Rethinking "Addiction"

My column on SEEDMAGAZINE.COM today addresses the definition of "addiction." Does it make sense to lump all dependence on substances and even all habits under the umbrella of "dependence?" Here's a selection:

We often think of true addicts as street junkies who prostitute themselves or steal from others to support their habits, but in reality there's a wide variety of behaviors associated with abusing mind-altering substances. They can range from the casual drinker who sometimes has a few too many martinis, to the pothead who still lives in his mother's basement, to a talk-show host zoned out on antidepressants....

Indeed, partially because APA's definition of drug dependence is so flexible, researchers have begun to apply similar reasoning to other "addictive" behaviors. I reported earlier this year on a study in Psychological Science claiming that 7.9 percent of US kids are "addicted" to video games. Dutch psychiatrist Walter van den Broek uncovered a similar study purporting to show that 4 percent of Australian undergraduates were "dependent" on the internet. Van den Broek isn't buying it: He doesn't agree that the scale the researchers used adequately defines dependence.

Here's the link to the whole article.

Also, in case you missed it, here's my here's my list of Editor's Selections for this week for psychology and neuroscience from


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It certainly cannot be right to discuss being hooked on heroin, a slave to sex, and inappropriately internet active in a single breath as all being addictions. Presumably, there are reward centres being rewarded for the various activities and some "rewiring" going on, but there is surely a world of difference between dependency on a substance and the kinds of addiction that don't involve small molecules that interfere with your neurones.

Dr. Douglas Gentile's research (linked from "Study Finds Some Youths 'Addicted' to Video Games" which was in turn linked from your "Pathological video gaming in kids: How common is it?" article) is patently stilted in favor of identifying addiction - disingenuous as it is, it will likely sell plenty of books and bring in a few talk show appearances.

I spent a little time debunking the presentation of this obvious publicity-grab in my April 20th, 2009 post Results Of Study Sponsored By Watchdog Group âNot Entirely Clearâ.

Most telling are the excerpts from Dr Gentile's own website:

"I prefer the term pathological computer or video game use rather than computer, Internet, or video game addiction."

This statement is made on a page titled "Video Game 'Addiction'" - I would hope there is no doubt amongst readers that there is a great deal of cognitive dissonance in Dr. Gentile's apodictically-framed hypothesis, the body of the research presented, and subsequent approach to fear-mongering and self-promotion.

This just in: 99% av human population addicted to food. (With remaining 1% having different eating disorders, like anorexia)

Substance abuse among those 99% are higher in industrial countries, where fast food is more accessible.

Most, however, are simply users of food.

Now, using food is not the perfect analogy but it serves to exaggerate my point. Change it for sugar (candy) or fat (fast food) if you will.

This is not a simple subject. Under careful analysis, addiction as well as the definition of 'drug' becomes slippery.

I think something along the lines of the "Addiction comprises any activity undertaken which over time impacts negatively upon the relationships and life goals of the subject" allows the right things in while keeping the wrong out.

Furthermore, this seems to be butting up against the limits of scientific inquiry and into the philosophical. In other words, defining 'addiction' is not an empirical matter. The researcher must subscribe to a definition and then report his or her findings as consistent or inconsistent with that definition.

By Heavy Top (not verified) on 23 Sep 2009 #permalink

I've noticed the term 'spectrum disorders' (especially re: autism and FASD) appearing more frequently in recent years. In general, the term describes specific disorders with symptoms having effects ranging from mild to severe.

Perhaps it's time for a new DSM category of 'addiction spectrum disorders', to describe addictive behaviors having effects ranging from mild to severe concerning the criteria for psychological/mental disorders (i.e., a pattern of behavioral and/or psychological symptoms causing significant personal distress and/or impaired functioning in one or more important areas in daily living).

By Tony Jeremiah (not verified) on 24 Sep 2009 #permalink

Thankfully, Nora Volkow, head of NIDA, and if I recall correctly, Chuck O'Brien of U Penn have championed getting rid of the ludicrous DSM term "substance dependence" and replacing it with addiction in DSM V. The only reason it got called substance dependence in the first place was a misguided attempted to reduce stigma.

What the attempted stigma-reducers missed was that dependence is perfectly natural and is not the problem in addiction. We're all dependent on air, water and food. One can have addiction without dependence (cocaine doesn't produce physical withdrawal symptoms, only psychological ones) and dependence without addiction (some blood pressure meds can cause fatal withdrawal).

The problem in addiction is compulsive behavior despite negative consequences. By calling addiction dependence, the PC folks wound up expanding stigma and causing real problems for pain patients and people on antidepressants, who may well be dependent in the sense of needing substances to function, but who are by no means addicts in that those substances improve their lives, not destroy them.

Incidentally, they also reflected America's fears about dependence itself: we like to pretend we're independent, but in reality, of course, we're not.

By Maia Szalavitz (not verified) on 24 Sep 2009 #permalink

Reading this article, began a journey into self discovery on what makes an addict. Is it environment, or truly genetic trait? This article had peaked my interest, and also many questions left unanswered. The article began with a clear message, but towards the end he went in too many directions. I hope to delve further into research and tie drug addicts (who are they and various types from the wealthy-example Michael Jackson to the poor-a prostitute I would see everyday on my way to work.) I wanted to also take a little more further other types of addicts; workaholics, internet junkies, shopaholics, etc and understand how they tie together.

This article was very brief and only skimmed the surface of this fascinating topic, in other words, and left me wanting more. It has always been something of a personal subject; more than half of my families on both sides are addicts, while there a few of us that are not. Then again, I began to think maybe my addiction is in other forms and I just donât realize it. So the question the title portrayed loomed in my head. What exactly makes an addict? Is it as plain as the nose on my face, or is it something deeper. Maybe it is genetic, and I have it in a different form. In order for me to come to any sort of a conclusion, I want to understand if itâs biological or environmental or is it a combination of both. This article does not disclose this answer, and only talks about meth and heroin addicts and other forms such as video game addicts. In my research topic, I will delve further into the findings that the Drug Monkey has come up with, but I will also look to other psychologists, scientists, and former addicts (I have a few in my family so that will not be a stretch) and truly rethink what an addict is.