What Is Addiction?

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“I’m not addicted, I just really like X, Y or Z.”

The public often makes a mistake in linking the word addiction to some substance or activity. It’s as if addiction were a property of any of these things: drugs, alcohol, sex, gambling, the Internet, porn… and the list of nouns grows longer every year. This is false.

Why Addiction Isn’t about Things

The idea comes from a classical notion that some substances had addictive properties and some didn’t. You could be addicted to heroin but not water, even though if you stopped getting either one cold turkey, it could kill you.

This older notion of addiction was centered on changes in the body as it accommodated to having a regular supply of a drug. Become dependent on heroin and a physical need will result – in everyone who uses the drug frequently. Everyone who has become physically dependent will suffer withdrawal symptoms. The idea is a good one until you find people who can use these substances once in awhile and never become dependent. This is especially true for things like gambling, where there isn’t any physical withdrawal at all, but some cannot resist the compulsion. And the gambling addict will ruin her life just as surely as the heroin addict.

A better picture is to look at the person who is addicted instead of what they are addicted to. This gives us the modern view: addiction is a behavioral disorder, a compulsion to continue with a harmful behavior, even though you know it’s harmful. So the modern definition centers on the person who has the condition instead of the substance or activity they cannot escape.

Real or Fake?

“I’m addicted to donuts.”

Really? Would you risk your job, your relationships, your self-respect to avoid not having them?

It’s unfortunate that we toss off the word to mean any strong desire or minor bad habit. And because this is so common in the media, the pendulum has swung too far in the other direction. Addiction is a disease. Calling a minor impulse an addiction is akin to calling a paper cut a “serious traumatic injury.”

Knowing that addiction is centered on the victim and not the activity allows us to cut through the real/fake categories. Is “Internet addiction” real? It doesn’t matter. All you have to do is treat the person who is enslaved to the harmful, unwanted behavior. There’s no reason to paint the Internet as inherently dangerous to accept that it may be dangerous for some.

The easiest way to escape the real/fake falsehood is to think of addiction like an allergy. We accept that some segment of the population may be allergic to copper or to cat dander and a greater portion to poison ivy. It isn’t the allergen that is the important factor, but any particular person’s reaction to it.

The Official Definition

Now that we’ve seen how the word is misapplied, the official definition is easier to understand. This is the “short” version from the American Society of Addiction Medicine. (The full version is more than two pages.)

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Note two ingredients. The first is that it is a disease of the brain – no one chooses to be an addict, no more than they choose to be right or left handed. The second is the “pathological” pursuit of substances and behaviors. That second bit is what we’ve been talking about so far.

The idea of addiction as a real disease is relatively new. However, there is good evidence from brain scans and neuroanatomy that this is so. Scientists have known for a long time that there was a genetic link – children of addicts are more likely to be addicts themselves. But this didn’t explain all, or even most of what played out in practice. The two-page definition delves into this part – that although genetics can make someone prone to becoming an addict, it doesn’t force it. Other factors, like environmental and cultural cues figure in.

Finally, here is a description of addiction from an addict’s point of view:

"Even when I took the drugs I realized that this just wasn't fun anymore. The drugs had become a part of my routine. Something to wake me up. Something to help me sleep. Something to calm my nerves. There was a time when I was able to wake up, go to sleep, and have fun without a pill or a line to help me function. These days it felt like I might have a nervous breakdown if I didn't have them." - Cherie Currie

And one more, from Amy Reed in her book, “Clean”:

"Imagine trying to live without air.
Now imagine something worse."

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