Addictions and how they affect our lives

Author: Andrada Orodan, Maria-Alexandra Izghirean

Illustration of a person trying to climb out of a bottle
Tang Yau Hoong

Contents:

What are addictions?

Addiction or dependency is a mental health disorder characterised by a persistent and intense need to consume a substance (e.g. tobacco, caffeine, alcohol or other drugs) or engage in a behaviour (such as betting and gambling, video games, shopping or pornography use) to the point where it can damage mental health, physical health or relationships with others. At first, the use or behaviour provides a sense of well-being, calm, happiness and pleasure and may reduce symptoms of stress or anxiety, which is why the person repeats the addictive behaviour. In the long term, however, it becomes the main focus of their preoccupation, resulting in loss of control and negative effects on mental, physical and relational health and affecting personal safety. [1]

How common are they?

In general, addiction prevalence data are scarce in Romania. More common are data related to the use of different substances, with high consumption being an indicator of addiction risk.

1. Drug use

Regarding drug use, 2024 data from the National Anti-Drug Agency [2] show that:

  • 12.8% of Romanians (aged 15-64) have used illicit drugs at least once, and 5.7% have used illicit drugs in the past year;
  • Cannabis is the most commonly used drug (7.8% once in a lifetime, 4.3% in the last year, 2.5% in the last month);
  • Stimulants (cocaine, ecstasy, amphetamines) have prevalences below 1%, but cause ~23% of medical emergencies;
  • Heroin/opioids: 0.5% once in a lifetime, 0.3% in the last year; ~7,600 injecting users in Bucharest;
  • New Psychoactive Substances (NPS): ~1.3% used (most common age of onset: 18 years); 16.7% of new drug treatment cases (most under 24 years).

2. Alcohol consumption

In terms of alcohol consumption, a 2025 analysis from the National Institute of Public Health (INSP) states that 2.9% of the population aged 15 years and over report binge drinking every day, and 28.3% report at least one binge drinking episode every month. [3]
Also, another INSP report from 2022 shows that the frequency of alcohol dependence is estimated at 2% of men and 0.6% of women in the Romanian population. [4] However, it is important to note that the prevalence of alcohol dependence may be underestimated in the reported data due to cultural factors, social norms and stigma associated with the recognition of problematic drinking.

3. Tobacco use

As regards tobacco consumption, an INSP report from 2024 [5] gives the following estimates:

  • The frequency of daily smoking among people aged 15 and over is 18.9% (comparable with the European average – 19%);
  • 3.8% of people over 15 smoke more than 20 cigarettes a day;
  • Daily smoking is more common among men than women: 24% and 15% respectively;

The highest frequency of daily smoking is found in the 25-34 age group – 26.6% (higher than the EU average of 23.4%); by comparison, only 8.3% of Romanian teenagers (15-19 years) smoke daily (below the EU average of 14.1%)

4. Behavioural addictions

The prevalence of behavioural addictions is harder to measure, in large part because people usually consider their excessive involvement in certain behaviours to be unproblematic as long as they seem harmless. However, the World Health Organization estimates that 1.2% of the world’s adult population has a gambling addiction. [6] Data from Romania show a prevalence of 2.6-4% of pathological gambling among adolescents (11-19 years). [7]

Causes and risk factors

The development of addiction is influenced by a combination of interacting genetic, neurobiological, psychological and social factors.

1. Genetic component:

A family history of addiction increases a person’s risk of developing a lifelong addiction. On the basis of genetic predisposition, an addiction can be triggered by the other factors mentioned.

2. Neurobiological basis:

In the case of substance addiction, the substance consumed interacts in the brain with receptors for various neurotransmitters (chemical messengers involved in the communication of information between neurons). The interaction is different depending on the type of substance: some drugs act on receptors for serotonin (e.g., hallucinogens), endorphins (e.g., opioids), cannabinoids (e.g., cannabis), etc. However, almost all substances act directly on the neuronal circuits involved in motivation, of which dopamine is the main messenger. This is a neurotransmitter that signals the importance of an event and processes and stores rewards. Thus, the consumption of potentially addictive substances creates a reward response by activating the dopaminergic system in the brain, which is directly associated with a feeling of pleasure experienced by the individual [8]. This link between consumption and the feeling of pleasure can lead to an ongoing desire to experience this positive state, resulting in a cycle of seeking or ‘chasing’ the feeling of well-being through repeated consumption [9].

3. Psychological factors:

There are different reasons why a person chooses to engage in potentially addictive activities, one of which is curiosity. These activities can also improve mood in the short term – many substances can cause feelings of euphoria, confidence, strength and can increase physical strength and alertness; gambling can bring financial gains, etc. Moreover, people suffering from various mental disorders (such as anxiety or depression) may use these substances or behaviours as a way of coping to life’s challenges, while others may use drugs to improve their academic, professional, creative or sports performance . [10]

4. Social factors:

Our family or social environment can also be a risk factor for addiction. For example, alcohol consumption is normalised in most societies, so alcohol is highly accessible and consumption can start at an early age, usually in a family environment. Lack of active parental involvement in the child’s life or trauma caused by various forms of abuse also predispose to the development of addictions. [10]

Note that addiction is not the result of a weak will or lack of morals.

Illustration of a boy stepping over a beer, cigarettes and a box of pills
Michael Helfenbein

Types of addiction

A. Substance addiction

Substance addiction falls into the broader category of substance use disorders, which are divided into two groups:

  1. Substance-related disorders – substance abuse (abuse may progress to dependence, but not all abusers become addicts), addictions;
  2. Substance-induces disorders – intoxication, delirium, psychotic disorders, sleep disorders, etc.

According to the ICD-11 International Classification of Diseases [11], substance use disorders are divided according to the substance used:

  • Alcohol;
  • Cannabis (marijuana);
  • Synthetic cannabinoids (synthetic cannabis derivatives);
  • Opioids (e.g., morphine and heroin);
  • Sedatives, hypnotics and anxiolytics (e.g., benzodiazepines – Anxiar, Xanax, etc.);
  • Cocaine;
  • Stimulants (e.g., amphetamine, methamphetamine, etc.);
  • Synthetic derivatives of cathinone;
  • Caffeine;
  • Hallucinogenic substances (e.g., LSD, psilocybin, ayahuasca, etc.);
  • Tobacco;
  • Inhalants;
  • MDMA and its derivatives;
  • Dissociative drugs (e.g., ketamine or PCP);
  • Other psychoactive substances (including medicines);
  • Other non-psychoactive substances;
  • Other substances (unknown).

B. Behavioural addictions

In the category of behavioural addictions, the ICD-11 classification officially recognises only gambling addiction (ludomania) and video game addiction. Ludomania has symptoms similar to those of substance use disorders because winning at gambling activates circuits similar to those activated by substances (the dopaminergic reward system). Other types of behavioral addictions (addictions to video games, sex, exercise or shopping) are less well understood and under research.

How do they manifest?

The most common psychological and behavioral symptoms of addiction (both substance use and behavioral addictions [12]) include:

  • Poor control over use or behavior: the person uses the substance or engages in the behaviour in greater quantity and/or for a longer period of time than intended, and the desire and attempts to reduce or stop the use or behaviour fail. In addition, the person spends a lot of time obtaining and using the substance or engaging in the behaviour;
  • Craving (intense craving): an urgent, uncontrollable desire to consume the substance or resume the behaviour, often triggered by contexts or stimuli previously associated with it;
  • Satiety: taking up a significant portion of a person’s time and preoccupation with substance use or addictive behavior to the detriment of other important activities (school, work, socialising);
  • Euphoria or emotional relief: following the use of the substance or performance of the behaviour, a state that helps to reinforce and maintain the addiction;
  • Tolerance: the diminishing effects of the substance or behaviour in the usual dose and the need to increase the amount consumed or the duration and/or intensity of the behaviour to achieve the same state of satisfaction or euphoria as before;
  • Withdrawal: the syndrome developed following the reduction or discontinuation of the addictive substance or behaviour, either voluntarily (attempting abstinence) or involuntarily (lack of access). Withdrawal can include psychological symptoms (anxiety, irritability, restlessness, compulsive thoughts, intense desire to resume use or behaviour) and, in the case of some substances, physiological symptoms;
  • Social impairment: such as inability to fulfill professional or personal obligations and significant reduction or withdrawal from important activities (school, work, time with friends) due to substance use or addictive behaviour;
  • Relapse: resumption of addictive use or behaviour after periods of abstinence or attempts at control.

Although substance and behavioural addictions show significant overlap at the psychological and behavioral levels, there are important differences, particularly in withdrawal:

  • In substance dependence, addiction involves the use of a chemical substance, and withdrawal can include physiological symptoms (e.g. trembling, sweating, nausea, vomiting, insomnia, rapid pulse) in addition to psychological ones. In some cases (such as alcohol withdrawal), severe medical risks, including seizures, can occur.
  • In behavioural addictions, withdrawal is usually predominantly psychological, manifesting as anxiety, irritability, restlessness, emptiness or difficulty concentrating, without severe physiological manifestations.

Treatment

Interventions to treat addictions are numerous, with varying effectiveness depending on the individual. Treatment needs to be personalized according to the stage of addiction and the person’s individual particularities (personality factors, wider family and social environment, etc). Thus, the first step should always be a consultation with a psychiatrist.

The most commonly used treatments for addiction are psychological interventions and medication (pharmacotherapy). These can be combined where appropriate.

1. Psychological interventions:

They aim to guide and support the addicted patient to identify the most effective method of recovery. Thus, the focus is on building a program of recovery, with a view to changing attitudes and behaviours related to substance use or addictive behaviour and developing motivation and skills that help build a healthy life. The most commonly used psychological interventions are:

  • Motivational interviewing (exploring the desire to stop using, education about addiction, family involvement);
  • contingency management (human, financial or material resources to maximise success)
  • cognitive-behavioral therapy (CBT) focused on behavioural (addressing factors that reinforce the desire to repeat addictive behaviour) and cognitive (changing attitudes and thoughts related to addiction) interventions.

2. Medication:

In the case of substance addiction, it is intended to help the body eliminate the substance the patient is addicted to, in the case of intoxication, and to relieve withdrawal symptoms. Intoxication can range from euphoria to life-threatening emergencies, and detoxification can take place in inpatient intensive medical care (but also outpatient social detoxification programs).

Medication also helps treat psychiatric disorders that can contribute to a person’s addiction (such as anxiety or depression).

At the moment, drugs are available to treat addiction to opioids (buprenorphine, benzodiazepines, antivomics, anti-inflammatories, etc.), tobacco (varenicline, bupropion) and alcohol (acamprosate, disulfiram, naltrexone). The development of other drugs to treat stimulant and cannabis dependence is being explored, as there is currently no pharmacological treatment for these. For this type of addiction, other psychiatric symptoms may be treated or detoxification, rehabilitation and therapy may be used. [13] [14]

Medication can also be used for behavioural addictions. In this case, drugs such as opioid antagonists, antidepressants and mood stabilizers, which are also used in substance dependence or bipolar disorder, are used. Their role is to inhibit addictive behaviours. [15]

3. Social support:

As well as treatment itself, social support can help people suffering from addiction. Support groups can therefore help the addicted person through socialising and sharing experiences. These can be of the Alcoholics Anonymous (AA) or Narcotics Anonymous (NAA) type or support groups facilitated by psychologists/psychotherapists (such as those offered by the Origins Association, both for people who are struggling with an addiction and their families).

What should I do if I have symptoms?

If you think you are suffering from an addiction, consult your GP. They will refer you to a psychiatrist for assessment, diagnosis and medication if necessary. They will usually also recommend psychotherapy for a complete and effective recovery plan, and may refer you to a psychotherapist who offers services covered by CNAS (the National Health Insurance House). Avoid choosing medications without consulting a psychiatrist!

You can also go directly to private psychotherapy services, as the psychotherapist can also guide you to a psychiatric evaluation to establish a pharmacological treatment if necessary, and then continue behavioural and cognitive interventions with him/her. You can see therapist options, including those offering free or discounted services, on the Mental Health for Romania Map of Professionals. Further resources in Romania can be found at the end of the article in the Resources section.

Moreover, for external support, you can turn to the trusted people in your life. You can ask them to supervise your addictive behaviour and reinforce healthy behaviours. You may feel ashamed or embarrassed to do this, but it is better to take action before things get out of control and become more difficult to manage. People struggling with substance addiction usually present to the doctor in a state of acute intoxication, when substance-induced emotional or cognitive changes and other medical complications are already present. You can also turn to support groups (such as those mentioned in the previous section).

Pay attention to the triggers of activities that increase consumption. Often the environment/context is one of the common triggers (e.g., going to parties, going to places where substances are consumed, with certain people, etc.). If you notice a pattern in your behaviour, you can try to replace the activities that lead to substance use with healthier behaviours (e.g., I notice that I take more money with me when I go to a place where there might be a possibility of substance use, to be always prepared I try to take only the bare essentials with me, so I can no longer afford buying substances or gambling money).

Remember! Quitting an addiction takes awareness, time and energy. It’s rarely a quick or linear process: for many people, addiction is a chronic disorder that requires constant effort and repeated adjustments, not a “fix” in a day or a week. Motivation and willingness to change are essential, but they need to be backed up by patience and support. Setbacks can be part of the process and do not mean failure, but opportunities to better understand triggers and the most effective ways to manage them. This is why it is important to look at change in the long term, even when progress seems slow.

Illustration of a person pulling another person out of a jar of pills, syringes and bottles
Sofia Varano

Guide for loved ones: what should I do if I think someone close to me might be suffering from an addiction?

It is important to know that how you react can affect the behaviours of those who trust you. Therefore:

  • Be there for the person who is struggling with addiction and show understanding and empathy for their feelings. Do not treat their concerns as superficial.
  • It is good if you show an interest in their health, so you can suggest that you do some research together about their addiction.
  • Encourage them to seek professional help and guide them to their GP.
  • Make sure they know that you are with them in their recovery and help them when they need support.

At the same time, it is essential that understanding and empathy do not unintentionally turn into behaviours that maintain or facilitate the addiction (e.g., minimising the problem, constantly taking over the person’s responsibilities, or covering up the consequences of the addiction). Being supportive does not mean tolerating all behaviour, but being able to set healthy boundaries that protect both the person affected and yourself. In the process, it is important to take care of yourself. There are support groups for families and loved ones (such as the Origins Association) where you can find information, understanding and useful strategies to help without overburdening yourself.

Resources:

Bibliography:

1. Bredicean, A. C., Dehelean, L., Enătescu, V. R., Giurgi-Oncu, C., Ienciu, M., Papavă, I., Romoșan, F., & Romoșan, R. (2014). general psychiatry course. Timișoara: Editura Victor Babeș. ISBN 978-606-8054-61-2.

2. National Anti-Drug Agency. (2024). National Drug Situation Report. https://ana.gov.ro/wp-content/uploads/2025/02/RN_2024.pdf

3. National Institute of Public Health (2025). Situation analysis on alcohol prevention. https://insp.gov.ro/wp-content/uploads/2025/05/Analiza-de-situatie-preventie-consum-alcool-2025.pdf

4. National Institute of Public Health. (2022). Situation analysis: alcohol. https://insp.gov.ro/download/cnepss/stare-de-sanatate/determinantii_starii_de_sanatate/alcool_si_droguri/alcool/ANALIZA-DE-SITUATIE-ALCOOL-2022-.pdf

5. National Institute of Public Health. (2024). Situation analysis: tobacco. https://insp.gov.ro/wp-content/uploads/2024/05/Analiza-situatie-tutun-2024.pdf

6. World Health Organization. (n.d.). Gambling. https://www.who.int/news-room/fact-sheets/detail/gambling

7. Romanian Association for the Study of Gambling. (n.d.). Prevalence of gambling in Romania. https://rasgcluj.org/research/prevalenta/

8. Johnson, S. W., & Kenny, P. J. (2010). Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nature Neuroscience, 13(5), 635-641.

9. Volkow, N. D., Fowler, J. S., & Wang, G. J. (2019). The addicted human brain: Insights from imaging studies. Journal of Clinical Investigation, 129(1), 26-35.

10. Healthline. (n.d.). Addiction risk factors. https://www.healthline.com/health/addiction/risk-factors

11. Matone, A., Gandin, C., Ghirini, S., & Scafato, E. (2022). Alcohol and substance use disorders diagnostic criteria changes and innovations in ICD-11: An overview. Clinical Psychology in Europe, 4(Special Issue), e9539. https://doi.org/10.32872/cpe.9539

12. Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., & Setare, M. (2012). Behavioral addiction versus substance addiction: Correspondence of psychiatric and psychological views. International Journal of Preventive Medicine, 3(4), 290-294. https://pmc.ncbi.nlm.nih.gov/articles/PMC3354400/

13. Addiction Center. (n.d.). Addiction statistics. https://www.addictioncenter.com/addiction/addiction-statistics/

14. World Health Organization (n.d.). Psychoactive drugs. https://www.who.int/health-topics/drugs-psychoactive

15. Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S. (2018). An overview of gambling disorder: From treatment approaches to risk factors. F1000Research, 7, 434. https://doi.org/10.12688/f1000research.12784.1 https://doi.org/10.12688/f1000research.12784.1

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