Addiction and dependency

Understanding addiction and dependency: What happens in the brain and why relapses are not a failure of willpower

Addiction doesn't simply arise from a lack of discipline. It develops through an interplay of learning experiences, changes in the reward and stress systems, personal burdens, genetic predisposition, and social environment.

From Petra Pinder, Psychotherapy Practice in Bad Schwalbach · Estimated reading time: about 13 minutes

Addiction does not simply arise from a lack of discipline. It develops through an interplay of learning experiences, changes in the reward and stress systems, personal burdens, genetic predisposition, and the social environment. In the process, the brain can adapt to a substance or a behaviour in such a way that the craving takes up more and more space, even though the negative consequences have long been known.

The term addiction memory describes an important part of this process. This does not refer to a single storage location in the brain. Rather, effects, feelings, situations and stimuli are linked together. Places, people, times of day, smells, music or internal states can later trigger craving. This explains why the desire can suddenly reappear even after a long period of abstinence. It also explains why relapse prevention involves more than just a firm resolution.

In this post

When does consumption or behaviour turn into an addiction?
Substance-related and behavioural addictions
What happens in the reward system?
What is addiction memory?
Which neurotransmitters are involved?
Why do tolerance, withdrawal and craving occur?
What role do stress, trauma and psychological strain play?
Why can relapses occur even after a long time?
What can treatment achieve?
Digital self-help: additional support
When is medical help urgently required?

When does consumption or behaviour turn into an addiction?

Not every type of consumption and not every intensive behaviour is an addiction. The overall picture is what counts. Warning signs can include a progressive loss of control, the substance or behaviour becoming increasingly important and being continued despite recognisable harm. Additional factors may include strong cravings, unsuccessful attempts to cut down, neglect of other areas of life, development of tolerance and withdrawal symptoms.

There are many gradations between inconspicuous use and severe dependence. Even risky or harmful consumption can already have significant consequences without all the characteristics of a dependence being met. A diagnosis therefore cannot be made on the basis of a single symptom. It requires a careful professional medical history.

Substance-related and behavioural addictions

Substance-related addictions centre on a psychoactive substance. These include alcohol, nicotine, cannabis, opioids, cocaine, amphetamines, and sedatives and sleeping pills, among others. The substances act on different receptors and neurotransmitter systems. Nevertheless, similar core processes can develop: intensified learning processes, craving, loss of control, habit formation, and an increasing restriction of life to consumption and recovery from consumption.

In behavioural addictions, no psychoactive substance is consumed. The World Health Organization lists gambling disorder and gaming disorder in the ICD-11 as disorders due to addictive behaviours. Other behaviours, such as problematic use of social media, shopping or sexual activities, can also cause considerable distress. However, they are not automatically diagnostically equivalent to a recognised addiction. The decisive factors are loss of control, shift in priority, continuation despite negative consequences and significant impairment in daily life.

Further information on digital behavioural patterns can be found in the article Problematic media use: warning signs and help.

What happens in the reward system?

The reward system helps us to recognise meaningful experiences and repeat helpful behaviour. Involved in this, among other things, are the ventral tegmentum, the nucleus accumbens and areas of the prefrontal cortex. These regions work together with memory, emotion and stress systems.

Dopamine is often referred to simply as the happy hormone. Scientifically, this description is too simplistic. Dopamine plays a vital role in giving significance to a stimulus, updating expectations and reinforcing behaviour. Therefore, it supports learning and wanting rather than exclusively enjoyment.

Addictive substances can influence these learning processes particularly strongly. Gambling and certain digital services also use rapid, shifting and hard-to-predict rewards. Over time, the brain can weight addiction-related stimuli more heavily than other goals. At the same time, ordinary rewards, such as social encounters, exercise or everyday successes, lose their effect for some sufferers.

What is addiction memory?

During consumption or addictive behaviour, the brain does not just store the immediate effect. It also learns which stimuli herald this effect. These can be a specific environment, a person, a bank balance, a notification on a smartphone, a time of day or a stressful feeling.

The hippocampus is involved in context and memory. The amygdala links experiences with emotional significance. Striatal networks support habits and automated action sequences. The insular cortex processes signals from the body and may be involved in the conscious experience of craving. The prefrontal cortex is important for planning, balancing and inhibition. Addiction memory therefore describes a network of learned connections rather than a single location.

If a former trigger reappears, the learned pattern can be activated very quickly. The body may then react even before a conscious decision has been made. This does not mean that behaviour is unchangeable. However, it does mean that new reactions must be practised repeatedly in various everyday situations.

Erasing old connections is usually not the right metaphor. During unlearning, a new, competing experience is created instead. Old reactions can reappear under stress, after renewed use or in a previous environment. Relapse prevention therefore takes into account specific triggers, high-risk situations and a plan for dealing with acute cravings.

Which neurotransmitters are involved?

Addiction cannot be reduced to a single messenger substance. Several systems work together:

Dopamine is involved in reinforcement, motivation, expectation, and the special significance of addiction-related cues.
Glutamate is an important excitatory neurotransmitter and plays a central role in learning, memory and neuronal adaptation.
GABA is the most important inhibitory neurotransmitter in the brain. Alcohol and benzodiazepines affect this system. In the case of physical dependence, sudden withdrawal can trigger dangerous hyperexcitability and seizures.
endogenous opioids are involved in reward, pain relief and well-being. Opioids intervene particularly strongly in this system.
Serotonin and noradrenaline contribute to mood, impulse control, attention and stress management, amongst other things.
The endocannabinoid system regulates various processes such as stress, appetite, memory and reward processing. Cannabis interferes with this system.
stress neurotransmitters such as CRF and dynorphin gain importance with repeated use. They contribute to tension, dysphoria and use for relief.

Which changes occur depends on the substance, the duration and intensity of use, age and individual vulnerability. Neuroscientific models therefore describe networks and developmental processes, not a simple chemical cause.

Why do tolerance, withdrawal and craving occur?

The brain tries to compensate for repeated strong effects. This can lead to tolerance: a larger amount or more intensive use is required for the same effect. If the substance is withheld, withdrawal symptoms can occur.

Initially, consumption often occurs to experience a positive effect. Later, the motive may shift. Consumption then increasingly serves to reduce restlessness, emptiness, irritability, sleep problems or physical withdrawal symptoms. In professional terminology, this is referred to as negative reinforcement: the focus is no longer on the pleasant experience, but on the temporary cessation of an unpleasant state.

The well-known three-stage model of addiction describes a recurring cycle of intoxication or excessive behavior, withdrawal with negative affect, and preoccupation and anticipation. The systems involved in reward, stress, and self-regulation undergo reciprocal changes.

What role do stress, trauma and psychological strain play?

Addiction rarely has just one cause. Genetic influences, early learning experiences, availability, social environment, chronic stress and mental health conditions can influence the risk. Substances or behaviours are sometimes used to briefly dampen anxiety, inner restlessness, loneliness, distressing memories or sleep problems. The relief is real, but usually only temporary. In the long term, this very effect can solidify the problematic pattern.

Traumatic experiences are neither present in all affected individuals nor do they explain every addiction. However, if unprocessed stress helps trigger craving, integrated treatment is advisable. Initially, safety, stabilisation and the management of consumption risks are the main priorities. EMDR can be used complementarily, where indicated appropriately, to process trauma-related stress. It does not replace addiction-medical diagnostics, necessary withdrawal treatment, or comprehensive treatment for the addiction.

You can find out more about the method in the article EMDR Therapy: Procedure and Areas of Application.

Why can relapses occur even after a long time?

Relapses are not inevitable, but they are a known part of the risk trajectory of many addictive disorders. Previous triggers can cause drug craving, especially during stress, sleep deprivation, conflicts, positive excitement or renewed contact with the substance. A large meta-analysis showed that reactions to addiction-related cues and reported craving are associated with subsequent use and relapses.

A relapse does not mean that the entire treatment was ineffective. However, it should be taken seriously and carefully evaluated. Helpful questions are: What happened beforehand? Which warning signs were missed? What support was lacking? What needs to be changed in the emergency plan? This attitude avoids shame without trivialising the risk.

What can treatment achieve?

Good treatment is based on the type and severity of the addiction, any co-existing conditions, physical risks and the goals of the individual concerned. Depending on the situation, the following components may be useful:

medical diagnostics and, where appropriate, professionally supervised detoxification
Motivational work and clarification of personal goals
cognitive behavioural therapy and relapse prevention
Identifying triggers and practising alternative responses
Treatment of anxiety, depression, trauma or other co-morbidities
medication-assisted treatment, if recommended for the respective dependency
Self-help groups, advisory centres and support from family members
Establishing a daily routine, relationships, physical activity and reliable positive experiences

For opioid dependence, medication-assisted treatment can be lifesaving. For alcohol, nicotine, and other dependencies, effective medications and psychotherapeutic methods are also available, depending on the diagnosis. The selection belongs in the hands of a doctor or addiction medicine specialist.

In my practice, I combine my training in addiction counselling with psychotherapeutic work. This is not just about counting consumption or setting rules. Together, we examine the function, triggers, cravings, previous attempts to change and psychological distress. A prerequisite is the active cooperation of the individual concerned. Which treatment is suitable and whether additional medical or inpatient support is required can only be assessed after a detailed anamnesis.

If an addiction is related to a driving licence issue, you can find supplementary information in the article MPU Preparation: What Really Matters.

Digital self-help: additional support

A cannabis-use diary, exercises for managing cravings and structured online counselling can help you recognise your patterns and practise concrete changes in everyday life. These resources should suit your personal circumstances. They do not replace necessary medical treatment, medically supervised withdrawal or an individual diagnostic assessment.

Free support for reducing or stopping cannabis use

Quit the Shit is a free, anonymous German-language information and counselling service for people who want to reduce or stop using cannabis. The programme includes a four-week cannabis-use diary with individual support. Its website explains participation and privacy.

What to look for in other online programmes

Check the provider’s qualifications, evidence supporting effectiveness claims, privacy information, total costs, any subscriptions and cancellation terms. A course attendance certificate is not recognised evidence of abstinence for a German medical-psychological driving assessment (MPU). Promises of a guaranteed cure or a guaranteed positive MPU outcome are not a sound basis for choosing a programme.

Further online resources on cannabis consumption

Currently not available.

If you are unsure whether self-help is sufficient or whether professional support is needed, a personal consultation can clarify the next step.

Source for the mentioned program: Quit the Shit, reviewed on October 10, 2026.

When is medical help urgently required?

Abrupt withdrawal from alcohol or benzodiazepines can be life-threatening. Possible consequences include severe circulatory problems, seizures or delirium. Immediate medical help is also required in cases of opioids, poly-substance use, pregnancy, severe physical illness, psychotic symptoms, impaired consciousness or suicidal thoughts.

In the event of acute danger, call the emergency services on 112. Planned withdrawal should be medically evaluated and, depending on the risk, accompanied on an outpatient or inpatient basis. This article is not a substitute for medical diagnostics and does not constitute an individual treatment recommendation.

Frequently asked questions

Is addiction an illness or a choice?

The onset of substance use or behaviour can involve decision-making. As dependency increases, learned responses, cravings and control processes alter the scope for decision-making. Professionally, dependency is understood as a treatable health disorder, not a moral failure. Responsibility and compassion are not mutually exclusive in this context.

Does the addiction memory remain forever?

Learned associations can persist for a very long time. However, they do not mean that relapses are inevitable. New experiences, changed routines, treatment and a good support network can significantly improve how triggers are managed.

Are behavioural addictions just as real?

Yes. Gambling disorder and gaming disorder are recognised in the ICD-11 as disorders due to addictive behaviours. In the case of other problematic behaviours, it must be carefully examined which diagnosis and which treatment are professionally appropriate.

Does dopamine fasting help with addiction?

The term is scientifically misleading. Dopamine cannot be reset through temporary abstinence. It can be useful to interrupt specific triggers and automated habits. However, an addiction requires individual and professionally justified treatment.

Can EMDR help with cravings?

EMDR can be a useful adjunct if trauma-related memories or distressing experiences help trigger cravings. Whether the method is suitable must be assessed on an individual basis. It is not a substitute for medical treatment or comprehensive addiction therapy.

Scientific sources and further information

As of September 2026. This post is for general information purposes only. It is not a substitute for personal medical, psychiatric or psychotherapeutic diagnosis and does not constitute an individual treatment recommendation.