with relatively inconsequential outcomes; ‘where will I sit while I drink from my water bottle?’ or ‘should I take the path leading towards the lookout, or the waterfall?’ are not taxing decisions to make, and will not prompt fearful or pessimistic thought patterns. There is an easiness to natural environments in which things seem to flow along their own course, and we are able to simply jump into the stream and flow along with it.

Aside from experiential benefits, time in nature can help us orient ourselves in the world in more grounded and productive ways. In today’s society, our attentional abilities are sapped by large corporations who profit from our distractibility, and it seems as though a way to remedy this mental breach is routine contact with nature. Attentional abilities are bolstered by spending time in nature (Ebata & Izenstark, 2017), making you less susceptible to the temptations of modernity (i.e. problematic social media scrolling, binging streaming services, etc).

Thus, making time in nature a priority in our lives – especially when we do not even feel stressed or anxious – can help us orient ourselves to the world around us and find a sense of personal empowerment. Taking time to be immersed in nature can help us regain confidence, ground us in a personal sense of meaning, and re-establish our wellbeing. Being in nature is correlated with increased positive emotions and feelings of control over one’s life (Chowdhurry, 2021), so even if we do not believe we need some sort of mental intervention, the benefits are there for everybody to experience.

How can I fit more nature-time into my life?

For the most part, we only need to reflect on our daily behaviours to see how we can incorporate time in nature into our lives. James Clear, in his wildly popular book Atomic Habits (2018), suggests incorporating a “budding habit” into an existing habit.

So for instance, if you have a lunch break during the work day, you could spend it outside on a park bench instead of in the staff room. If you come home at the end of the day and like to sit on the couch with a book, go outside and sit on the grass instead. These are simply ways to adopt more nature-time into your life, without having to add another separate activity to your schedule. In a 2017 study (Austin, et al., 2017), some participants were asked to take a brief walk in nature once per day, and other participants weren’t. The results showed that those who walked daily had higher levels of positive emotions and well-being than those who walked less. It doesn’t take a lot of time to nourish our minds in the deep ways that only nature offers us, and it seems to be a worthwhile habit to form.

Making the time to experience nature is easy to ignore in lieu of more ‘important’ tasks. That walk in the park you planned on taking this afternoon suddenly seems overshadowed by a looming deadline or a sink full of dirty dishes. For this reason, it can be beneficial to keep yourself accountable by planning nature-time with other people. Planning to go for a walk with friends means there is a lower likelihood of cancelling. Better yet, if you can join a weekly community group or class of some sort then you won’t even have to continually plan your time in nature.

There are volunteer groups who aid revegetation in nature reserves, there are community gardens who need people to tend to plants and crops, and there are clean up groups who dispose of discarded rubbish in bush-lands. If volunteering isn’t appealing to you, then you could change your routine by canceling your gym membership in lieu of outdoor exercise classes or yoga, or even new activities like cycling or rowing. Making scheduled appointments to spend time in nature can assist those who have trouble achieving this with sheer willpower, and your mental health will thank you for it.

Our acknowledgment of the value of time spent in nature is growing each day, which is why more urban living environments are incorporating ‘green spaces’ into their design. Using the latest neuroscience research, we are able to determine which types of natural environments compliments our mental states the most effectively. For example, it has been found that areas with high levels of biodiversity can alleviate symptoms of anxiety and depressions more-so than those with low levels of biodiversity (Wyles, et al., 2019). Similarly, people who watched videos featuring a diverse array of flora and fauna reported lower anxiety and higher vitality than those who watched videos of less biodiverse landscapes (Wolf, et al., 2017).

Findings like these offer valuable insight into how we can engineer our surroundings to best facilitate the highest levels of wellbeing possible. It is clear that spending time in nature is invaluable for our mental health, but a half-hour lunch break doesn’t give us time to go hiking through a biodiverse mountain landscape; what we can do, however, is have access to green spaces which replicate the stimulus that we would receive if we were in nature. This has proven to be an eloquent solution to the pressing issue of depression rates in urban CBD areas (Ebata & Izenstark, 2017).

Summary

In conclusion, the role of nature in our lives is of paramount importance to our health and should be a priority for us all. Although it may feel like adding a daily walk outside to our schedules would be in futility, the positive mental health benefits outweigh the costs significantly. Making time in nature a priority, no matter how little, can greatly increase our overall sense of wellbeing, and remind us that we are interconnected to the living world around us.

There is no minimum threshold required to reap the benefits of nature, so we can all find a way to capitalise on just a little bit of time in natural environments. As a species, it is our natural disposition to enjoy the outdoors, and the benefits are more abundant than you might expect. So pop on a pair of joggers, Google search ‘hikes near me’, phone a friend, and get out there amongst the fresh air; you can thank us later!

References:

1. Berman, M. G., Kross, E., Krpan, K. M., Askren, M. K., Burson, A., Deldin, P. J., . . . Jonides, J. (2012, November). Interacting with nature improves cognition and affect for individuals with depression. Retrieved from: Website.
2. Bush, R., Dean, J., Lin, B., & Fuller, R. (2016). Health Benefits from Nature Experiences Depend on Dose. Scientific Reports.
3. Chowdhury, M. (2021, February 19). The Positive Effects Of Nature On Your Mental Well-Being. Retrieved from: Website.
4. Clear, J. (2018). Atomic habits: An easy and proven way to build good habits and break bad ones. London: RH Business Books.
5. Hunter, M. R., Gillespie, B. W., & Chen, S. Y. (2019, March 15). Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers. Retrieved from: Website.
6. Huston, M. (2018). How Many Decisions Do We Make Each Day? Retrieved from: Website.
7. Izenstark, D., & Ebata, A. (2017). The Effects of the Natural Environment on Attention and Family Cohesion: An Experimental Study. Children, Youth, and Environments.
8. Wyles, K. J., White, M. P., Hattam, C., Pahl, S., King, H., & Austen, M. (2017). Are Some Natural Environments More Psychologically Beneficial Than Others? The Importance of Type and Quality on Connectedness to Nature and Psychological Restoration. Environment and Behavior, 51(2), 111-143. doi:10.1177/0013916517738312

Retrieved from Issue 346 of Institute Inbrief 20/01/2021

Paranoia: Definition and levels

When a person believes that others are “out to get them”, trying to stalk or harm them, or paying excessive attention to them for no reason, they may be experiencing paranoia. Occurring in many mental health conditions, paranoia is most often present in psychotic disorders. It involves intense anxious or fearful feelings and thoughts, most often related to persecution, threat, or conspiracy (Mental Health America, n.d.). It can be a symptom of illnesses such as schizophrenia, brief psychosis, paranoid personality, psychotic depression, mania with psychotic features, delusional disorders, or substance abuse (chronic or momentary) (Barron, 2016).

Mental health experts have identified three levels of paranoia:

1. Paranoid personality disorder (PPD): Characterised by odd or eccentric ways of thinking, PPD involves an unrelenting mistrust and suspicion of others when there is no reason to be suspicious. It is one of the personality disorders in the DSM-5’s Cluster A, along with schizoid and schizotypal personality disorders. Thought to be the mildest form of paranoia, a person with PPD may still be able to function in relationships, employment, and social activities. The onset is typically in early adulthood and is more common in men than in women.
    
2. Delusional (paranoid) disorder: Found in the DSM-5 chapter, “Schizophrenia spectrum and other psychotic disorders”, this is a condition in which an individual holds one major false belief or delusion; it will often be an implausible but not bizarre delusion. A delusional disorder typically occurs without any other signs of mental illness. So a person might think that others are talking behind their back if they have a persecutory delusion, or believe that they need immediate medical attention for a (non-existent) medical problem if they have a somatic delusion. This condition is slightly more common in women than men.
    
3. Schizophrenia with bizarre delusions: People with this condition do not function well in society and need consistent treatment (Sunrise House, 2018; WebMD, 2018).This is the most severe form of paranoia, involving bizarre delusions without basis, such as that aliens are trying to abduct them, or that an unseen enemy is removing their internal organs and replacing them with others’ organs.

This article is about Levels (1) and (2), the paranoid personality disorder (PPD) and delusional disorder, which you may encounter more commonly, either in your client or the client’s partner.

Identifying paranoia

We have several options for finding out what characteristics should be called “paranoid”: we can assess how we experience the person — how we describe them and what they evoke in us — and/or we can run with DSM-5 descriptions, which outline the clinical symptoms we can observe specifically with the paranoid personality disorder and delusional disorder. Let’s do both.

Descriptions of the paranoid person

Joe Navarro, who has written extensively about mental disorders, asked those who had either lived with or been victimised by paranoid personality types to describe this personality type from their experiences. Here is the list of some of their words:

“Angry, anxious, apprehensive, combative, complainer, contrarian, critical, delusional, demanding, difficult, distrustful, disturbed, eccentric, fanatic, fearful, fixated, fussy, guarded, hard-headed, inhospitable, intense, irrational, know-it-all, menacing, mentally rigid, moralistic, obsessed, odd, offensive, opinionated, sensitive, peculiar, pedantic, quarrelsome, questioning, rigid, scary, strict, stubborn, suspicious, tense, threatening, tightly-wound, touchy, unforgiving, unhappy, vindictive, wary, watchful, withdrawn” (Navarro, 2016).

What they evoke in us:

Experiencing a relationship with someone described by such intense words as those above cannot fail to bring forth a reaction in us. Laurel Nowak (2018) outlines the common feelings evoked by paranoid individuals in those with whom they are in relationship. She talks about: “feeling weighed down, negative, stressed, isolated from the people and activities you used to enjoy, and like you’re walking on eggshells”. Some have noted that it can feel to the other person like they are not being seen — ever — for who they truly are. The exaggerated negative spin on events or in response to statements occurs in the context of relating which lacks tenderness, humour, or comfort (Navarro, 2016). While these authors are describing feelings evoked in intimate relationships with paranoid individuals, they could have been talking about how therapists feel when faced with a client with this condition. Dealing with such a person eats away at the most robust sense of happiness and self-esteem. Here are the DSM-5 symptoms.

Paranoid Personality Disorder: DSM-5 symptoms description

According to the DSM-5, there are two primary diagnostic criteria for Paranoid Personality Disorder, of which Criterion A has seven sub-features. Four of these must be present to warrant a diagnosis of PPD:

Criterion A is: Global mistrust and suspicion of others’ motives which commences in adulthood. The seven sub-features of Criterion A are:

1. Belief others are using, lying to, or harming them, without apparent evidence thereof
2. Doubts about the loyalty and trustworthiness of friends and associates
3. Inability to confide in others due to the belief that their confidence will be betrayed
4. Interpretation of ambiguous or benign remarks as hurtful or threatening
5. Holding grudges (being unforgiving of insults, injuries, or slights)
6. In the absence of objective evidence, belief that their reputation or character are being assailed by others; retaliation in some manner
7. Being jealous and suspicious without cause that intimate partners are being unfaithful.

Criterion B is that the above symptoms will not be during a psychotic episode in schizophrenia, bipolar disorder, or depressive disorder with psychotic features (American Psychiatric Association, 2013).

Delusional Disorder: DSM-5 definition and types

According to the DSM-5, this condition is characterised by at least one month of delusions but no other psychotic symptoms. Delusions are false beliefs based on incorrect inference about external reality that persist despite the evidence to the contrary; these beliefs are not ordinarily accepted by other members of the person’s culture or subculture. In delusional disorder (a moderate level of paranoia), a person experiences non-schizophrenic (i.e., not bizarre) delusions, such as that they are that they are being spied on. Because only thoughts are affected, a person with a delusional disorder can act normal and function in everyday life, although they may display paranoia or other symptoms related to their delusion. The five types of delusions people with this disorder have are:

1. Erotomanic, where there is a belief that a person with higher social or financial standing (such as the president or a movie star) is in love with them; it can lead to stalking and obsession.
    
2. Grandiose, involving the false belief that the person has a special power or ability not shared by anyone else (such as that they are extremely lucky and will always win at the casino).
    
3. Jealous: a mistaken belief that a current or former loved one is unfaithful or even harmful. Paranoia about the loved one’s words or actions can be a symptom of these delusions.
    
4. Persecutory, in which the common sense of the paranoia is that someone is out to get the individual, because the person believes they are being threatened, mistreated, or that they will be harmed in the future.
    
5. Somatic: a delusion in which the individual believes that they have an illness, disability or physical defect (Sunrise House, 2018; Mental Health America, n.d.; Bourgeois, 2017).

Treating and coping with paranoia

For the therapist

First, we must note the common advice: a person suffering from either PPD or a delusional disorder needs to seek professional help, although most such individuals do not believe that they are paranoid; rather, they think they are perceptive, noticing things that no one else sees. In this sense, it can be difficult to get such a person to therapy, as the condition tends to be ego syntonic. If such an individual turns up in your therapy rooms, however, note that a referral to a medical doctor is in order to determine if medication is needed.

Medication generally is not a major focus of treatment for PPD; therapy is. However, medications, such as anti-anxiety, antidepressant, or anti-psychotic drugs, might be prescribed if the person’s symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression (WebMD, 2018).

With delusional disorders, the diagnosed individual begins a combination of medication and psychotherapy. The anti-psychotic medication helps the individual improve enough to be able to understand reality and the need for therapeutic help. In milder cases, the individual may receive anti-anxiety medications or anti-depressants, which allows them to undergo therapy, where they learn coping skills, how to recognise delusions as false, and how to manage stress or difficult feelings. Hospitalisation may sometimes be indicated to stop the person from harming themselves or others during violent delusions (Sunrise House, 2018).

As the condition affects the client’s thought patterns and beliefs, it can be worked with effectively using cognitive behavioural therapy, which transforms the unrealistic, maladaptive thoughts by replacing them with more helpful, realistic adaptive thoughts. In addition, some therapists have observed that psychodynamic work, such as object relations, can help paranoid clients look into reasons for becoming mistrustful and suspicious which arise from early childhood relationships (Everyday Health, n.d.).

You might be asking, “Wait a minute; chief symptoms are a tendency to be suspicious and an inability to trust. How, then, can a therapist make any reasonable headway with such a client, given that trust is the basis for any solid therapeutic alliance?” If you twigged to this issue, congratulations; you have nailed the problem: how to keep the paranoid client in therapy long enough for enough trust to be built so that real progress can be made. Building trust is where the challenge is, no matter what modality is being used with the client.

To help a client in relationship with a person living with paranoia

You are likely to see the partner of a person acting paranoid. Once it is established that some form of paranoia is indeed the diagnosis, some clear guidelines exist for helping the partner. Some of the following tips also hold true for therapists working with this client population.

Setting boundaries. The paranoid person needs compassion and understanding, true, but that does not equate to acceptance of poor treatment on the grounds that the person has a disorder and is frustrated. Clear lines of what is acceptable and what is not must be drawn; those expectations for decent treatment must be communicated clearly, including around the issue of refusing to collude with delusional thinking (compromising one’s own needs) because of the person’s paranoia or fear.

Practicing self-care. For therapists and partners alike, this one is paramount! Dealing with this disorder is exhausting and sometimes heart-breaking. Those in close relationships (whether intimate or therapeutic) with paranoid individuals must have regular, solid habits of self-care. All the usual practices go into this category: relaxation/meditation, exercise, decent diet, support systems activated, and perhaps journalling or creative work to vent frustrations. Particularly for partners of those with PPD or a delusional disorder, maintaining a healthy social life — not allowing oneself to become isolated — is important.

Don’t abandon own stance, but empathise with their fear. If either the partner of the paranoid person or you, as therapist, hear an accusation that seems really “off” — totally unfounded — you can employ the tactic of empathising with the feeling, but not necessarily agreeing with the facts (though outright disagreeing doesn’t work, either). Carrie Baron, M.D., and Director of the Resilience Program at Dell Medical School in Texas, explains that consoling the person and refuting what they have said will not likely alter any paranoid convictions or delusions. What works better is “observation, reflection, curiosity and openness without judgment”, which lead to better understanding (Barron, 2016). Thus, the partner could say to the paranoid person, “I can imagine you’re worried if you think that the inheritance you counted on for your retirement might be taken away through your dad marrying. Have you observed any behaviour that made you question her motives?” (curiosity). However they do it, partners of people with any form of paranoia must look beneath the surface before getting swept up in the partner’s claims (Barron, 2016).

Recognise that the paranoid person can still contribute to life. Because of the fact that mild or moderate forms of paranoia are circumscribed, showing up only in particular thoughts and delusions, only those involved or accused may be aware of the psychopathology of the condition. The person can thus contribute to family life, work, and aspects of social life in positive ways, which you as therapist can help highlight for the partner.

Having either a client or a client’s partner who is paranoid is not easy, but the worst heartbreak and chaos can be avoided if the person can engage treatment, including medication when necessary.

References:

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders.(5th Edition). Washington, DC.: APA.
2. Barron, C. (2016). 7 Tips for coping with a paranoid partner. Psychology Today. Retrieved on 4 December, 2018, from: Website.
3. Bourgeois, J. (2017). Delusional disorder. Medscape. Retrieved on 9 December, 2018, from: Website.
4. Everyday Health. (n.d.) Coping with paranoia in a loved one. Everyday Health. Retrieved on 4 December, 2018, from: Website.
5. Mental Health America. (n.d.). Paranoia and delusional disorders. Mental Health America. Retrieved on 6 December, 2018, from: Website.
6. Navarrro, J. (2016). The paranoid partner: Identifying the paranoid personality in relationships. Psychology Today. Retrieved on 4 December, 2018, from: Website.
7. Nowak, L. (2018). Paranoid personality disorder and relationships: Moving past fear, together. Bridges to Recovery. Retrieved on 4 December, 2018, from: Website.
8. Sunrise House. (2018). Is there a difference between paranoia and delusional disorders? American Addiction Centers. Retrieved on 9 December, 2018, from: Website.
9. WebMD. (2018). Paranoid personality disorder. WebMD LLC. Retrieved on 9 December, 2018, from: Website.

Addiction fundamentally alters the brain’s reward and decision-making systems through well-documented neurobiological mechanisms. When substances like drugs (including alcohol and nicotine) are consumed, they trigger massive releases of dopamine in the brain’s reward circuit, particularly in areas like the nucleus accumbens and ventral tegmental area. With repeated exposure, the brain adapts by reducing natural dopamine production and decreasing the number of dopamine receptors, creating tolerance and requiring increasingly larger amounts of the substance to achieve the same effect. This neuroadaptation hijacks the brain’s natural reward system, making everyday activities less rewarding while the addictive substance becomes disproportionately important.

Over time, addiction also impairs the prefrontal cortex, the brain region responsible for executive functions like decision-making, impulse control, and weighing long-term consequences. This creates a neurological double-bind: the midbrain structures driving craving and drug-seeking behaviour become hyperactive, while the prefrontal systems that would normally regulate these impulses become weakened. Chronic substance use also disrupts stress response systems, making individuals more vulnerable to relapse during difficult periods. These changes help explain why addiction is recognised as a chronic brain disease rather than simply a matter of willpower – the neuroplastic changes can persist long after substance use stops, though the brain does have remarkable capacity for recovery with sustained abstinence and appropriate treatment.

The Challenge of Stopping

The challenge of stopping stems from the profound neurobiological changes addiction creates in the brain’s fundamental survival systems. The brain essentially learns to treat the addictive substance as necessary for survival, similar to food or water. When someone tries to quit, they face intense physical withdrawal symptoms as their neurochemistry struggles to return to homeostasis, combined with psychological cravings that can persist for months or years. The damaged prefrontal cortex makes it extremely difficult to override these powerful urges with rational decision-making, while stress, environmental cues, and emotional states can trigger automatic drug-seeking responses that feel almost involuntary. This creates a cycle where attempts to quit often lead to temporary success followed by relapse, which many interpret as personal failure rather than recognising it as part of the neurological reality of the condition.

Addiction appears progressive because tolerance drives escalating use over time, while the brain’s reward system becomes increasingly dysregulated. What begins as recreational use gradually shifts to compulsive use as natural dopamine production diminishes and neural pathways become more deeply entrenched. The condition typically follows a predictable pattern: initial experimentation leads to regular use, then to use despite negative consequences, and finally to compulsive use where the person continues despite severe impairment in major life areas. Additionally, chronic substance use often damages the brain regions responsible for insight and self-awareness, making it harder for individuals to recognise the severity of their condition. The progressive nature is also influenced by external factors – as addiction advances, people often lose social supports, employment, and housing, creating additional stressors that fuel continued use and make recovery more challenging.

Understanding addiction when you’re not “addicted” to alcohol or other drugs

The difficulty in understanding addiction, even among people with their own compulsive behaviors, stems from several key differences in how these conditions manifest and are perceived. While behaviors like sugar consumption, social media use, or shopping can indeed activate similar dopamine pathways, they typically don’t create the same level of neurobiological hijacking that occurs with substances like alcohol, opioids, or stimulants. Addictive drugs often produce dopamine surges 2-10 times greater than natural rewards, creating more profound and lasting changes to brain structure and function. Additionally, many behavioral compulsions allow people to maintain relatively normal functioning in major life areas, whereas substance addiction typically leads to progressive deterioration across multiple domains – relationships, work, health, and legal standing.

The social and cognitive factors also create barriers to understanding. Most people can relate to losing control occasionally – eating too much dessert or spending too much time scrolling their phone – but these experiences usually involve temporary lapses that can be corrected relatively easily through willpower or environmental changes. This creates a false sense of equivalency where people think “I can stop eating cookies when I want to, so why can’t they just stop drinking?” They don’t grasp that addiction involves a qualitatively different level of brain change where the substance has become neurobiologically essential, not just psychologically preferred. There’s also often a moral lens applied to addiction that doesn’t exist for other compulsive behaviours – society tends to view overconsumption of legal, socially acceptable things as personal quirks or minor character flaws, while addiction to illegal substances or excessive alcohol use carries heavy stigma and assumptions about moral failing, making it harder to see as a medical condition requiring treatment rather than simply better self-control.

A Word On Nicotine (Tobacco Products)

Yes, nicotine absolutely does release large amounts of dopamine, making it highly addictive despite being legal and socially accepted in many contexts. Nicotine causes an increase in dopamine levels in the brain’s reward pathways, creating feelings of satisfaction and pleasure.Research shows that nicotine, like opioids and cocaine, can cause dopamine to flood the reward pathway up to 10 times more than natural rewards.

This helps explain why nicotine addiction can be so powerful and difficult to overcome, even though people often view smoking or vaping as less serious than other forms of substance addiction. Repeated activation of dopamine neurons in the ventral tegmental area by nicotine leads not only to reinforcement but also to craving and lack of self-control over intake. The addiction develops through the same basic mechanisms as other substances – as people continue to smoke, the number of nicotine receptors in the brain increases, requiring more of the substance to achieve the same dopamine response.

What makes nicotine particularly insidious is its legal status and social acceptance, which can make people underestimate its addictive potential. The rapid delivery of nicotine to the brain (within 10-20 seconds when smoked) creates an almost immediate reward that strongly reinforces the behaviour. This is why many people who successfully quit other substances still struggle with nicotine, and why nicotine addiction often serves as a gateway that primes the brain’s reward system for addiction to other substances.