Comparison table of four relationship dependency types: Dependence, codependence, independence, and interdependence, across seven psychological characteristics

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.

NOTE: All these skills will require practice

1. Cognitive (thinking) techniques

• Identify your stressors or potential stressors. Sometimes, “stress” is frustration or fear in disguise.
• Plan ahead
• Decision making and problem solving
• Accept what we cannot change

Changing how we see stressful situations

We may not be able to change our circumstances, but we can see them differently (Forsyth & Eifert, 2016). For example, stress can be viewed as an experience that will support our learning, growth, and personal development.

Technique: Accept – Choose – Take action

Acceptance and Commitment Therapy (ACT) has proven valuable for people learning to manage anxiety and stress; it encourages:

• Letting go of the struggles that keep them stuck
• Cultivating peace of mind
• Accepting what is, and doing what works

Rather than struggle to reduce stress and anxiety, we:

a. accept what we are already experiencing and then 

b. choose the direction we would like our life to take, and then

c. take action that reflects are values

Technique: Radical acceptance

Radical acceptance is often practiced within Dialectical Behaviour Therapy (DBT).  Radical acceptance is based on the notion that suffering does not come directly from painful experiences but our attachment to them. For example, workplace stress may be more about your identity and status in the workplace rather than the stress itself.

Radical acceptance means fully accepting everything that you are experiencing in the present moment i.e., thoughts, feelings, emotions, body sensations, reactions, attitude, environment etc. We fully accept the present moment because what we resist persists. The more we deny reality the more painful (or unpleasant) we will perceive it to be. Radical acceptance is about saying “yes” to exactly what is happening for us in the moment.

• Radical acceptance is about accepting life on life’s terms and not resisting what one cannot or chooses not to change.
• Accepting doesn’t mean agreeing. It’s simply exhausting to fight reality, and it doesn’t work.
• Resisting reality delays healing and adds suffering to one’s pain.

Technique: Challenging core beliefs

Our core beliefs can shape how we face up to the difficult times and how we react to stress (Beck, 2011) and reconstructing them in a balanced way that allows room for perceived shortcomings.

Humans subconsciously “look for” evidence to support their core beliefs about themselves and the world.

You may have to take mental control to actively on-purpose look for evidence to the contrary.

Technique: Acceptance of our thoughts and feelings

The goal of ACT is to accept what lies beyond our control and commit to life-enhancing actions instead.

There are six core processes in ACT:

1. Contact with the Present Moment

Conscious awareness of your experience in the present moment enables you to perceive accurately what is happening Gives you important information about whether to change or persist in behaviour Enables you to ‘catch’ cognitive fusion ‘in flight’ Allows you to engage fully in what you are doing.

2. Acceptance

Actively contacting psychological experiences directly, fully, and without needless defense Definition: defused, open, undefended contact with the present moment, as a fully conscious human being.

‘Opening yourself fully to experience, as it is, not as your mind says it is’.

3. Defusion

Looking at thoughts, rather than from thoughts Noticing thoughts, rather than being caught up in thoughts Seeing thoughts as what they are, not as what they seem to be Aim of Defusion is NOT to feel better, nor to get rid of unwanted thoughts Aim of Defusion IS to reduce influence of unhelpful cognitive processes upon behaviour; to facilitate being psychologically present & engaged in experience; to facilitate awareness of language processes, in order to enhance psychological flexibility.

4. Self-as-context or The Observing Self:

Observe and accept all changing experiences.

How rigid is your thinking? Allow for psychological flexibility. Think in new ways. Consider other perspectives. Ask people for their perspective.

It is a process, not a thing: an awareness of awareness itself: ‘pure awareness’.

It is that aspect of a human being that does all the noticing/observing of one’s inner and outer world. You could call this “meta-awareness” or “pure awareness” if you prefer: it’s the awareness of one’s awareness, or the noticing of one’s noticing, or the consciousness of one’s consciousness.

5. Values

 Chosen life directions ‘Your heart’s deepest desires for the sort of person you want to be and the things you want to do in your time on this planet; in other words, what you want to stand for in life’ Provide motivation & inspiration Provide guidance for your actions Give life meaning Give a sense of abundance Are different to goals 6.Committed Action Overt behaviour in the service of values (may require skills training) Committed action is: values-guided, effective & mindful

Technique: Meditation for acceptance

Meditation is a powerful tool for accepting stressful situations and difficult emotions. Bring your attention, non-judgementally, to your mind, body, and environment. Here are some alternative definitions:

 “Bringing one’s complete attention to the present experience on a moment-to-moment basis.” (Marlatt & Kristeller)

“Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn).

“The nonjudgmental observation of the ongoing stream of internal and external stimuli as they arise.” (Baer)

“Awareness of present experience with acceptance.” (Germer, Segal, Fulton)

“Consciously bringing awareness to your here-and-now experience, with openness, interest, and receptiveness.”

Allow everything to be just as it is. Do the following to start for 2 minutes, 5 minutes, 10 minutes, or as long as you like, whenever you like:

1. Take a seat. Find place to sit that feels calm and quiet to you.

2. Set a time limit.

3. Notice your body.

4. Feel your breath.

5. Notice when your mind has wandered.

6. Be kind to your wandering mind.

7. Close with kindness.

Technique: Grounding and centering

• 5-4-3-2-1 Technique

Using the 5-4-3-2-1 technique, you will purposefully take in the details of your surroundings using each of your senses. Strive to notice small details that your mind would usually tune out, such as distant sounds, or the texture of an ordinary object.

Vision	What are 5 things you can see? Look for small details such as a pattern on the ceiling, the way light reflects off a surface, or an object you never noticed.
Touch	What are 4 things you can feel? Notice the sensation of clothing on your body, the sun on your skin, or the feeling of the chair you are sitting in. Pick up an object and examine its weight, texture, and other physical qualities.
Sound	What are 3 things you can hear? Pay special attention to the sounds your mind has tuned out, such as a ticking clock, distant traffic, or trees blowing in the wind.
Smell	What are 2 things you can smell? Try to notice smells in the air around you, like an air freshener or freshly mowed grass. You may also look around for something that has a scent, such as a flower or an unlit candle.
Taste	What is 1 thing you can taste? Carry gum, candy, or small snacks for this step. Pop one in your mouth and focus your attention closely on the flavours.

• Naming categories

Choose a category (e.g., colours, shapes, textures), then look around the room and name all of the things you can see in that category.

Cold water

Have a few slow sips of cold water, feeling the sensation of the cold water in your mouth and notice the sensation as you swallow.

Washing your face with cold water can also reduce your heart rate and lower stress levels.

• Counting

Count backwards from 20. You can do this as many times as you need to. Say to yourself that you are becoming calming as you count down each number.

• Notice your breath

Take a deep breath and as you exhale, imagine breathing out strongly through the soles of your feet. Feel the connection of your feet with the floor. Do this three times.

2. Behaviours that can protect our vulnerability to stressful situations

It is essential to consider what skills and tips we can use to manage stress and ultimately improve our wellbeing inside and outside work:

• Exercise i.e., running, swimming, resistance training, aerobics etc.
• Eating healthy foods
• Avoiding alcohol and other drugs
• Recommended sleep at the recommended times i.e., 8 hours during the night hours.
• See your GP if you are experiencing physical or psychiatric illness
• Spend time with family and friends
• Engage in a hobby or create a hobby
• Meditation, yoga, group exercise, group mindfulness classes
• Listening to music
• Setting a time to watch tv and having boundaries re length of time watching tv
• Read a book

Self-care tips

Life, and particularly work, can be stressful. Self-care is essential to keep us functioning well and improving our overall wellbeing (Bush, 2015).

The following aspects of our health are vital to our wellbeing and crucial for managing stress better. Ask yourself the following questions when your intuition tells you that you may be in a deficit:

1. Without sleep, we cannot think clearly – are you getting sufficient sleep?
2. Exercise is one of the best cures for stress – are you prioritizing physical activity?
3. Our brain is maintained by the food we eat – are you eating a balanced and varied diet?
4. Healthy relationships are vital for our wellbeing – are you making time for the people you care about?
5. Self-expression enriches who we are and how we live – are you giving the focus you would like to the things you are passionate about?
6. Community and spirituality ground who we are and how we live – how can you make yourself more open to both?

Managing stress in the workplace

Stress is a significant factor in many workplaces, resulting in countless hours lost due to time off or non-productive hours. We may think the responsibility is on workplaces to create environments that reduce stress and help workplace stress, but it’s also very much an individual responsibility.

Putting in place each of the following will help (modified from HBR guide to beating burnout, 2021):

1. Increase psychological safety
   Trust and collaboration will reduce the perception that the workplace is a threat.
2. Build regular break times
   We cannot focus for beyond 120 minutes without appropriate rest breaks. Build them into the day and encourage people to use them.
3. Encourage the use of private workspaces
   Open offices often have many distractions that can frustrate staff when unable to concentrate. Supply private workplaces where staff can focus without interruption.
4. Set boundaries around time outside of work
   The borders between work and personal life are often blurred, especially if working remotely. Set clear expectations and stick to them.
5. Create flexible work policies
   Juggling work and family life is not easy. Flexibility can remove or reduce that stress without feelings of guilt.
6. Make sure people are in the right roles
   When staff are doing jobs they enjoy and are well supported they thrive and take challenges in their stride.
7. Encourage autonomy
   Micromanaging is stressful for everyone. Give teams the autonomy to manage their own projects and staff their individual tasks.

3. Further Stress Relief Activities

Positive emotions such as joy, awe, hope, and optimism are essential to living the good life and are known stress relief techniques. They strengthen our psychological resources for overcoming tough, stressful times (Seligman, 2011).

Boosting positive emotions

• Practice gratitude. A helpful way to practice gratitude is to think of everything you have in life and imagine if something was taken away.
• Spent time with people who you love.
• Do something kind for someone else.
• Spend time in nature.
• Take a break from screens (tv, mobiles, computers).
• Take a break from listening to the news.
• Take a work holiday.
• Laugh more – find something to laugh about and share it with someone. How often are you laughing?

Build hope

Hope is a positive, optimistic frame of mind in which we expect good events and scenarios to occur. The ability to remain hopeful can help you bounce back more effectively from life’s difficulties when they crop up (Seligman, 2011).

Improving self-awareness

Mindful reflection can leave us grounded and better aware of ourselves and our situation. The Who am I without this stress? exercise helps us focus on what is “right” with us rather than what is “wrong”.

Once centred by our breathing, ask yourself to consider:

What do I value most in life?
Are my current stressors more important than what’s most important?
What do I enjoy doing?
What do I look forward to every day?
When do I feel at my best?

Change the way you talk to yourself

When we are stressed, we sometimes say negative or self-defeating things to ourselves. Unhelpful self-talk might include things like, “I can’t cope”, “I’m too busy to deal with all this”, “This is all their fault”, or “I’ll never get this done”. Negative self-talk can make it more difficult to manage stress.

Notice your self-talk and work on using helpful, soothing, and calming self-talk, such as, “I am coping well given what I have on my plate”, “Relax, this stressful time will pass”, or “This is a stressful situation, but what is one thing I can do to help me get through this?”

Ask yourself:

• Am I overestimating the likelihood of a negative outcome?
• Am I overestimating how bad the consequences will be?
• Am I underestimating my ability to cope?