“Am I an addict?” That question might cross your mind when you realise how much you rely on a substance—whether it’s your triple-shot americano or the pack of cigarettes you burn through daily. But when does a habit turn into an addiction?
What are addictions?
According to the DSM-5, the handbook used by healthcare professionals, a Substance Use Disorder (SUD) is characterised by a pattern of cognitive, behavioural, and physiological symptoms where substance use continues despite significant harm or severe disruption to everyday functioning. So, if you can’t cut back on cigarettes despite liver issues from smoking, or if your caffeine intake is causing you so much anxiety that you can’t function at work, it may be time to take a closer look.
Types of addictions
According to the DSM-5, SUDs fall into ten categories:
- Alcohol – Alcohol Use Disorder is one of the top three mental health conditions in Singapore, affecting 4.1% of the population.
- Stimulants – Methamphetamine was the most commonly abused drug among new abusers in Singapore in 2023, accounting for 63% of cases.
- Cannabis – The second most commonly abused drug among new users in 2023, making up 19% of cases.
- Hallucinogens – Ecstasy was the third most commonly abused drug in 2023, with 9% of new abusers using it.
- Tobacco – While smoking rates in Singapore declined from 13.9% in 2010 to 10.1% in 2020, vaping cases surged, with 7,900 cases reported in 2023 compared to 4,700 in 2021.
- Opioids – Includes substances like heroin and prescription painkillers, which can lead to severe dependence.
- Caffeine – While commonly consumed, excessive caffeine use can lead to withdrawal symptoms and dependency.
- Inhalants – Substances like glue, paint thinners, and nitrous oxide can cause dangerous highs and long-term damage.
- Sedatives, Hypnotics, and Anxiolytics – Prescription medications such as benzodiazepines can become addictive when misused.
- Other (or Unknown) Substances – Covers substances that don’t fit into the above categories but cause significant addiction-related issues.
SUDs can also lead to substance-induced disorders, including intoxication, withdrawal, and mental health conditions such as psychotic disorder, depressive disorder, and neurocognitive disorders.
Why addictions happen
Can addictions be genetic? How does childhood shape addiction risk? Are your current circumstances enabling substance use? Several factors contribute to the development of addiction:
- Genetics: Genetic influences account for around 50% of SUD risk. Some genes are linked to specific substances, while others affect stress resilience.
- Upbringing: Adverse Childhood Experiences (ACEs) like trauma, abuse, neglect, or witnessing domestic violence can disrupt brain development, impair impulse control, and increase addiction risk. They may also lead to the development of mental health conditions, including behavioural issues, which may then lead to the use of substances to cope (self medicate).
Growing up with caregivers who were involved in substance use also plays a role, as it may influence an individual’s attitudes towards the substance (e.g. normalising).
- Environmental Factors: Easy access to substances and their normalisation in social circles or culture can encourage use. For example, the trend towards the legalisation of substances in certain countries, such as cannabis in Thailand, coupled with the proliferation of alternative perspectives on drug use via social media, may shift one’s perceptions and attitudes.
- Major Life Events & Mental Health: Stressful events may lead to substance use as a coping mechanism. Addiction often coexists with mental health conditions like depression, PTSD, and bipolar disorder, reinforcing substance dependence.
How addictions work
Why do people continue using substances despite knowing the risks? Quitting an addiction isn’t just about willpower—how addiction affects the brain also matters.
All addictive substances share a common trait: they directly activate the brain’s reward system, reinforcing behaviours and forming memories. This activation triggers a dopamine surge, producing intense pleasure or a “high.”
Over time, the brain adjusts, needing larger doses to get the same effect and leading to dependence. As addiction gets worse, it impairs the parts of the brain that handle judgment and decision-making, changing personality and behavior. This makes it difficult for individuals to stop using the substance even though they know it’s harmful.
Even after detoxification, changes in the brain can linger, causing intense cravings and a high chance of relapse when faced with triggers.
The challenges caused by substance use can deepen this destructive cycle. For example, failing to meet responsibilities at home and work might cause individuals to lose support from family and colleagues, or to view themselves negatively. This often drives them back to using substances as a way to cope with the problems they initially caused.
Do I have an addiction?
Addiction symptoms fall into four categories. For a diagnosis, at least two out of twelve symptoms must be present. The severity—mild, moderate, or severe—depends on the number of symptoms met.
- Impaired control
- You take the substance in larger amounts or over a longer period than originally intended.
- You have a persistent desire to cut down or regulate substance use, but efforts to decrease or stop have been unsuccessful.
- You spend a significant amount of time obtaining, using, or recovering from the substance.
- You experience intense cravings that make it difficult to focus on anything else.
- Social impairment
- Your ability to fulfill responsibilities at work, school, or home is compromised due to substance use.
- You experience ongoing social or interpersonal problems exacerbated by the substance.
- You have reduced or abandoned important social, occupational, or recreational activities.
- You withdraw from family activities and hobbies to use the substance.
- Risky use
- You use the substance in physically hazardous situations (e.g., driving, swimming, or operating machinery while intoxicated).
- You continue using the substance despite knowing it is causing or worsening a physical or psychological condition.
- Pharmacological criteria
- You have developed tolerance, requiring larger doses to achieve the desired effect.
- You experience withdrawal symptoms after prolonged heavy use.
How are addictions diagnosed?
Diagnosing addiction involves a comprehensive assessment using multiple sources of information. These include:
- Clinical interview & observations: A healthcare provider conducts a structured interview, asking about:
- Frequency and quantity of substance use
- Changes in usage patterns over time, including increased consumption or difficulties controlling your consumption
- Impairment in daily functioning and impact on relationships
- Cravings, withdrawal symptoms, or failed attempts to quit
- Reports from others: Family members, close friends, or colleagues may offer insights into behavioral changes, social withdrawal, or work-related issues that suggest an addiction. These external perspectives can be crucial, especially when the person struggling with addiction is in denial.
- Laboratory Testing: Blood, urine, or other lab tests may detect substance use and assess tolerance levels. Test results serve as supportive evidence rather than definitive proof of a SUD.
Can addictions be cured?
When addiction takes over, it can feel overwhelming—but recovery is absolutely possible. With the right treatment and support, you can regain control and rebuild your life. In fact, the CDC reports that 75% of people with substance dependencies eventually seek treatment and successfully recover.
For those experiencing severe dependence, the journey often begins with detoxification at facilities like the Institute of Mental Health’s (IMH) National Addictions Management Service (NAMS) or private hospitals. From there, individuals are guided toward evidence-based psychosocial treatments designed to support long-term recovery and healing.
How to quit an addiction
Cognitive Behavioural Therapy (CBT)
CBT is based on the idea that thoughts influence behaviours—by identifying and changing irrational thoughts, individuals can manage cravings, negative moods, and unhelpful behaviours.
One common CBT technique is cognitive restructuring, which helps individuals challenge dysfunctional thoughts about substance use. For example, someone struggling with alcohol dependence might think, “I need a drink to relax.” Cognitive restructuring helps replace this with a healthier belief, such as, “I can manage stress through deep breathing or exercise instead.”
Other behavioural strategies include cue exposure therapy, which gradually desensitises you to triggers, and promoting non-drug-related activities, encouraging you to experience pleasure and a natural “high” from healthy alternatives like running.
Motivational interviewing
Motivational Interviewing (MI) helps individuals explore and resolve ambivalence toward their substance use, facilitating positive behavioral changes. MI therapists express empathy through reflective listening and avoid direct confrontation, instead focusing on developing discrepancies between a person’s values or goals and their current behaviors. They adjust to client resistance and gently guide them toward finding motivation for change. Example questions include:
- “What do you value most in life, and how does your current substance use align with that?”
- “How would things change for you if you made a shift in your habits?”
- “What are the benefits and challenges of continuing your current path?”
Relapse prevention
Relapse Prevention (RP) can be done individually or in groups and helps people maintain their progress in recovery.
RP teaches clients to identify situations where they’re most vulnerable to using substances. For example, if being around people who drink makes you more likely to relapse, you might avoid high-risk places like bars. You’ll also learn how to manage cravings with strategies like positive self-talk, mindfulness, or distracting yourself with an activity.
RP helps you cope with setbacks by seeing them as opportunities to learn. For instance, if you slip up at an office party where alcohol is present, instead of feeling like you’ve failed, you can adjust your routine to avoid similar situations in the future.
Social support
Social support plays a crucial role in recovery, which is where self-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), along with support groups run by the National Addictions Management Service (NAMS) and community agencies like the Singapore Anti-Narcotics Association (SANA), become vital. Additionally, for some individuals, learning to rebuild healthy and positive relationships with their loved ones through couple and family therapy can also be beneficial. These therapeutic approaches help individuals develop stronger support networks and enhance their resilience against relapse.
Where to get help for addictions
Worried that you—or someone you love—might be struggling with addiction? You may feel ashamed, afraid, or unsure where to start, but you don’t have to face this alone. At Intellect Clinic, our clinicians offer a safe space to help you take the first step towards healing.
50-minute sessions with our counsellors and clinical psychologists are priced at $160 and $240 (Singapore dollars) respectively, and we offer appointments at our clinics in Marina One, Tanjong Pagar, Dhoby Ghaut, Woodleigh, and Tembeling. If medication is deemed beneficial for you, we will refer you to a partner psychiatrist within Intellect Clinic’s network. In such cases, some treatment sessions may take place at their clinics.
