© Mart Production
August 27, 2025
Margit Hiebl
Addiction typically develops gradually over time. Here, an expert explains why people become dependent, what early warning signs to watch for, and what steps can help people overcome addiction.
Find a DoctorSearch the network for suitable specialists and contact them directly
It starts innocently enough—a glass of wine or an after-work beer meant to help you unwind, a joint to enhance the fun, or a sleeping pill to quiet your racing thoughts at night. But gradually, even these seemingly harmless indulgences can evolve into dangerous habits.
"At the beginning of an addiction, there is often curiosity, peer pressure, or a desire to manage certain emotions or stress," says PD Dr. Eva Döring-Brandl, MBA, Chief Physician of the Clinic for Psychiatry, Psychotherapy and Psychosomatics at Alexianer Hospital Hedwigshöhe in Berlin. At this stage, there are usually no clearly identifiable negative consequences.
But over time, when an evening glass of wine becomes a fixed relaxation ritual, habitual consumption develops. It only becomes addiction when the amount increases and consumption is accompanied by loss of control or other negative consequences.
"From this, actual dependency develops—both psychological and physical," says the addiction behavior expert. "This process is highly variable and often develops gradually over years or even decades, which makes it difficult in many cases to notice when an addiction is developing."
According to the "2025 Addiction Yearbook," approximately nine million people in Germany engage in problematic alcohol consumption. Cannabis-related disorders are the second most common reason for people to seek addiction treatment.
People develop addictions for various reasons involving both biological and psychological factors. At the core is the brain's reward system—the same mechanism that drives all cravings. A crucial role is played by dopamine: this neurotransmitter motivates us to repeatedly seek out stimuli that feel rewarding, in this case the addictive substance.
And when we encounter it again, dopamine essentially marks it as something pleasant and stores it as a positive memory. This sets the stage for the reward system to malfunction. Over time, the initial rush fades: what was once exciting and thrilling becomes less effective.
Rather than the original excitement, there's only the craving for the next dose—to fill the reward deficit. With each repetition, the compulsion intensifies. Over time, substance use becomes a coping mechanism for navigating life's challenges and difficult emotions.
A new US study found an unusually high rate of colon polyps among marathon and ultramarathon runners. What do the findings really mean, and should endurance athletes be concerned? A gastroenterologist explains.
Christine Bürg & Marianne Waldenfels
Carrot juice and coconut water are being hailed on TikTok as the secret to a natural summer glow. Beta-carotene can indeed alter skin tone — though not in the way many social media videos suggest. A dermatologist explains what the science actually shows.
Christine Bürg & Marianne Waldenfels
With
Dr. med. Timm Golüke
Artificial intelligence is taking over routine tasks and freeing up time for what truly matters: the relationship between doctor and patient. Prof. Dr. Dominik Pförringer explains why empathy is becoming the most important factor for success in medicine in the age of AI.
Prof. Dominik Pförringer
By
Univ.-Prof. Dr. med. Dominik Pförringer
Prevention should not only detect diseases early — it should stop them from developing in the first place. Dr. Jan Hennigs explains which examinations are genuinely worthwhile today, why cardiovascular risks are so often underestimated, and how artificial intelligence is set to transform the field of prevention.
Christine Bürg & Marianne Waldenfels
An interview with
Dr. med. Jan K. Hennigs
Is that considered a weakness of will? "No," says Dr. Döring-Brandl. There's no single "addiction gene"; rather, it's an interplay of several genetic risk factors—as is the case with most mental illnesses. People with addictions often have other mental illnesses simultaneously, such as personality disorders, affective disorders, psychotic disorders, or ADHD. "At least half of people with addiction disorder have one or more additional mental illnesses," Dr. Döring-Brandl explains.
However, individual risk factors also play a significant role, particularly when addiction problems run in the family. Research shows that children in these situations face substantially elevated risk of developing such disorders. "About a third of children of alcoholics will later become dependent themselves," explains Dr. Döring-Brandl. This isn't solely due to changes in brain neurotransmitters, but also involves learning processes and various external factors, including social environment and personal experiences.
According to the expert, virtually anyone can develop an addiction, though there are some key differences. Men tend to start using substances earlier and often engage in riskier consumption patterns, such as using hard alcohol or drugs like heroin and cocaine—possibly to conform to male stereotypes. Women and girls, by contrast, are more likely to turn to "socially acceptable" substances such as painkillers and tranquilizers, light alcoholic beverages like sparkling wine or alcopops, cannabis, or medications that affect body and weight.
At the same time, women have a significantly lower tolerance for alcohol, for example, and can develop dependency more quickly. However, the addiction potential also depends on the substance consumed. The likelihood of developing psychological and physical dependence on opiates is significantly higher than with alcohol.
Addiction is no longer limited to biological or chemical substances. Social networks, gambling, binge-watching, shopping portals, video streaming, sex, and even sports can trigger the same psychological dynamics as addiction to drugs or alcohol.
The top three include computer games, online pornography, and social networks. These behavioral addictions follow patterns that activate the brain's reward system in the same way as substance use—but without physical dependence. "Substance-related addictions typically involve physical dependence, which results in increased tolerance to the substance and physical withdrawal symptoms," explains Dr. Eva Döring-Brandl.
"While many people with substance addictions primarily seek to dull or intensify certain emotions, behavioral addictions often involve a more pronounced escape from reality." However, the social consequences can be equally severe—loss of relationships, employment, and social standing are common outcomes. What makes behavioral addictions particularly problematic is that they're even harder to identify, since the actual behavior can be easily concealed by those affected.
"Often it's the environment that first notices when someone has a problem," says Dr. Döring-Brandl. "The affected individuals themselves don't recognize the addiction immediately." Everything is first dismissed or denied. And as mentioned before, it's often a gradual process. But there are still some signs that should give one or others pause.
These include intense cravings—a strong desire for a substance or behavior. Another symptom is tolerance development, where you need increasingly higher doses to satisfy the craving. Additionally, withdrawal symptoms can occur, such as restlessness, sweating, trembling, and even seizures.
Mood swings and irritability are also signs of addiction. Another key indicator is loss of control—the person continues consuming even when clear negative health consequences are evident. This is often accompanied by neglect of personal and professional responsibilities, as the addiction takes increasingly higher priority. Additionally, people may experience social withdrawal and encounter problems in their relationships, family, and friendships.
Risky consumption is defined as, for example, alcohol intake exceeding 12 grams per day for women or 24 grams per day for men; problematic consumption occurs when at least three of the above criteria are met within a 12-month period.
How should family, friends, or colleagues respond when concerns arise? Often, those close to someone with an addiction react much like the person themselves – with denial, suppression, and avoidance. "It's important to address the observed problem, even if it initially leads to conflict, denial, or even loss of contact," advises the psychiatrist.
Even so, it's important to continue seeking dialogue and encouraging the person with addiction to pursue counseling or attend appointments together. Since this situation affects those close to them and can be quite taxing, professional support should also be available to the family—many addiction counseling centers and clinics provide specialized services for family members.
"There is no one classic way out of addiction," explains Dr. Döring-Brandl. "Therapy depends on the substance or behavior and must be individually tailored." Basically, however, particularly in substance-related addictions, physical withdrawal treatment is necessary. "This involves replacing the addictive substance or administering it in decreasing doses under control."
This is typically followed by gradual detoxification, usually in a full inpatient clinic setting. Both physical and psychological dependence can be pronounced and manifest physically through symptoms such as restlessness, sleep disorders, and irritability. "Therefore, a longer rehabilitation program is advisable, during which individuals also learn coping strategies for managing addiction," says the expert.
"After that, attending addiction counseling centers and self-help groups is an important part of maintaining abstinence." In many cases, particularly with adolescents, family therapy interventions are also recommended.
Even if complete abstinence cannot always be achieved, reducing consumption or decreasing the frequency of relapses can serve as a legitimate treatment goal. This approach also applies to behavioral addictions, which often lack sufficient available resources.
Combination therapies that pair classical psychotherapy with additional approaches—including mindfulness, acceptance-based procedures, non-invasive brain stimulation techniques, and biofeedback—are considered relevant treatment options for internet addiction.
Relapses occur repeatedly. They stem less from "positive temptation" than from an intense, often deeply distressing physical or psychological need to use the substance of dependence—commonly referred to as "craving" or "urge to use".
In a crisis situation, people struggling with addiction often feel they have no choice but to give in to overwhelming urges, such as for alcohol. To help protect them from relapsing—or to interrupt a relapse as quickly as possible—crisis plans are developed proactively during withdrawal treatment. However, this often requires repeated inpatient admissions or other professional intervention to be effective.
What tempts us, then, is often not what will make us happy in the long run. But fortunately, there are many things that activate our reward system with less risk. And that offers hope for anyone wanting to escape addiction.
