4.3.10 - Describing addiction

Addiction as a pattern

This lesson covers the AQA requirement: describing addiction: physical and psychological dependence, tolerance and withdrawal syndrome. These four ideas are descriptive features. They help psychologists recognise what addiction looks like before later lessons explain why it develops or how it can be reduced.

The important phrase is compulsive despite harm. A person who enjoys a behaviour, repeats it often, or has a strong preference is not automatically addicted. Addiction involves a loss of control and a pattern that damages health, work, relationships, finances or everyday functioning.

For AQA, organise the description like this:

Addiction can involve substances such as nicotine, alcohol, opioids or caffeine, but it can also involve behaviours such as gambling. This matters because behavioural addictions may show strong psychological dependence and tolerance-like escalation without the same bodily withdrawal pattern seen in many substance addictions.

Modern clinical terminology often uses substance use disorder rather than "addiction" for substances. Do not let that distract you in an AQA answer: the specification wants the descriptive concepts above, written accurately and applied to examples.

Physical and psychological dependence

Physical and psychological dependence describe different aspects of a pattern that can overlap.

Physical dependence is mainly about bodily adaptation. With repeated exposure, the body tries to maintain balance while the substance is present. The substance becomes part of the body's temporary "normal". When it is removed, the body is pushed out of balance, producing withdrawal symptoms such as nausea, sweating, shaking, headaches, insomnia or agitation, depending on the substance.

Physical dependence is therefore confirmed most clearly when the person cuts down or stops and a withdrawal syndrome appears. A careful answer should also know that physical dependence is not identical to addiction. For example, a patient taking prescribed medication exactly as directed may become physically dependent and need medical support to reduce it gradually, without showing compulsive drug-seeking or continued use despite harm.

Psychological dependence is about craving and motivation. The person learns that the substance or behaviour produces pleasure, relief, calm, excitement, escape or reduced distress. Over time, the person may feel unable to cope, relax, socialise or feel normal without it.

This is not "less real" than physical dependence. Cravings are psychological experiences, but they are also linked to brain reward, learning and stress systems. A person with a gambling addiction, for example, may not have classic drug-withdrawal tremors, but may still feel restless, irritable and unable to stop thinking about gambling when trying to cut down.

AO2 example: Harriet has smoked for years. When she goes several hours without a cigarette, she feels tense and keeps thinking about smoking. The craving and belief that she needs a cigarette to cope show psychological dependence. If she also develops headaches, agitation and sleep problems when she stops, this suggests physical dependence because her body is reacting to the absence of nicotine.

The best exam answers separate the two types of dependence, then show how they often interact. A smoker may want nicotine for its rewarding effect, but may also smoke to remove unpleasant withdrawal symptoms. The behaviour is maintained by both desire and relief.

Tolerance

Repeated exposure can change the amount needed to achieve a particular effect.

Tolerance develops because the body and brain adapt to repeated stimulation. At first, a substance or behaviour may produce a strong rewarding effect. With repetition, the same amount may produce less pleasure, less relief or less intoxication. The person may then increase the dose, frequency, duration or intensity to recapture the original effect.

This escalation can make addiction more dangerous. A person who increases alcohol or opioid intake because of tolerance may increase the risk of poisoning, overdose, accidents or long-term harm. In gambling, a similar pattern can occur when the person needs larger bets or riskier play to achieve the same excitement, even though no drug dose is involved.

Two optional extensions show that tolerance can involve more than simply increasing a dose:

For example, someone who often drinks alcohol may learn to speak carefully or walk slowly to hide intoxication.

For example, tolerance to alcohol's sedative effects can reduce sensitivity to some other sedative drugs. This is why medical teams need accurate substance-use histories before procedures involving sedation or anaesthesia.