Still Puzzled About What ADDICTION Is?

In response to my post yesterday about medication eventually helping people with addictions, Suber questioned what exactly addiction is.  My reply…

Addictive behavior can be looked at in many ways. Taking Suber’s example of obesity, there may be a problem with motivation (not exercising), decision making (eating more, despite health problems), pleasure seeking (not being satisfied with healthy portions of food), inhibitory control (not stopping eating when full), etc.

The medical definitions of addiction speak to behavior only – more and more gambling, despite having negative consequences, e.g. work suffers, family life suffers, finances suffer, etc. Medical definitions currently do not speak to cause – e.g. is it too much pleasure seeking or not enough inhibitory control?

My prediction would be that someday these causes will be understood biologically, and what may follow are specific treatments, including medication, for specific causes. E.g, if your dopamine levels are low, and you don’t get the normal pleasure from 1 piece of pie or 1 hour of poker, you could take a “dopamine-adjusting” pill to feel better, instead of needing the whole pie or a whole night of gambling to enjoy the experience. Conversely, if your GABA levels are low, and you don’t have normal inhibitory pathways working, you would take a “GABA-adjusting” pill instead.

Better living thru pharmacology.

4 thoughts on “Still Puzzled About What ADDICTION Is?

  1. Thanks Sparky for your explanation of “addiction”. I think it has helped me get a better idea of what you were saying in your prior posts. However, I still feel a little confused about the term.
    We all know plenty of people who don’t exercise enough, who are overweight, who don’t seem satisfied with healthy portions of food. You might even say that I satisfy this description. Do I think that these people have a problem with food, in particular with their motivation, decision making, pleasure seeking, and inhibitory control? Certainly I do. Would you describe them as being addicted? I am reluctant to do so.
    If you do want to say that they are addicts, then wouldn’t you have to say that everyone is addicted to something? On the other hand, if you don’t want to say that they are addicts, what do you think it is that makes the difference between a person who has a problem with something like food and someone who is an addict?
    I suspect that you might reply that it is all a matter of degree, that when your problem with some substance or activity gets so bad we should call it an addiction. Before it gets this bad we just call it a problem. Does this distinction appeal to you? If it does, then I ask “Is there any way to tell that one has crossed the line from “problem” to “addiction”.
    The medical definition of addiction that you gave may offer an answer to this question, as it suggests that you do “more of the activity, but suffer negative consequences”. The question that this raises for me is that under this definition, a person would not be an addict to poker if his life got better, e.g. made more money, had a better family life, etc. Something doesn’t seem right about this.

  2. The psychiatry residents I teach also ask what exactly is the line between “problem” and “addiction.” And you’re right, it is just a matter of degree. For gambling, medical lingo would use the terms “normal,” then “problematic gambling,” then “abuse,” and lastly “dependence.”

    “Abuse” and “Dependence” are specific medical diagnoses, but when making a decision between the 2, again there’s no specific line, just a matter of degree, dependence being worse.

    A short diagnostic screening tool for alcoholism, which can be used for other behavior is “CAGE.”
    C: Have you tried to CUT down drinking and can’t?
    A: Do you get ANNOYED when people question if you have a drinking problem?
    G: Do you feel GUILTY about your drinking, or problems it has caused?
    E: Do you have EYE-OPENERS (drinking right away in the morning)?

    The more “yes” answers, the greater the likelihood of a problem. You could ask the same questions about poker.

    What’s abuse and what’s normal behavior? You’re example is of someone’s whose life got better while playing poker. If there aren’t problems with relationships, balance of activities, finances, etc., then there’s no addiction. What doesn’t seem right about this?

  3. Two questions: First, what do you mean when you say that a person “can’t” stop doing what he or she is doing? Second, doesn’t it seem to you that you could find a person who is addicted to some substance or activity, but could still function normally in regard to the rest of his life?

  4. “Can’t,” as in has a great deal of difficulty doing. E.g. plans to play poker for 1 hour, or $10, but can’t tear himself away from the screen, even after 5 hours, or $100, etc.

    Re your second part, if the definition of “addicted” is used as “abusing,” as in not functioning in the rest of his life, then you couldn’t be addicted, yet function.

    One point of confusion may be “addicted” as a medical definition, versus “physically dependent,” which means needing higher and higher dosages to get the same result, as well as withdrawl symptoms when you stop or decrease a substance. Physically dependent often goes along with addiction, e.g. addicted to heroine, as having withdrawl symptoms when you don’t get the drug. However, you can have physical dependence on a prescribed narcotic for chronic pain, meaning you need higher and higher dosages and would have withdrawl symptoms if you stopped, yet you aren’t abusing the medication, i.e. you’re not taking it incorrectly, and it’s helping you function better, not worse.

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