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What is Addiction?


Most of us feel like we know what “addiction” means, without knowing the real medical definition: doing something you can’t stop, even though it’s interfering with your ability to work, go to school, have good relationships with your family and friends, etc. It’s something that we feel has power over us and controls us, no matter our good intentions to stop it.

An exact definition is hard to pin down. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), talks not about addiction per se, but about substance abuse and dependence. There’s a long list of substances that people can become addicted to, including alcohol, cocaine, marijuana, amphetamines, nicotine…and the list goes on.

According to the DSM-IV, people are considered chemically dependent if they meet three of the following criteria within a 12-month period:

  • A need for increased amounts of the substance to achieve intoxication, or inability to become intoxicated from amounts that used to produce that result
  • Having withdrawal symptoms after stopping use of the substance, or using the substance to avoid withdrawal symptoms
  • Taking in more amounts of the substance than usual, or for longer periods of time than intended
  • A continued desire for the substance or unsuccessful attempts to cut down or stop using it
  • Spending a lot of time obtaining, using or recovering from the effects of the substance
  • Giving up or cutting back on important social, work-related or recreational activities because of substance use
  • Continuing to use the substance even though it’s causing specific problems

Many in the field of addiction have come to accept a wider definition that includes non-chemical dependence. It’s now fairly well accepted to say that people who are unable to control behaviors like gambling, spending money, eating, having sex, etc., and who allow these behaviors to interfere with their daily lives, are addicted to these behaviors.

So even if it’s not a substance that’s taken hold, you can consider yourself addicted if

  • You get defensive or irritable when people criticize it
  • You feel guilty about it
  • You try to cover it up or get secretive
  • You’re unable to cut down

Whatever the substance or behavior that a person is addicted to, there’s a strong indication that the various addictions have similar effects on what’s called a “reward area” of the brain. Addicts experience a “rush” when they engage in the behavior they’re addicted to, and it’s the craving for that rush that keeps them from being able to quit.

But what is the cause?
When it comes to understanding exactly what causes addiction, you’ll find a lot of different opinions. The National Council on Alcoholism and Substance Abuse describes addiction as “…a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal.” There’s some evidence that genetics can play a role, especially in cases of alcoholism. But so far, nobody has identified a specific gene for alcoholism. Often, it seems that people whose parents were substance abusers are more likely to abuse substances themselves. But this doesn’t indicate a genetic cause, necessarily. It could be a learned behavior on the part of the child of the addicted parent.

A less traditional explanation is that addiction is more an emotional problem. In the book The Heart of Addiction, by Lance Dodes, M.D., the author notes that many people in his practice who have been trying to stop an addictive behavior but are having difficulty claim to feel better as soon as they make a decision to resume the behavior. For these people, he explains, relief occurs even before the activity itself occurs.

He describes a man with alcoholism who spent nearly an entire day trying to fix his computer, feeling helpless as he tried to follow the advice from a help line. His frustration mounted until he decided to go out for a bottle of vodka. Just deciding to buy the vodka helped the man to feel less helpless and more in control.

Dodes believes that people can learn to identify and understand what it is that makes them lose their resolve to avoid a certain behavior, and then replace the addictive behavior with something more productive. For most people, this approach will take a lot of hard work with a therapist.

The addictive personality
You may have heard the term “addictive personality” used to describe someone who may be more likely to develop an addiction than someone who does not have a so-called “addictive personality.” The truth is that, according to Craig Nakken in his book The Addictive Personality, this type of personality “gets created from the illness of addiction.” In other words, someone with an addictive personality did not have this personality before the addiction took hold.

Once someone has developed this addictive personality, Nakken explains, it’s common that even if they can give up one addiction, such as alcohol, they’re likely to replace it with yet another addiction. In Nakken’s view, “On some level, the Addict will always be searching for an object or some type of event with which to form an addiction.”

This is where the term “dry drunk” originates. A “dry drunk” is someone who may not currently engage in any addictive behaviors, but who still has the addictive personality that believes that some type of addiction will nurture them and make them happy. Nakken believes that before people can completely stop their addictive behavior and feel content with their lives, they must acknowledge their addictive personality and learn how to break that cycle. In doing that, Nakken believes, they can reach “total recovery.”

When addiction is likely to take hold
People seem to be more vulnerable to becoming addicted at certain times in their lives. The loss of a loved one or a job, the realization that something you hoped for will not happen, the challenge of proving yourself when you move to a new place…these kinds of things can create a situation that makes you more vulnerable to taking up an addictive behavior.

It seems logical that if researchers can find an exact cause of addiction, then it would be easier to find a cure. But it’s difficult to pinpoint one cause, because addiction seems to be the result of an interplay of factors, some genetic, some emotional. No matter what the cause is, people who suffer from addictions—and their families and other loved ones—have to work with professionals and do a lot of soul searching to find the best way to overcome their problem.

There are a lot of options out there. For many people, 12-Step programs, such as Alcoholics Anonymous, have been highly effective. Other people may have more success working closely with a therapist to understand any potential emotional issues that trigger the need to take part in the addictive behavior. Medication therapy can help some people overcome addictions as well.

If you or someone you love is suffering from an addiction, there are a lot of places to turn for treatment. You could start by talking with your doctor for advice. Your local telephone book will have programs listed under alcoholism or drug use. You could simply show up at a 12-step meeting, or ask friends or co-workers if they know of a good therapist. 

You may also want to visit the substance abuse treatment facility locator of the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, D.C., 2000; L. Dodes, The Heart of Addiction, HarperCollins Publishers, New York, 2002; The National Council on Alcoholism and Drug Dependence; H. Kaplan, B. Sadock, J. Grebb, Synopsis of Psychiatry, Williams and Wilkins, 1994; C. Nakken, The Addictive Personality, Hazelden Foundation, Minnesota, 1996.
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