What is love and how do I know if I’m in love?

Abstract

Addiction is a complex, multifaceted phenomenon that has been described variously as a disease, disorder, syndrome, obsessive-compulsive behaviour, learned behaviour, or spiritual malady. Modern scientific understanding emphasises addiction as a chronic brain disorder shaped by neurobiological changes, learning, and social context. This article examines each conceptualisation and presents an integrated definition that aligns with current neuroscience, psychological, and public health evidence.

Conceptualising Addiction: Labels and Their Accuracy

No single label fully captures addiction’s complexity; each highlights certain truths while overlooking others.

Disease

From a medical perspective, disease is the closest match. Addiction involves persistent neurobiological changes in reward, stress, and self-control circuits, increases relapse risk over years, and shows substantial genetic vulnerability (~50–60%) (NIDA, 2018; Heilig et al., 2021). Treatments improve outcomes but rarely “cure” the condition. This framing is used by the American Society of Addiction Medicine (ASAM), NIDA, WHO ICD-11, and DSM-5-TR (as “Substance Use Disorder”) (NIDA, 2018).

Disorder

Disorder is also scientifically accurate and slightly less medicalised. DSM-5’s “Substance Use Disorder” captures behavioural, psychological, and biological criteria and recognises functioning and harm rather than framing addiction strictly as a lifelong disease (Heather, n.d.; Heilig et al., 2021).

Syndrome

Addiction may be described as a syndrome because it is a cluster of symptoms with behavioural and physiological manifestations, without a single causative factor. However, the term is too generic for practical use outside clinical texts (Blithikioti et al., 2025).

Obsessive and Compulsive Learned Behaviour

Addiction involves learning, habit formation, and compulsion through reinforcement of rewarding behaviours (Hyman, 2005; Hausotter, 2013). Yet describing it solely as learned behaviour ignores genetic predisposition, neuroadaptation, withdrawal, and social factors.

Spiritual Malady

Some mutual-aid traditions characterise addiction as a spiritual malady. While this may be meaningful for individuals, it is not scientifically explanatory: addiction can be adequately explained via biological, psychological, and social mechanisms (Lewis, 2017).

Modern Integrative Definition

The most accurate contemporary description of addiction is:
“A chronic, relapsing disorder of brain circuits involved in reward, stress, and self-control, shaped by learning, environment, and social context”.

This definition encompasses:

• Disease/disorder: medical accuracy
• Learned behaviour and compulsion: neuroscience and behavioural accuracy
• Social determinants: public health relevance
• Flexibility for personal or spiritual interpretations

In short, addiction is best understood as a bio-psycho-social condition that is treatable and sometimes reversible, rather than a deterministic, lifelong curse.

Neurobiology: Why Addiction Is Considered a Brain Disorder

Repeated substance use alters structural and functional brain circuits involved in reward, stress, motivation, memory, and self-control (Nwonu et al., 2022; NIDA, 2018). These changes can persist long after use stops, explaining why addiction is more than a matter of “bad habits” or weak will (NIDA, 2025).

Chronicity and Relapse

Addiction is often chronic and relapsing. Even after long periods of abstinence, cues and stressors can trigger relapse (Meurk et al., 2014; SAMHSA, 2023). Key regions implicated include the basal ganglia (habit formation), extended amygdala (stress), and prefrontal cortex (decision-making) (Kirby et al., 2024). Nevertheless, many individuals achieve stable remission, highlighting heterogeneity in clinical outcomes (Heilig et al., 2021).

Learning, Memory, and Habit Formation

Addiction exploits neural mechanisms of learning and memory: rewarding behaviours are repeated and consolidated into habits, with cues triggering compulsive responses even when the substance’s reward diminishes (Hausotter, 2013; Lewis, 2017). This intertwines biological disorder and learned behaviour.

Critiques and Limitations

Some scientists caution that framing addiction strictly as a brain disease is simplistic:

• Brain changes may resemble those from other motivated behaviours (Lewis, 2017).
• Many recover without formal treatment (Heilig et al., 2021).
• Social, environmental, and psychological factors are crucial to understanding addiction (Blithikioti et al., 2025).

Thus, while the disease model is powerful, it does not fully represent addiction’s heterogeneity or socio-psychological dimensions.

Implications for Treatment

Addiction is treatable, not simply curable. Interventions combining pharmacological and behavioural approaches, alongside social support, can foster long-term recovery (Liu & Li, 2018; Heilig et al., 2021). Like other chronic conditions, management — rather than elimination — is often the realistic goal (NIDA, 2018). Neural circuits can gradually readjust, particularly when environmental and personal factors support recovery.

Conclusion

Addiction is a learned, compulsive brain disorder with chronic potential, shaped by neurobiological, psychological, social, and environmental factors. Recognising addiction as both a disorder and a behavioural learning condition avoids extremes: it is neither an unchangeable fate nor merely a moral failing. This integrated perspective supports nuanced understanding, compassionate care, and effective treatment strategies.

References

Blithikioti, C., Fried, E. I., Albanese, E., Field, M., & Cristea, I. A. (2025). Reevaluating the brain disease model of addiction. The Lancet Psychiatry, 12(6), 469–474. https://doi.org/10.1016/S2215-0366(25)00060-4

Hausotter, W. (2013). Neuroscience and understanding addiction. Addiction Technology Transfer Center (ATTC) Network. https://attcnetwork.org/neuroscience-and-understanding-addiction

Heather, N. (n.d.). What’s wrong with the brain disease model of addiction (BDMA)? Addiction Theory Network. https://addictiontheorynetwork.org/brain-disease-model-of-addiction

Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L., & Vanderschuren, L. J. M. J. (2021). Addiction as a brain disease revised: Why it still matters, and the need for consilience. Neuropsychopharmacology, 46(10), 1715–1723. https://doi.org/10.1038/s41386-020-00950-y

Hyman, S. E. (2005). Addiction: A disease of learning and memory. The American Journal of Psychiatry, 162(8), 1414–1422. https://doi.org/10.1176/appi.ajp.162.8.1414

Kirby, E. D., Glenn, M. J., Sandstrom, N. J., & Williams, C. L. (2024). Neurobiology of addiction (Section 14.5). In Introduction to Behavioral Neuroscience. OpenStax. https://socialsci.libretexts.org/…/14.05:_Neurobiology_of_Addiction

Leshner, A. I. (1997). Addiction is a brain disease, and it matters. Science, 278(5335), 45–47. https://doi.org/10.1126/science.278.5335.45

Lewis, M. (2017). Addiction and the brain: Development, not disease. Neuroethics, 10(1), 7–18. https://doi.org/10.1007/s12152-016-9293-4

Liu, J. F., & Li, J. X. (2018). Drug addiction: A curable mental disorder? Acta Pharmacologica Sinica, 39(12), 1823–1829. https://doi.org/10.1038/s41401-018-0180-x

Meurk, C., Carter, A., Partridge, B., Lucke, J., & Hall, W. (2014). How is acceptance of the brain disease model of addiction related to Australians’ attitudes towards addicted individuals and treatments for addiction? BMC Psychiatry, 14, 373. https://doi.org/10.1186/s12888-014-0373-x

National Institute on Drug Abuse. (2018). Drugs, brains, and behavior: The science of addiction (Rev. ed.). https://irp.nida.nih.gov/…/NIDA_DrugsBrainsAddiction

Nwonu, C. N. S., Nwonu, P. C., & Ude, R. A. (2022). Neurobiological underpinnings in drug addiction. West African Journal of Medicine, 39(6), 874–884. https://pubmed.ncbi.nlm.nih.gov/36063103

Substance Abuse and Mental Health Services Administration. (2023). What is substance use disorder? U.S. Department of Health and Human Services. https://www.samhsa.gov/substance-use/what-is-sud

Psychological factors influencing drug use in Sydney’s gay community often stem from unique social and emotional challenges. Research highlights that stigma, discrimination, self-stigma, and internalised homophobia can lead to feelings of isolation, shame, and mental distress, which may increase vulnerability to substance use.

Additionally, the normalisation of partying in certain social settings, such as bars and clubs, has historically been a way for subcultural populations of LGBTQ+ individuals to connect and find community. However, this environment can also contribute to higher rates of drug use. Emotional coping mechanisms, such as using substances to manage stress or trauma, are also significant factors.

The biopsychosocial model provides a comprehensive framework for understanding alcohol and other drug dependency in the LGBTIA+ community. Here’s a breakdown of the factors:

1. Biological Factors:
   • Genetic predisposition plays a role, with some individuals being more vulnerable to chemical dependency due to inherited traits.
   • Neurobiological changes caused by substance use can alter brain function, making it very challenging to reduce or stop using substances despite the negative consequences occurring in the individual’s life.
2. Psychological Factors:
   • Trauma, such as adverse childhood experiences, peer bullying, neglect, authoritarian child rearing, seemingly innocuous societal messages, and/or discrimination, can lead to emotional distress and substance use as a coping mechanism.
   • Internalised stigma, homophobia, or transphobia can exacerbate mental health issues like anxiety and depression, increasing the risk of substance use and potential physical and psychological dependency.
3. Social Factors:
   • Experiences of ostracism, violence, or lack of acceptance and belonging can lead to isolation and substance use.
   • Social norms in certain LGBTQ+ spaces, such as bars or clubs, may normalise or encourage substance use.

This model underscores the importance of addressing all these interconnected factors in prevention and treatment efforts.

The Flux Study, also known as “Following Lives Undergoing Change,” is a longitudinal research project focusing on the lives of gay and bisexual men in Australia. Conducted by the Kirby Institute at UNSW Sydney, it examines various aspects of health, behaviour, and social factors, including drug use, sexual health, and the adoption of HIV prevention strategies like PrEP.

Key findings from the study include:

• Recreational drug use is common among gay and bisexual men, with substances like marijuana, amyl nitrite (“poppers”), and party drugs being frequently used. However, dependency rates are relatively low.
• Drug use is often linked to enhancing pleasurable experiences, including sexual enjoyment.
• The study has provided insights into how men mitigate risks, such as using biomedical HIV prevention methods alongside drug use.

The Flux Study is a collaborative effort involving organisations like the National Drug and Alcohol Research Centre, ACON, and the Victorian AIDS Council. It aims to inform health interventions and support services tailored to the needs of this community.

The Flux Study has provided valuable insights into the health and behaviours of gay and bisexual men in Australia. Here are some key findings:

• Drug Use: While recreational drug use is common, most participants reported infrequent use. Harm reduction strategies, such as not sharing injecting equipment, were widely practiced.
• HIV Prevention: There was a significant increase in the uptake of HIV pre-exposure prophylaxis (PrEP), with usage rising from less than 1% in 2014 to about one-third of participants by 2017.
• COVID-19 Impact: During the pandemic, participants reduced sexual contacts and adapted strategies to minimize risks in sexual contexts. Many also paused PrEP usage due to reduced sexual activity.
• Mental Health: A notable proportion of participants reported mental health challenges, highlighting the need for targeted support services.

There are several support services available for addressing mental health challenges, particularly for the LGBTIA+ community in Australia. Here are some key options:

1. QLife: A free, anonymous peer support and referral service for LGBTQ+ individuals. It operates via phone and webchat from 3 PM to midnight, 7 days a week. Phone: 1800 184 527. Their website provides a webchat service: QLife – Support and Referrals
2. Beyond Blue: Offers 24/7 mental health support, including phone and online counselling. They also provide resources tailored to the LGBTQ+ community. Phone: 1300 22 4636. Click the following link to Beyond Blue’s Wellbeing Action Tool: beyond-blue-wellbeing-action-tool_dec_2024_updated.pdf
3. Lifeline: A leading crisis support service available 24/7 for anyone in distress. They offer phone, text, and online counselling. Phone: 13 11 14
4. Head to Health: Connects individuals to mental health resources, including helplines, apps, and digital programs. Medicare Mental Health is a free service that connects you with the mental health support that is right for you. Phone: 1800 595 212 or visit their website: Home | Medicare Mental Health
5. WayAhead Directory: An online database to find local mental health services and resources. Phone: 1300 794 991
6. NSW Mental Health Line: A 24/7 telephone service providing advice and recommendations for appropriate care. Phone: 1800 011 511

These services are designed to provide immediate support and guide individuals toward long-term mental health care.

Low self-worth is one of those things almost everyone has heard of, but it’s often misunderstood. It’s not simply “not liking yourself” — it’s a deeper, often quiet belief that you’re somehow not enough: not good enough, not lovable enough, not worthy of good things. This belief can shape how a person thinks, feels, behaves, and connects with others, sometimes without them even realising it’s happening.

This article walks through what low self-worth can look like, how it tends to develop, why it’s not always the explanation for a behaviour it might seem to explain, and what genuinely helps.

What Does Low Self-Worth Actually Look Like?

Low self-worth doesn’t show up in just one way — it tends to ripple across several areas of a person’s life.

In the way someone thinks

• A harsh inner voice that’s quick to blame and slow to forgive
• Black-and-white thinking about their own worth (“I’m a failure” rather than “that didn’t go well”)
• Brushing off compliments or achievements (“I just got lucky”)
• Constantly comparing themselves to others, usually unfavourably

In how someone feels

• A background hum of shame or guilt that isn’t tied to anything specific
• Anxiety in situations where they feel judged or evaluated
• Taking criticism much harder than the moment probably warrants
• Struggling to feel like they deserve good things — joy, rest, success

In how someone behaves

• People-pleasing, and real trouble saying no
• Avoiding challenges for fear of failing in front of others
• Perfectionism, partly as a way to dodge criticism before it happens
• Overcompensating — bragging, chasing status, or over-achieving to cover up insecurity underneath
• Self-sabotage, like procrastinating or quitting before they can “fail properly”
• Over-apologising, even when nothing’s actually their fault

In relationships

• Putting up with disrespectful or unequal treatment
• Needing frequent reassurance from others
• Trouble setting or holding boundaries
• Pulling away from people to avoid the risk of being rejected

Physically

• Guarded body language, poor posture, avoiding eye contact
• Neglecting self-care, sometimes because they don’t feel “worth the effort”

Worth remembering: none of these signs are exclusive to low self-worth. They overlap with anxiety, depression, trauma responses, and other things going on for a person. It’s the overall pattern — and the story underneath it — that matters, not any single item on this list.

Where Does It Come From?

Low self-worth is very often learned rather than something a person is simply born with — which is actually good news, because what’s learned can also be unlearned.

Watching the adults around us Kids learn a lot about how to treat themselves by watching how the important adults in their life treat themselves. A parent who’s constantly self-critical or dismissive of their own needs is teaching a child a template, even without saying a word directly to them.

Love and attention that come with strings attached If approval or affection is only given for achievement, appearance, or good behaviour, a child can learn that their worth depends on ticking boxes — rather than being something they simply have, no strings attached.

Being told directly Repeated criticism, shaming, or put-downs from parents, teachers, or peers get absorbed, especially in childhood before a person has the tools to separate “someone said this about me” from “this is true about me.”

Early relationships with caregivers Inconsistent, neglectful, or dismissive caregiving is strongly linked to a shaky sense of self-worth in adulthood — the underlying logic often being something like, “if the people meant to care for me didn’t, maybe I’m not worth caring for.”

Peers and wider social environments Bullying, exclusion, and highly competitive or comparison-heavy environments — including social media — can teach the same lesson outside the family entirely.

Broader social messaging Cultural narratives around race, gender, body type, class, or ability can also send repeated messages of lesser worth, reinforced across many different settings over time.

Why It’s Not Always the Explanation

It’s tempting, once you’re aware of low self-worth as a concept, to see it everywhere. But plenty of behaviours that look like they’re about self-worth are actually about something else entirely — or several other things at once.

Take a few common examples:

• Substance use can be tangled up with self-worth (numbing shame or a harsh inner critic), but addiction is genuinely shaped by many factors — genetics, brain chemistry, trauma, mental health conditions, and environment all play a real part.
• Having few or no friends might reflect low self-worth (believing you’re not worth others’ time), but it could just as easily be social anxiety, depression, being naturally introverted, or simply preferring one’s own company. The key difference is usually the story underneath — does the person want connection and feel blocked by fear, or is being alone genuinely fine by them?
• Coming across as arrogant or superior is often assumed to be a mask for hidden insecurity — and sometimes it is. But it’s worth being cautious here, because this assumption can become impossible to disprove (“if they’re arrogant, they’re secretly insecure; if they’re humble, that confirms it too”). Sometimes confidence is just confidence.
• Frequent casual sex or a high number of partners doesn’t automatically point to low self-worth either. For many people, this is simply how they’ve chosen to structure their sex life, without any distress or underlying insecurity attached. What matters more is the function the behaviour seems to serve for that particular person — for example, someone who says they need to tell others about their experiences afterward specifically “to feel validated” is giving you a much clearer signal than the behaviour itself would.

The takeaway: self-worth is worth holding as a hypothesis to test with a person, rather than assumed from the outside based on how something looks.

What Actually Helps

If low self-worth is at the heart of things, here’s what tends to make a genuine difference — not overnight, but over time.

1. Notice and challenge the inner critic Pay attention to the specific language your mind uses about you. Often it’s harsher and more sweeping than how you’d ever speak to someone else. Try the “friend test”: would you say this to someone you cared about? If not, that’s a sign of distortion, not truth. It also helps to separate the behaviour from the self — “that didn’t go well” instead of “I’m hopeless.”

2. Loosen the strings attached to your worth Notice what your sense of worth currently depends on — achievement, appearance, being liked, being productive. Then start building small experiences of worth that aren’t tied to those things: resting without earning it, being liked without performing. This is slow, quiet work, but it’s often the real target.

3. Build evidence, not just insight Small, doable actions build a track record of competence over time — self-worth grows partly through lived proof, not just understanding. Avoiding challenges or social situations might feel safer, but it also blocks the very experiences that could prove the harsh self-view wrong.

4. Practise boundaries Struggling to say no, or putting up with poor treatment, is common with low self-worth. Practising small boundaries — even minor ones — can genuinely shift things, not just relieve symptoms temporarily. Pay attention to the fear beforehand versus what actually happens afterward; they’re often quite different.

5. Try self-compassion rather than self-esteem Self-compassion doesn’t require feeling good about yourself — it just means relating to yourself kindly, especially when things are hard. That’s often a far more achievable starting point than trying to force positive self-regard from a standing start. Remembering that struggling is part of being human (not a personal failing) is a big part of this.

6. Pay attention to relationships If low self-worth was shaped by relationships, it often needs relationships to help un-shape it too — this is part of why therapy, and a genuinely supportive relationship, tends to work better than self-help alone. Where possible, it also helps to reduce contact with people or environments that actively reinforce the negative self-view.

7. Shift from approval to values Instead of asking “what will make people think well of me,” try asking “what actually matters to me.” This shift — living by your own values rather than by anticipated approval — reduces the constant self-monitoring that keeps worth tied to outside opinion.

A Final Note

Self-worth work is rarely quick, and it’s rarely a straight line. It’s more like slowly rebuilding a belief system than fixing one single thought. Old patterns will likely resurface here and there — that’s not a sign the work isn’t working, it’s just part of how deeply learned beliefs unwind over time.

If this sounds familiar to you personally, it’s worth having a conversation with a psychologist or therapist — someone who can help you work out what’s underneath the patterns, and support you through actually shifting them.