Many questions come up in therapy, questions where an individual may be looking for a black-and-white definition of something. What is depression? Do I have anxiety? What is ADHD? A particular question came up in a Psychology Today article that caught my interest and it stemmed around the concept of addiction. The topic focused on sexual addiction and pornography addiction and discussed what those terms meant, however, the article itself questioned what constituted as an addiction, (Skinner, 2014).
The truth is that ANYTHING can lead to an addiction. When we look at the black-and-white definition of addiction the dictionary states, “The state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, to such an extent that its cessation causes severe trauma,” (Dictionary.Com, 2002). Take caffeine for example, many individuals are dependent on their cup of coffee in the morning, without it they may joke that they cannot function. Now put yourself in this person’s shoes if they were addicted to the caffeine. It must be habit forming (having a daily ritual of how many to drink, when you need to drink it by, etc.), and it can affect you psychologically and physically.
The psychological component relates to how the caffeine, or lack thereof, may affect your functioning in a literal sense. If you were dependent on it and were running late that morning and happened to run out of the house without your cup of joe, but not realizing it until you got to work, things may seem catastrophic for a moment. You may become crabby or irritable, your self talk or inner voice may become negative for the day until you can grab a cup of coffee, and you may even have a hard time concentrating. This is due to your brain having a neurological response to the lack of caffeine it is used to daily. Physically you may get a headache and your muscles may tense, none of which you want to experience. So what do we do to avoid these side effects? Well, grab some coffee of course!
If the question were to arise, “What things do people get addicted to?” a certain stereotype may enter your mind, which may include substances such as alcohol, heroin, cocaine, or prescription medications. This is because we portray these as common addictions in the media constantly in reality TV shows, fictional dramas, radio stations, and literature. Certain topics are beginning to make educational headway in the addiction world that includes sexual addiction, pornography addiction, gambling addiction, and even technology addiction. In the past these topics have not been quick to discuss in the addiction world because they seemed either taboo or quite simply did not seem to meet the criteria for the diagnosis. The recent release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) acknowledges new addictions as diagnosable such as gambling and internet addiction, but even the new edition states that they are “new” disorders and still need further research.
But what does that mean? The new DSM no longer uses the terms “dependence” or “abuse” but rather calls all addictions “disorders” and they are ranked based on severity. For example a diagnosis would state, “Cannabis Use Disorder, Mild,” versus the old, “Cannabis Abuse.” Because of this (new) change and because research still needs to be conducted to measure the validity of the changes, the DSM-IV-TR will be referenced to discuss addiction and dependence. In this fourth addition the DSM states that to meet criteria to have a dependence, the individual must have,
“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 (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
(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
(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use
(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
(6) important social, occupational, or recreational activities are given up or reduced because of substance use
(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 (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption),” (American Psychiatric Association, 2013).”
The DSM-IV-TR has a fault of primarily only focusing on substances, rather than behavioral addictions (i.e. resulting in the changes made for the DSM-V mentioned above).
One more definition of addiction to be pointed out is that of the American Society of Addiction Medicine (ASAM). On the ASAM website they have a wonderful page describing a short definition of addiction as well as a longer, more elaborative definition. In the short definition they state,
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”
If the definitions from all sources are combined it can be gathered that the definition of addiction is not always black-and-white, rather, it may include many gray areas that are characterized by the individual. Is the individual addicted to a substance or to a behavior? Once that question is answered then treatment is primarily the same across the board and may include topics such as:
It is important to remember that may definitions can exist describing the same phenomenon, so we must take all into consideration and relate them to the individual themselves instead of putting them in one large dynamic group. It really gives you something to think about next time you go to make your coffee…
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th & 4th ed). Washington, D.C.
American Society of Addiction Medicine. (2011, April 19). Public Policy Statement: Definition of Addiction. Retrieved from http://www.asam.org/for-the-public/definition-of-addiction
BehaveNet. (2015, October 3). Diagnostic Criteria for Substance Dependence. Retrieved from http://behavenet.com/node/21516
Dictionary.com. (2002). Addiction. Retrieved from http://dictionary.reference.com/browse/addiction
Skinner, Kevin B. (2014, November 3). Is Pornography (Sexual Addiction) Real? Retrieved from https://www.psychologytoday.com/blog/inside-porn-addiction/201411/is-pornography-sexual-addiction-real