The question comes up often: “What is the definition of addiction?” The assumption is that one true definition actually exists. It doesn’t. Indeed, there are many definitions of addiction--hundreds, perhaps. A few of those are quite good.
Morse & Flavin’s (1992) definition of addiction is the one traditionally utilized by treatment centers and substance abuse counselors. It is very good and touches all of the bases. Published in the Journal of the American Medical Association (Vol. 68, No. 8), Morse & Flavin defined addiction thusly (paraphrased): Addiction is a primary, progressive, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over use of the substance, preoccupation with the substance, use of the substance despite adverse consequences, and distortions in thinking.
The DSM IV (1994) relies on symptoms for its definition. The DSM says that addiction, or dependence, is present in an individual who demonstrates any combination of four or more of the following symptoms:
Preoccupation with use of the chemical between periods of use.
Using more of the chemical than had been anticipated.
The development of tolerance to the chemical in question.
A characteristic withdrawal syndrome from the chemical.
Use of the chemical to avoid or control withdrawal symptoms.
Repeated efforts to cut back or stop the drug use.
Intoxication at inappropriate times (such as at work), or when withdrawal interferes with daily functioning (such as when hangover makes person too sick to go to work).
A reduction in social, occupational or recreational activities in favor of further substance use.
Continued substance use in spite of the individual having suffered social, emotional, or physical problems related to drug use.
I appreciate and concur with both of these widely respected definitions. I have found, though, that the following conceptualization of addiction has proven to be understandable and meaningful to a lot of people, both professionals and lay people alike. It suggests that there are reliable, concrete differences between social users of alcohol and drugs, abusers of alcohol and drugs, and addicts, or those addicted to alcohol and drugs. The categories break down as follows:
Social User: One who uses alcohol and/or drugs simply to enhance the pleasure of normally pleasurable situations. The social user experiences the following:
No negative consequences;
No surprises or unpredictability;
No loss of control;
No thoughts of or need for limit setting.
Substance Abuser: One who uses to enhance pleasure and/or compensate for something negative, such as physical or emotional pain, insecurity, fear, anger, etc. The substance abuser experiences some or all of the following:
Occasional negative consequences that are not repeated;
Limit setting that is adhered to;
Promises that are made and kept;
Complaints are heard and dealt with.
Addict: One who uses to celebrate, compensate, or for any other reason, legitimate or not. The addict experiences some or all of the following:
Negative consequences are recycled;
Limit setting & promises to self or others are broken;
Complaints are denied and/or not heard;
Reliable symptoms of addictive disease become more evident. Reliable symptoms include those listed under the DSM IV definition of addiction and others, expressed as follows:
Continued use despite negative consequences;
Loss of control, as in more use than planned (broken limits);
Unpredictability, as in use despite plan not to use (broken promises);
Compulsivity/preoccupation in thinking;
Denial; Use of defenses to maintain denial;
Build up of (or "break" in) tolerance;
Remorse & guilt about use or behavior when using;
Memory loss, mental confusion, irrational thinking;
Family history of addictive behavior;
Withdrawal discomfort (physical, mental, emotional, and/or psychological).
The following conceptualization of addiction is drawn primarily from the work of John Bradshaw. I took his basic premise and expanded it to its present form. It says that addiction exists in the individual who demonstrates a pathological relationship with any mood altering experience that results in ongoing, recurring life damaging negative consequences. Within the context of this definition, the following sub-definitions are offered:
Pathological refers primarily to the presence of the following:
Denial and delusion—defense mechanisms that look very crazy to the objective, outside observer; and
The intention to control one’s use combined with unsuccessful attempts to do so.
Mood altering experience refers to both of the following:
Substances, including for example, alcohol, illegal drugs, prescription drugs, nicotine, caffeine, food, and sugar; and
Behaviors, including for example, gambling, work, sex, relationships, exercise, religion, emotions, shopping/spending, and TV.
Life damaging negative consequences refers to both of the following:
The Obvious, including for example specific health problems, specific legal problems, accidents, and loss of jobs or relationships; and
The Subtle, including for example loss of self-respect or respect of family or peers, lowered job performance or efficiency, arguments, and generally negative attitude.
Obviously, this conceptualization of addiction is broad and captures more than just alcohol- and drug-addicted people. It suggests that addiction to alcohol, heroin, nicotine, gambling, and shopping are all similar conditions as long as they meet the criteria of the definition.
Other definitions of addiction include those that are based strictly on biological, biochemical, or neuro-chemical presuppositions. They require evidence of a genetic predisposition to addiction coupled with a biochemical or neuro-chemical "error" or "malfunction" in the brain. These conceptualizations of addiction may well prove to be exactly correct. Time will tell.
In the meantime, however, defining addiction according to behavioral symptoms appears to offer the most reliable means of accurately diagnosing addiction. In layman’s terms, "If it looks like a duck, acts like a duck, walks like a duck, and quacks like a duck, it’s probably a duck." Very simply put, if an individual is having problems associated with his/her substance use, and really tries but fails to control his/her use, then the chances are pretty good that there’s an addiction lurking nearby.
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