How we change what others think, feel, believe and do
What is Addiction?
Addiction is a commonly used word to indicate that a person repeatedly behaves in a certain way. Certain characteristics are common:
Craving is a strong desire that can be virtually omnipresent. This may appear in an obsessive way, where the person thinks about the addiction almost constantly.
The addict may feel driven to engage in the given behavior, with a desire so strong they seem unable to say 'no', even if they know that the addiction is harmful. It is perhaps the associated loss of control that makes addiction so troublesome.
The addictive behavior is repeated in predictable patterns. In extreme, this is to the exclusion or reduction of many other 'normal' activities, including socializing, eating and sleeping.
The thing to which the person is addicted has some benefit for them. This may be direct or indirect stimulation of pleasurable feelings, including euphoria, relaxation and general feelings of well-being.
Benefit many also be gained through anesthetization and numbing of unpleasant feelings, such as those experienced in depression.
Addiction often has the connotation of harm, with the notion that the addict will, sooner or later, be harmed by being addicted. This may include:
A dependent person cannot do without some named thing. They have an attachment to it that may be physiological, psychological or some combination of the two.
If the dependent person is deprived of their target, then they suffer in some way, experiencing some kind of withdrawal symptoms. These can range from the 'cold turkey' fever of withdrawal from 'hard' drugs to irritability and moodiness when a child is denied access to their favorite computer game.
Withdrawal is often an opposite effect. Heroin causes euphoria, relaxation and constipation. When it is removed the person gets dysphoria, cramping and diarrhea.
Some addictions result in the person becoming tolerant to the point where repeated action leads to decreasing effect.
In other addictions, the person is sensitized, such that smaller actions are required for the same effect.
The term 'addiction' is often used quite loosely in common conversation with phrases such as 'marijuana is addictive' or 'he's addicted to computer games' without too much consideration of what the boundaries of the 'addiction' classification might be.
Physiological and psychological
Addiction is often separated into physiological addiction, as characterized by the use of hard drugs, and psychological addiction, such as nymphomania or excessive video gaming. In practice it is difficult to separate these, for example in the way that psychological 'choices' use the physiological systems of the brain.
It is often believed that some people are more susceptible to addiction than others, inheriting this tendency through their genes. As an example, a study has shown that over a third of relatives of people with an alcohol use disorder also suffer from alcohol abuse, and even more so amongst siblings. Whilst there appears to be clear proof in this, the effect is difficult to determine exactly, as other factors such as socioeconomic status can have cloaking effects. Adoption studies have, however, proved more clearly that alcohol dependence susceptibility has a genetic aspect.
Twin studies have led to estimates of the heritability of alcohol dependence ranging from 39 to 60% of the total variance (Heath, 1995, and others). Similarly, the heritability of smoking addiction has been estimated at 53% (Heath and Martin, 1993), and that for nicotine dependence between 60 and 70% (Kendler et al. 1999).
Neuroadaptation is a theory of dependence that assumes changes in the brain following significant drug usage. Within-systems adaptation occur where changes are within a single neural system and between-systems adaptation occurs where multiple systems are affected.
Discontinuance of the drug thence disrupts the balanced homeostasis that has been set up, causing withdrawal symptoms.
Learning and habit
Addiction can be viewed as a form of learning, albeit aberrant, and learning theory can be applied.
'Habit' is a form of instrumental learning where a stimulus elicits a response without reference to the goal (reinforcer) that originally motivated the learning. In other words, it becomes a relatively unthinking action.
Addiction can also be linked to psychological factors whereby the addict becomes conditioned into use of the behavior. This may be applied to drug use, which may be directly linked to neural effects, and other forms of addiction which seem to have a more behavioral and motivational basis. In this way, drugs may have both physiological and psychological motivational aspects.
Behaviourism also explains the importance of cues that trigger sequences of thinking and acting, such as when the heroin addict sees a needle or when an alcoholic sees an advert for vodka.
Aspects of personality have been linked to addiction, for example Eysenck and Eysenck, (1985) suggest there are three major and independent personality dimensions: P (psychoticism), N (neuroticism), and E (extraversion). Further research has shown dependence correlating when both N and P are high, although this still does not prove cause and effect.
We are, at least in part, rational beings and can make logical choices. People 'in sound mind' do choose to take drugs or indulge in other harmful activity. This has been investigated found that a tendency to focus on the near future more than the uncomfortable more distant future can be a factor and has been labelled 'cognitive myopia' (Hermstein and Prelec, 1992).
This effect may be moderated by the way that we tend to weight the near future more highly than the more distant future (Ainslie, 1992).
Effective forgetting the pain of past indulgences is also an effect as addicts focus on the near-term benefits.
The ability to overcome cravings and compulsions can depend on willpower in general and self-control in particular. An addictive personality may have high tendency towards experiencing desires and a low ability to resist them. When a person seems not to be addictive, they may have low tendency to desire or have a sufficiently high self-control to manage those desires, keeping fulfilment of them to acceptable levels and situations.
There has been some linkage between drugs, for example where a person who is drunk is more likely to accept other drugs. In particular nicotine has been shown to be a gateway to other substance abuse (although of course many smokers do not indulge in illicit substances).
There are many contextual factors that can lead to addiction, including:
A person who has given up the addictive substance/behavior may relapse into addiction again. This can be caused by:
The danger of relapse can continue indefinitely, for example where smokers easily take up smoking again long after they have 'given up', and particularly where the craving never fully goes away.
Addiction vs. compulsion
Compulsive disorders are sometimes seen as addictions, yet psychologists often separate them, though the boundary can be rather fuzzy even for psychologists. For example in Obsessive Buying Disorder (or 'shopaholic' to most of us) is often considered to not be an addiction, although this is sometimes differentiated as 'Behavioral Addiction' in contrast to 'Drug Addiction'.
A compulsion is perhaps more of a ritual that has few goals other than performance of the behavior (such as counting things), as opposed to an addiction, which has a more specific end in mind (such as pleasurable feelings). Addiction is more about harmful behavior. Both have physiological and psychological elements.
Addicts feel compulsion and those who have compulsive disorders may well seem addicted. Both are about a lack of control. And they can overlap: a study has shown that a significantly larger number of alcoholics had suffered compulsive disorders than would be found in the normal population.
In the end, it is as much about definition as anything. There are clear drug addicts and obsessive-compulsive disorders. It all gets a bit gray, though, when you get to gambling and shopping.