In trying to navigate human existence, addiction emerges as a formidable adversary, weaving its tendrils through the fabric of mental health and well-being. As mental health challenges and substance use disorders often coexist, it becomes imperative to confront stigma, provide support, and foster pathways to recovery. Here we try to unravel the complexities of addiction, from its definition and determinants to the neurological changes that underpin its grip on individuals. Through understanding, compassion, and advocacy, we strive to break the chains of addiction and illuminate the path to recovery.

An addiction, by definition, is the continued use of a mood or behavior altering substance despite adverse consequences. They result from the motivated repetition of the same thoughts and behaviors until they become habitual. Addictions can include, but are not limited to, drug abuse, sexual addiction, gambling, overeating and even exercise addiction. Dependence upon addictions occurs when the body learns to adjust to the substance by incorporating it into the body's normal function. This adjustment creates conditions of tolerance and withdrawal. Tolerance refers to the body's ability to adapt to the substance which then requires increasing amounts of the substance to achieve the original effect. Withdrawal refers to the symptoms, both physical and psychological, experienced when substance use is discontinued or even reduced. Withdrawal symptoms include anxiety, irritability, intense cravings, nausea, headaches tremors and hallucinations.

The "addictiveness" of a substance is often determined by one of four factors:

1.  The substance is a highly stimulating version of a natural product (for example, high-calorie foods)
2. The substance is available in limitless supply.
3. The substance comes in lots of varieties (novelty)
4. The substance causes us to binge without realizing it is triggering brain changes.

Very addictive substances usually meet 2 or more of the categories (high-sugar foods, exercise) or even all 4 categories (internet porn). All addictions have a common theme; they induce physiological changes in certain structures of the brain. So why do addictive patterns occur? Addictions arise because of the misuse of the normal reward pathways of the brain.

Internet Pornography

Now that we have a basic understanding of addiction, we can talk a little about the brain and rewards. At the forefront of the reward system of the brain is the neurotransmitter dopamine. In brief, the purpose of dopamine is to motivate, thus, the bigger the dose, the bigger the motivation and the more desire to do something. For example, chocolate and ice cream are great motivators for dopamine release, broccoli, by comparison, is not. Not surprisingly, sexual activity causes large surges of dopamine. Dopamine surges increase with novelty. Internet pornography is especially enticing because endless novelty is just clicks away (points 2 and 3 of "addictiveness"). The brain will eventually adapt and require access to a super-stimulating reward to maintain normal homeostasis. This adaptation is what leads to addiction.

All addictions lead to the same major brain changes:

Desensitization: the neurotransmitter dopamine declines, and the dopamine receptors are down regulated. This creates a less sensitive area for natural dopamine release and leaves the individual craving for activities that result in high dopamine release. The addict will tend to neglect interests and/or behaviors that were once of high personal value.

Sensitization: The newly wired brain and reward pathway will start to turn on in response to any addiction-related stimuli or even thoughts.

Hypofrontality: The frontal lobe centers, those associated with understanding consequences, begin to weaken. The result is a reduced response to the ability to foresee consequences of actions.

Dysfunctional stress circuits: This means that stress, which before the addiction was easily managed, can now trigger relapses when the individual comes under stress.

Heavy pornography use can also result in tolerance unless the user moves into new directions in search of more intense experiences to produce a more powerful chemical response. Therefore, the more intense the event, for example adding masturbation, the stronger the response, which results in an increased brain re-wiring.

What makes Internet pornography unique and so addictive?

It offers extreme novelty: Internet pornography allows for hundreds of "new" scenes per session. Novelty is highly stimulating. Today's pornography is even more addictive than pornographic magazines of the past. With Internet pornography, one can escalate both with new scenes and with new types of pornography. It's quite common for a user to move to ever more extreme and degrading forms of pornography.

Limitless exposure: Unlike food and drugs, in which there is a physical limit to consumption, there are no physical limitations to Internet pornography consumption. The user can simply click and begin the process all over again.

Lack of Aversion mechanism: An aversion system is activated when you don't like the symptoms, for example, eating too much is associated with pain so typically you stop bingeing in response to the pain (aversion system). Internet pornography doesn't have any immediate side effects to activate the natural aversion system. However, long term side effects include:

• Distress about escalation to more extreme pornography.
• Frequent masturbation.
• Uncharacteristic, worsening social anxiety or lack of confidence.
• Morphing pornography tastes that don't match sexual orientation.
• Inability to concentrate, and extreme restlessness.
• Depression and anxiety.

Many of these symptoms arise from the changes in dopamine levels and dopamine receptors.