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What is addiction? How do you recognize it?

  
 
Pappa Cass
10:39 / 26.04.05
I was reading in a friend of mine's journal the other day and he confessed that he thought he was a pothead. Now, having known this guy for a few months, I am not so sure I would agree with that. This got me to thinking. How could I tell if he was or wasn't. I've done some reading and some thinking and haven't really gotten that many places.

Think about it. Is addiction a "need" for something? If so, then you are addicted to food and liquid, as you need it. Is addiction the use of something to enhance one's lifestyle in exclusion to other things? If that is the case than addiction is a much wider phenomenon than I could have possibly imagined. Everyone who finds that life is a bit easier by watching football(American or otherwise) on Fridays and/or following their favorite team would be an addict(as they can technically live without it, but there life goes better if they do such). How about if you make harm a required element to the defintion, that you have to want something in your life despite the fact that it harms you. In that case a responsible(does it at home, holds down a job and relationships, etc,etc) pot smoker who uses a vaporizer and/or uses it in cooking(which makes it much less harmful than smoking cigarettes) every day isn't addicted. Try and tell that to any authority figure and see how far you get with that.

So here's my question. What is a reasonable definition of addiction, including how to distinguish an addict from someone who simply enjoys XYZ harmful activity in a responsible manner?

P.C.
 
 
Ariadne
11:22 / 26.04.05
I think the saying that 'if you think you have a problem, you probably have' is a good one - if the desire to drink/gamble/smoke feels outside your control, then it's fair to say you're addicted.
 
 
Scrambled Password Bogus Email
11:52 / 26.04.05
It's a good question, and Ariadne's point is a good one - if the question has arisen, either in your own mind or from friends / relatives questioning it, it's usually a good time to test yourself.

Whatever it is, stop it, for one month. Gauge your physical and psychological reaction to the cessation, ask other opinions re: mood and behaviour.

I would go for an operational definition along the lines of addiction being a necessity to engage in a voluntary activity without which a marked disturbance in the equilibrium of either the physiological or psychological or both systems of the organism occurs.

The 'voluntary' is perhaps the wrong term, but intended to exclude breathing / eating / water...it is not really very useful to describe all vertebrate organisms and most invertebrates as being 'addicted' to oxygen, water and food.

Coffee, sugar, fags, junk food, smack, crack and, er, adrenochrome, on the other hand, make some sense within that definition.
 
 
STOATIE LIEKS CHOCOLATE MILK
12:42 / 26.04.05
The thing that really told me I had a problem with alcohol was when I was actually structuring my life around the next drink- if something that isn't necessary for survival becomes the most important thing in your life, it's either addiction or obsession.
 
 
lord henry strikes back
13:10 / 26.04.05
'What is addiction?' is an interesting debate but I don't think that it tackles any real issues. What I have always felt is much more important is 'is this causing a problem?' (I use the word problem as opposed to harm because I do not think that it is an issue of what is physically good for you, but the effect is has on your way of life). Basically, if someone drinks a bottle of vodka a night and still goes to work every day and performs well, it does not disrupt their relationships with others, and they can happily live the life that they want, then, as far as I can see, they do not have a problem. By contrast, someone who drinks rarely, but when they do they invariably become violent and attack their partner, that person has a problem and should probably stop drinking for good.

In the case of your friend the question, I feel, should not be 'is he a pothead?' but 'is the pot stopping him from doing something positive/making him do something negative?'. If the pot is holding him back then there is an issue to be addressed, and as his friend I'm sure you would help him as much as you could, but if he just likes a few smokes of an evening, and there are no negative results, then there is nothing to worry about.
 
 
Ganesh
14:13 / 26.04.05
Insight into addiction isn't always present. Conversely, people frequently believe themselves addicted when they're not.

The good ol' ICD10 lists a variety of criteria used in making a diagnosis of a dependence state. A definite diagnosis should only be made if three or more are present within the past year:

a) a strong desire or sense of compulsion to take the substance;

b) difficulties in controlling substance-taking behaviour in terms of its onset, termination or levels of use;

c) a physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms;

d) evidence of tolerance, such that increased doses of the substance are required to achieve effects originally produced by lower doses (for example, alcohol or opiate-dependent individuals taking daily doses sufficient to incapacitate or kill nontolerant users);

e) progressive neglect of alternative pleasures or interests because of substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;

f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature or extent of the harm.

In addition, narrowing of the personal repertoire of patterns of psychoactive substance use (eg. tendency to booze in the same way on weekdays and weekends, regardless of the social constraints that determine appropriate drinking behaviour).

That's the 'official' way of diagnosing dependence/addiction, anyway.
 
 
Morpheus
16:11 / 26.04.05
My Name is Mark and I'm a drug addict.

Or...the guy who steals your playstation and a few of the games and pawns them, and comes home with said drug, injects said drug in your bathroom nods for 15 or so minutes then leaves bathroom with bottle of bleach on the floor and q-tips everywhere. Then nods again on the couch. When woken from said coma is asked what happened to the playstaion...he responds with, "it fell and I had to go get it repaired it should be back in a week or two...this guy is good with that stuff....
You might ask him then why you found said pawn ticket behind the toilet and they respond again with, "I don't know what the hell your talking about that must be someone elses play station."
And then you ask again, are you high right now, and they have to add, "noooo...what the fuck, I'm sick." Drooool.
That is a drug addict.
 
 
russdev
18:11 / 26.04.05
addiction is need to have something and you can not go on with life with out and you would to do things that otherwise do not normaly do to feed that addiction.

russ

peace
 
 
Shrug
18:12 / 26.04.05
While not exactly the nature of addiction; If somebody takes a substance or has been taking a substance and their own perception of the affect on their lives is negative vs. positive, or where they express a wish to stop yet find themselves repeating usage, I'd say that even if they're not addicted they have a problem.
 
 
Ariadne
21:05 / 26.04.05
That's interesting stuff, Ganesh, especially about people thinking they're addicted when they're not. Does that mean people worry too much, or that they blame 'addiction' when they drink/eat/whatever too much, when it's more within their control than they think?
 
 
Ganesh
21:19 / 26.04.05
Does that mean people worry too much, or that they blame 'addiction' when they drink/eat/whatever too much, when it's more within their control than they think?

Bit of both. I think there's also a cultural element at play, possibly related to the vested interests of the bigger pharmaceutical companies in medicalising aspects of life then handily providing a prescribable solution.

Us doctors seem to have a much lower threshold for diagnosing addictions - whether alcohol, substance use, sex, shopping, whatever - than their UK counterparts. We, in turn, are more likely to diagnose alcohol dependence than Russian doctors.
 
 
Spaniel
10:19 / 27.04.05
Lord Henry, just because something isn't preventing you from functioning normally *right now* doesn't mean that it's not a problem. As far as I'm concerned, if you drink a bottle of vodka a night you have a problem because you are risking serious damage to your health over the long term.
I think it would be a pretty strange definition of "problem" that didn't take that into account.
 
 
grant
15:44 / 27.04.05
As an adjunct to Ganesh's diagnostic explanation, there's another kind of definition of "addiction" based on a specific neurochemical chain reaction.

Kind of surprisingly, there are addictive activities, like eating, thrill-seeking, sex or gambling, that have the same neurochemical effects as ingesting the chemicals that directly affect the nervous system. Other compulsive behaviors have the same chemical signature in the brain.

And they all respond to similar medications, apparently.
 
 
grant
16:02 / 27.04.05
Weird -- I write that, I hit "post reply," I open a new window to look for science leads, and I find this report on naltrexone, a drug that curbs cravings for opioids, alcohol, and nicotine.

I bet it'd work on other compulsive/addictive behaviors too, although I don't know of any research on that... but Google tells me there's been some promising stuff with autistic patients.

Look
here for more on naltrexone. And here.


Edited to add: ring-a-ding, double-blind placebo-controlled study finds naltrexone at least somewhat effective in controlling gambling behavior. I don't know what a "time effect" is, though.
There's more related research here, at the U Minn home page.
 
 
ChasFile
23:47 / 28.04.05
The DSM-IV - The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994) - defines addiction thusly:

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
b. Markedly diminished effect with continued use of the same amount of the substance.

(2) Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for the substance
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

(3) The substance is often taken in larger amounts or over a longer period than was intended (loss of control).

(4) There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control).

(5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects (preoccupation).

(6) Important social, occupational, or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences).

(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. (adverse consequences).

Basically, addiction means that someone is incapable of engaging in an activity or ingesting a substance in, as you put it, "a responsible manner."
 
 
Zheng He
10:44 / 29.04.05
not being usually here, but at the temple, i'm a little surprised no one brought Szasz up yet. In most of the dubbed "antipsychiatry" movement (70s & 80s) addiction was considered a value judgement on a habit, and no more. most of the official diagnosis checklists for addictions could be used for things that are not in the addictions' list, for example sports.
I think sports qualify in all the ICD10 list from Ganesh (though the F point is a little tricky, but nearly all sport practitioneers have been injuried sometimes)...
when it comes to my mind I usually think of it more as a personal judgement, and one that is very difficult for other person to make... my needs are my own, and it's up to me to decide my relationships with them. what I mean is that , to quote ItsyBitsySpiderGod if "they express a wish to stop yet find themselves repeating usage" they have a problem (as she said), but I think it has nothing to do with addiction as an external problem (an illness), but with a sort of personal decision making and selfimage problem(what Szasz called "meaning", like in "a life without meaning") that i will not call illnes...
by the way, DSM-IV chacklist is very peculiar, because a person that has a steady amount of, say, hash, and has three a night everyday is not an addict if he intended to do exactly that... or so i think... it could fullfill 1 and 7, maybe... am i wrong?
 
 
Ganesh
11:16 / 29.04.05
I think sports qualify in all the ICD10 list from Ganesh

Except that the ICD10 specifies substances as opposed to activities ie. someone would have to be orally or intravenously ingesting endorphins rather than merely generating them through exercise.
 
 
iconoplast
12:27 / 29.04.05
I've found addictions can manifest not just in the normal "I want to stop but can't" manner, but also in more insidious ways. An addict's powers of rationalization are pretty extraordinary, so quite often you get "Why would I want to stop," resulting from either an inability to recognize the problems the substance is causing, or even resulting from a fear of trying to stop but being unable to do so.

Personally, I think it's the inability to connect the substance with its detrimental effects that's the give away.
 
 
Alex's Grandma
18:56 / 29.04.05
Bit unsure about the use of the term 'addiction' at all, except in the strict medical circumstances outlined above. Personally anyway, it implies a severe inability to cope in the face of whatever it is, which, when applied, seems as likely to enable the pattern of behaviour as it is to help curb it, ie, 'I can't stop maxing out my credit cards/surfing the net for porn/going to the bookies at lunchtime because I can't help myself. It's much harder to gve up cigarettes, for example, once you've self-identified as an 'addict,' as opposed to just someone who happens to smoke, and should probably quit.

It seems as if what used to be seen as personal vices ( an overfondness for casual sex, shopping, 'soft' drugs etc, ) are now being accorded almost demonic powers, whereby they can only be 'beaten' with recourse to an intercessional figure, be that the Twelve Steps programme, an evangelical church or the kind of therapist that charges heavily, the problem being that none of these 'exorcists' ( in the States in particular, it doesn't seem far off that, ) are without an agenda - I just wonder if a lot of the time it's the 'addict' who really benefits.
 
 
IPEX
13:04 / 30.04.05
So, having been an addict, and being currently in the thrall of something which will beat me around the head with withdrawl symptoms at around 4 o'clock tomorrow afternoon, something which hits 1,2,3,4 and 7 on the DSM list...

The most important part of being addicted is coming back to it later. I have/have had an opiate addiction for some time now, since being put on a high dose of them for a month or so. Since then (three years ago), I've had three(?) periods of use longer than about a month, and gone through withdrawl in various degrees of severity about six times (some of these withdrawls have only been a week apart).

Despite knowing that I don't actually enjoy opiates that much, and that the health effects outweigh what mild enjoyment/numbness I might develop from their use, every now and then, typically in high stress situations...

Anyway, the point is that, despite having been clean, having had no physical addiction and no use for a year or several months at a time, there's always(?) an addiction present somewhere in the back of my brain, and I think the sort of recurrent-use-syndrome thing is something that the DSM and the European version should recognise.

My experience may not be typical, as I am a medically sanctioned addict, but I gather from reading around AA and other 12step programs that a significant portion of people who self-identify as addicts feel that addiction is permanent, and/or that one slip will put them back in the middle of an addiction as serious as their previous addiction.

Alternate coping mechanisms might help, and there are certainly addiction counselling programs for alcohol that don't preach abstinence, but management and maintenance and keeping your shit together to the point where you don't need the coping mechanism of the drug/addiction of whatever type anymore, and, in the studies I've read, they're about as effective as AA and the like. Then again, AA and the like are about as effective as deciding not to do it anymore, at 12 months from date of decision.

The whole issue is fairly confused. The simplest answer I can think of to the original question is: If you or another person thinks it's causing a problem, and you can't stop though you want to, that's an addiction.
 
 
Unconditional Love
22:41 / 01.05.05
one problem of those labelled as addicts or those with mental health problems, of which i have been both of in the past, is the self identity of the labelled with the label, once taking on that identity and percieving oneself in that way its easy to remain there and use it as an excuse not to change. to begin with if you have a problem its nescessary to recognise that and treat that yourself with help from the services around you, but to continue to self identify with a label like addict is part of the problem, one which mental health services and service users are increasingly becoming aware of. labels and terms that imply permanacy of conditions do nothing to empower an individual and can in some cases become an excuse to remain in the position you may find yourself in, and not effect a change of any kind. the question is, do you really want to change, if you do, you can, and you can start now. dont wear the definition of addiction or mental illness, what you identify with you will become.

i was an addict.
 
 
iconoplast
13:18 / 02.05.05
"Then again, AA and the like are about as effective as deciding not to do it anymore, at 12 months from date of decision."

I think I have a skewed perspective, as a member of AA, but - I really think AA is misunderstood a lot, even by the people at the meetings.

To actually do AA requires an outlay of effort and willingness. Courts mandate people to meetings all the time. That's fine - but I'd say that attending AA meetings isn't at all the same as working the AA program. So I have a feeling that many of the people for whom AA didn't work maybe didn't understand that there's more to it than going to meetings and sharing.

Going to meetings is nice and all, but when all's said and done it's just talk. AA is something you do. In fact, it's twelve things you do which, if you do them, manufacture a spiritual awakening. But if you're not doing them, I've never really understood how you're "In AA".

Here's why -

Jung, when treating an alcoholic, told him that he was essentially doomed. That in his experience alcoholics of his caliber never recovered, and his only choices to stay off the booze were to hire bodyguards to restrain him or to lock himself away.

The only recoveries Jung had ever seen had resulted from a sudden spiritual experience. But you couldn't really do anything to get one. Religion was no help.

So AA is just twelve things you do which manufacture what William James calls the "educational variety" of spiritual transformations. Enabling you to change the person who entered AA, and to become a person who doesn't drink.

The program, as written, is elegant and beautiful and amazing. The program as practiced is often hidden under annoying evangelical christians who think AA meetings are soapboxes for their church. They're not the program, though. They're just drunks with agendas.

Okay, enough threadrot. In terms of identity and "the self identity of the label", and the assertion that "... labels and terms that imply permanacy of conditions do nothing to empower an individual..."

I found, and still find, that identifying myself as an alcoholic was a liberating choice. Because it removed any question of moral fiber or defecit in willpower or whatever from the equation. Why was I such an utter fuckup when I was drinking? Because I react differently.

A couple of times a week I say that I am an alcoholic. Because I believe the people who have told me that alcoholics react differently to alcohol. That we metabolize it differently. And the disease concept of addiction turns a moral issue into a medical one. I feel about as labelled by the word 'alcoholic' as I would by the label "allergic to strawberries" or "diabetic."
 
 
Unconditional Love
16:56 / 03.05.05
i agree that it has to come from you, everything you stated about it coming from you and the work you put in, is in my opinion where it is at.

i disagree about calling myself an alcoholic, i am increasingly being drawn to the recovery model of mental health if nothing more for than it provides hope and empowers service users, by literally being about recovery rather than a continuation of a condition.

the point is to become well, too many encourage a victim type mentality, and a well and unwell cycle continues, my point is about breaking that cycle entirely and recovering.

as to wether alchoholism is a disease or a product of social environment it is perhaps part of both, but in the long run i am drawn to the social side, because i can change that, if a set of behaviours are seen to be a disease then i will have to wait for treatment,the correct drug etc. but i dont think it is, from my own life i can see that it is a learned set of behaviours inheritied from family members and society at large and its relationship with alcohol.

i never tried aa and used a rehab program, having said that my main reason for quitting, the impetus was an nde caused by alcohol and drugs. i think that tends to do the trick.

a label like alcoholic defines far too much and binds a personal identity, something transitory for example like a description rather than a category doesnt offer identity, for example at the moment i have a problem with drinking alcohol, i am learning to recover from that problem. the definition of alcoholic isnt open ended, its a closed identity, no room for movement.its easy for it to become static and lock those who identify with it in stasis.
 
 
Dutch
14:26 / 21.11.06
I wasn't sure about starting a new topic, so I found an old one to post this in:

For a few years I used (hard)drugs regularly (on a weekly basis). Mostly xtc & speed, combined with liberal amounts of alcohol. The people who I hung out with, whom I still consider my best friends have gone a few different ways. Two of them, we were a group of five, have sober girlfriends and are off drugs (save for the occasional two/three month party). I moved away (with a girl that is now my current ex) and am largely off it. The other two are still using every week, and often three to four days in a row.

The problem is that I think the latter two friends of mine are sliding way, way down. One of them goes to school, but misses a few days out of every week at least. One just finished school and is looking for a job, working now and then through a temp-agency. I have the fear that drugs have become too big a problem with them. Also, as a side-effect of the speed, they consume large amounts of beer and liquor, bordering on full-blown alcoholism. Their personalities have changed, they've become harder, more self-centered and scoffing of any criticism.

The thing that has me fearing they are completely addicted is the fact that they admit they are using too much, and then turn around to do even more. This being one of the points mentioned earlier.

My question is, how to help them? These are good friends of mine, and we already lost a good person to drug use. I fear the same thing is going to happen if they keep on doing what they are doing right now. I know that they have to be willing to make that change, but do you think there is a way to make them "see the light?" - godawful term here but still.

Another complicating factor is that there's still a part of me that likes to party/revel in excess. When I am with them (once a month or so), the beer starts flowing and I end up wanting to do drugs again, and sometimes doing so. Hereby validating their behaviour and way of life. Should I wait to give advice, show the changes they can't (or won't) see in their personalities and or push to help them until after I've been off the drugs for a good half year? Or should I act now and risk appearing hypocritical or unable to tell them truthfully they are on the wrong side of the road, running headfirst into uncoming traffic?
 
 
maneki neko
13:57 / 22.11.06
I'm not sure how helpful this is but here you go...
First of all I think that there is a difference between recreational use of drugs and addiction and I don't think that you'll need to be completely off drugs in order to help your friends. "Making them see the light" can be quite hard though as in my personal experience people tend to become a bit defensive when their excessive drug use is pointed out to them (myself included). I think it's more helpful if you tell them how their behaviour affects you and how you feel about it - as in I fear that I might loose you etc. Another thing that might help is to find something in your friends' lifes that is important to them and to point out any negative effects their addiction has on that. Giving up drugs can feel like a big loss in someone's life (at least that's how I felt) and if there isn't anything to gain the whole exercise can seem pointless.
 
  
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