How to Recognize and Treat an Addiction

At first, it's just the glass of wine or the after-work beer intended to provide relaxation. The joint that boosts the fun factor. Or the sleeping pill that stops the nightly carousel of thoughts. But gradually, even the most harmless little temptations can turn into dangerous habits.

"At the beginning of an addiction, curiosity, peer pressure, or the desire to reduce certain emotions or stress are often present," says PD Dr. Eva Döring-Brandl, MBA, chief physician of the Clinic for Psychiatry, Psychotherapy, and Psychosomatics at the Alexianer Hospital Hedwigshöhe in Berlin. At this stage, there are usually no clearly noticeable negative consequences.

But as time progresses, when the evening glass of wine becomes a fixed relaxation ritual, a habit consumption develops. It only becomes an addiction when the quantity increases and consumption is accompanied by loss of control or other negative consequences.

Around nine million people in Germany consume alcohol in a problematic manner

"This develops into actual dependence - both psychological and physical," says the expert on addiction behavior. "This process is very heterogeneous, often insidious, and can last for years or decades, making it difficult to notice the development of an addiction in many cases."

According to the 'Yearbook of Addiction 2025,' around nine million people in Germany consume alcohol in a problematic manner. The second most common reason for accessing addiction support services is cannabinoid-related disorders.

The reasons why people fall into addiction can be varied. The biological level is just as important as the psychological one. Initially, as with any desire, the classic reward system in the brain is behind it. Dopamine plays a key role here: the neurotransmitter motivates us to keep looking for stimuli that make us feel good. In this case, one of the aforementioned substances.

And when we come into contact with it again, it's essentially 'liked' by the dopamine and positively stored. The foundation for a misdirection of the reward system is laid. Eventually, the kick starts to fade: what was initially exciting and thrilling loses its effect.

Instead of the excitement originally experienced, there is only the craving for the next dose - to compensate for the reward deficit. The more often this process is repeated, the stronger the need to do it again. Thus, substance use becomes more and more the means to deal with various life situations and moods.

There is no explicit "addiction gene," but rather an interplay of several genetic risk factors.

Does this count as a lack of willpower? "No," says Dr. Döring-Brandl. There is also no explicit "addiction gene"; rather, there is an interplay of several genetic risk factors - as with most mental disorders. Addicts often simultaneously have other mental disorders, such as personality disorders, affective disorders, psychotic disorders, or ADHD. "At least half of people with an addiction disorder have one or more other mental disorders," says Dr. Döring-Brandl.

But individual risk factors also play a role, such as if someone comes from a family where addiction problems already exist. Studies show that the risk of children developing such a disorder is significantly increased. "About one-third of children of alcoholics later become dependent themselves," says Dr. Döring-Brandl. But not only changes in neurotransmitters in the brain, but also learning processes and various external influences, such as the social environment and personal experiences, play a role here.

Basically, anyone can develop an addiction, according to the expert. With small differences: Men start earlier and often show riskier consumption patterns, such as hard alcohol or drugs like heroin and cocaine - perhaps also to cater to male stereotypes. Women and girls tend to lean towards "more socially acceptable" substances such as painkillers and sedatives, light alcohol like sparkling wine or alcopops, cannabis, or medications that affect the body and weight.

The likelihood of developing a psychological and physical dependence on opiates is significantly higher than with alcohol.

At the same time, women have a significantly lower tolerance, for example, to alcohol, and can develop a dependency more quickly. However, the addiction potential also depends on the substance consumed. The likelihood of developing a psychological and physical dependence on opiates is significantly higher than with alcohol.

It is no longer just biological or chemical substances that are considered addictive. Social networks, gambling, binge-watching, shopping portals, video streaming, sex, and even sports can trigger the same psychological dynamics as dependence on drugs or alcohol.

The top three here include computer games, online pornography, and social networks. These so-called behavioral addictions are patterns that activate the reward system in the brain just as much — but without physical dependence. "Substance-related addictions are usually accompanied by a physical dependence, which leads to an increased tolerance to the substance and physical withdrawal symptoms," explains Dr. Eva Döring-Brandl.

"While for many people with substance-related addictions it is more about dampening or inducing certain emotions, behavioral addictions often involve a more pronounced escape from reality." However, the social impacts can be just as severe — loss of relationships, jobs, and social status are not uncommon here either. Particularly problematic: They are even harder to identify because the actual consumption can be well concealed by those affected.

"Often it is the environment that first notices that someone has a problem," says Dr. Döring-Brandl. "The affected individuals themselves do not immediately recognize the addiction." Everything is initially dismissed or denied. And in fact, as already mentioned, it is often a creeping process. However, there are still some characteristics that should make oneself or others cautious.

This includes the so-called craving, a strong desire for a substance or behavior. Another symptom is the development of tolerance: You need more or higher doses to satisfy the desire. Also: the occurrence of withdrawal symptoms, such as restlessness, sweating, trembling, up to seizures.

Alcohol addiction: Risky consumption is defined, for example, as more than 12 grams (for women) or 24 grams (for men) per day.

Mood swings and irritability are also an indication. Finally, loss of control, so that even when clear negative health consequences are apparent, consumption is continued. Added to this is the neglect of private and professional duties — the addiction is given more and more priority. Associated with this: social withdrawal and problems in partnerships, family, or with friends.

So-called risky consumption is defined in the case of alcohol as more than 12 grams (for women) or 24 grams (for men) per day; problematic consumption when at least three of the criteria mentioned above are met within 12 months.

How should family, friends, or colleagues react when suspicions accumulate? Relatives or those close to addicts often react similarly to them — with denial, suppression, and turning a blind eye. "It is important to address the observed problem, even if this may initially lead to arguments, denial, or even a break in contact," advises the psychiatrist.

However, even then, the conversation should always be sought, and the addict should be motivated to visit a counseling center or attend appointments together. Because this situation involves the direct environment and can be very stressful, professional help should also be sought for support – many addiction counseling centers and clinics offer targeted services for relatives.

"There is no one classical way out of addiction," explains Dr. Döring-Brandl. "Therapy depends on the substance or behavior and must be individually tailored." However, in principle, especially with substance-related addictions, a physical withdrawal treatment is part of it. "In the process, the addictive substance is replaced or administered in controlled, descending doses." This leads to a gradual detoxification, usually in the inpatient environment of a clinic. But not only the physical, the psychological dependence can also be very pronounced and manifest physically, for example through restlessness, sleep disorders, and irritability. "A longer weaning treatment is therefore sensible, in which strategies for dealing with addiction are also learned," says the expert. "Subsequent visits to addiction counseling centers and self-help groups are an important building block to remain abstinent." In many cases, especially with adolescents, family therapeutic interventions are also recommended.

There is no one classical way out of addiction.

Even if complete abstinence cannot always be achieved, at least a reduction in the amount consumed or a lower frequency of relapses can be a treatment goal. This also applies to behavioral addictions, for which there are not as many contact points as would actually be necessary. As a relevant therapy path for internet addiction, combination therapies of classical psychotherapy and various additive approaches such as mindfulness- and acceptance-based procedures, but also non-invasive brain stimulation and biofeedback procedures are considered.

Relapses occur again and again. These have less to do with "positive seduction" than with a pronounced, mostly very tormenting need for consumption of the substance on which there is a dependence – often called "addiction pressure." In a crisis situation, for example, those affected then do not know any other way to help themselves than to give in to the extremely strong need, for example for alcohol. In order to protect those affected from relapses or to interrupt the relapse as quickly as possible, crisis plans are developed as a precautionary measure in the withdrawal treatment. Often, this only works with renewed inpatient admission or with other professional help.

What tempts us is often not what makes us happy in the long run. But the list of things that activate our reward system with less risk is fortunately long. And therein lies an opportunity – for all those who want to escape their addiction.