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.