As Stanford University’s acclaimed psychologist Albert Bandura declared in a major research review, “alcohol abuse is not a monolithic condition with an inevitable progression” but rather, “a multi-determined pattern” varying from person to person in its severity and causation.

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I define addiction as a psychological and behavioral disorder. We are all aware of the traits present. There is a loss of control, a continuation of the behavior despite adverse consequences and an obsession or preoccupation with continuing the behavior and/or obtaining and using a substance. People are more susceptible to addictive behavior through genetic predisposition, growing up in a dysfunctional home, dealing with sexual identity issues, experiencing trauma and violence, having parents that did not provide sufficient love and approval, and having narcissistic personality traits.

Keep in mind, many people that continuously use drugs become physically dependent on the drug, but that physical dependence, has nothing to do with addiction. Yet, the DSM-IV does not categorize addiction, instead they list the signs and symptoms of substance dependence to mean addiction. Therein lies much confusion. The cancer patient self administering opioids in doses over time that would kill a normal person becomes physically dependent. Few continue to be physically dependent once they leave the hospital. The small percentage that may have problems have many of the susceptible risk factors I mentioned above. Why can some recover from physical dependency?

Because they want to live. They are using pain killers to kill real physical pain, not psychological or emotional pain. Rehabs are filled with pain management patients. Many became addicted to prescription drugs. At first the pain was directly related to actual physical distress. For some, the realization that these drugs also provided a quick fix to relieve emotional and psychological distress as well made their recovery more challenging. It is not about quantity, its about mindset. College campuses are filled with young people that are preoccupied with getting loaded. Many are heavy drinkers. But, they are generally having parties or finding reasons to celebrate to enjoy themselves. The mindset is positive. This is different from someone who is experiencing depression or anxiety and rather than cope in a healthy way, they turn to the quick fix provided by addictive behaviors, and the numbing and masking of emotional and psychological pain. This is very different.