Defining Addiction

Defining Addiction

Addictions, whether to substances such as alcohol or heroin, or to behaviours such as gambling or gaming, are a major area of vulnerability for human beings. They are therefore presumably a major area of vulnerability for autistic people, though you wouldn’t think so from the tiny amount of attention that has been focused on the question of autism and addiction to date, by researchers and clinicians. I’ll come back to this issue, and the likely areas of vulnerability specific to autistic people, in a later blog post. In the meantime (and prompting this blog post), I’ll be contributing to an AUsome Training webinar on Autism & Addiction this Thursday 1^st July: https://ausometraining.com/product/autism-and-addiction/

For now, I’ll just revisit some more general thoughts about the phenomenon of addiction.

Addiction has always been a controversial subject - even trying to define it has given rise to a lot of discussion and argument over the years. The following is the current definition of the American Society of Addiction Medicine, for instance:

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. 

For many, the term “disease” is not welcome, but on the other hand there does need to be some emphasis on the neurological realities of the addicted “state of mind”. For others, terminology that puts addictions in the same category as mental illnesses is seen as useful.

Goodman proposes the following definition of addiction:

 A condition in which a behavior that can function both to produce pleasure and to relieve painful affects is employed in a pattern that is characterised by two key features:

(1)    recurrent failure to control the behavior, and

(2)    continuation of the behavior despite significant harmful consequences.

(Goodman, A. (1998) Sexual Addiction: An Integrated Approach.)

The American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM) largely avoids the term “addiction”, and instead separately defines categories such as “Substance Use Disorder” and “Gambling Disorder”.

My own attempt at a comprehensive definition is as follows:

Addiction is a progressively tolerated & progressively damaging biopsychosocial adaptation to (and therefore preoccupation with) the intense emotional rewards (pleasure/pain-relief) provided by certain artificially-enhanced activities, and their associated rituals, which require minimal personal investment (e.g. heroin use, gambling, pornography use, etc). As addiction progresses, these Supernormal Stimuli hijack innate motivational systems, leading to a self-perpetuating cycle of compulsive behaviours, which the addicted person sporadically tries to control, with decreasing success, when crisis points are reached, but which they at other times resist acknowledging by the use of various cognitive-emotional defences.

 

There are various other points regarding addiction that I have made over the years while teaching on the subject; each of them would find agreement from some practitioners/researchers in the field, and disagreement from others.

· Addictions can arise not just in relation to certain mood-enhancing drugs such as alcohol or heroin, but in relation to any intensely mood-enhancing activity such as gambling, pornography use, eating chocolate, etc. These can all be described as Supernormal Stimuli, i.e. artificially-enhanced stimuli that can hijack the natural reward systems of the brain.

· Addictions occur along a continuum, i.e. they can be mild, moderate, severe. While it is certainly possible for an addiction to develop very rapidly, they more usually develop over a period of time.

· Addictions have biological, psychological and social aspects. The traditional medical approach to addiction focused almost entirely on the biological aspects; psychologists, psychotherapists and counsellors could be over-focused on the emotional-mental aspects; and community and social workers have been understandably most concerned with the socio-political aspects of addiction. Nowadays, more and more of those working in the addiction field are taking a bio-psycho-social approach to the problem.

· Addictions have obsessive and compulsive elements, but they are not the same as obsessive compulsive disorders. OCD does not require an intensely mood-altering object, and can be seen as primarily a pathological self-protective strategy rather than a pathological self-rewarding one.

· Addictions are not always just symptoms of underlying issues, such as trauma or depression. Dependence on a mood-altering activity may begin in response to such issues, but it eventually becomes self-perpetuating.

· Addicts enjoy their addiction less & less as it develops, and are not simply indulging themselves. Addiction is not the same as having a passion for something.

· Quantity of acting out (e.g. (“He drinks a lot”) is not always the best criterion of an addiction Judgments of quantity are always relative and subjective.

· Drugs, pornography, gambling, prostitution etc. can be addictive; this does not necessarily make them “bad” or wrong in themselves. Of course, we can have valid moral judgments about some of these activities, but this is a separate issue from their potential addictiveness.

· Many different helping approaches to addiction work for different people. The 12-Step approach is probably still the most familiar to a lot of people, but various schools of psychotherapy also have important things to say about addiction; in particular, Motivational Interviewing and Cognitive-Behavioural Therapy have been found to be particularly helpful in the early stages of helping people to recover from an addiction.

· Complete, final recovery from addiction is not necessarily possible, in the sense that there may always be a remaining vulnerability (just as with depression etc). This is especially true if the addiction is chronic, and true in particular ways for food and sex addictions, given how central these activities are to our lives.