The term "
addiction" is used in many contexts to
describe an obsession, compulsion, or excessive psychological
dependence, such as:
drug addiction
(e.g.
alcoholism,
nicotine addiction),
problem gambling,
crime,
money,
work addiction,
compulsive overeating,
credit card addiction,
compulsive debting,
computer addiction,
video game addiction,
pornography addiction,
television addiction, etc.
In medical terminology, an
addiction is a chronic
neurobiologic disorder that has genetic, psychosocial, and
environmental dimensions and is characterized by one of the
following: the continued use of a substance despite its detrimental
effects, impaired control over the use of a drug (compulsive
behavior), and preoccupation with a drug's use for non-therapeutic
purposes (i.e. craving the drug). Addiction is often accompanied by
the presence of deviant behaviors (for instance stealing money and
forging prescriptions) that are used to obtain a drug.
Tolerance to a drug and
physical dependence are not defining
characteristics of addiction, although they typically accompany
addiction to certain drugs. Tolerance is a pharmacologic phenomenon
where the dose of a medication needs to be continually increased in
order to maintain its desired effects. For instance, individuals
with severe chronic pain taking
opiate
medications (like
morphine) will need to
continually increase the dose in order to maintain the drug's
analgesic (pain-relieving) effects.
Physical dependence is also a pharmacologic property and means that
if a certain drug is abruptly discontinued, an individual will
experience certain characteristic
withdrawal signs and symptoms. Many drugs used
for therapeutic purposes produce withdrawal symptoms when abruptly
stopped, for instance oral steroids, certain
antidepressants,
benzodiazepines, and opiates.
However, common usage of the term
addiction has spread to
include
psychological
dependence. In this context, the term is used in drug addiction
and
substance abuse problems, but
also refers to behaviors that are not generally recognized by the
medical community as problems of addiction, such as
compulsive overeating.
The term
addiction is also sometimes applied to
compulsions that are not substance-related, such as problem
gambling and computer addiction. In these kinds of common usages,
the term
addiction is used to describe a recurring
compulsion by an individual to
engage in some specific activity, despite harmful consequences, as
deemed by the user themself to their individual health, mental
state, or social life.
Classification
Not all doctors agree on the exact nature of addiction or
dependency however the
biopsychosocial
model is generally accepted in scientific fields as the most
comprehensive theorem for addiction. Historically, addiction has
been defined with regard solely to psychoactive substances (for
example
alcohol,
tobacco and other
drugs) which cross the
blood-brain barrier once ingested,
temporarily altering the chemical milieu of the brain. However,
"studies on phenomenology, family history, and response to
treatment suggest that
intermittent explosive
disorder,
kleptomania,
problem gambling,
pyromania, and
trichotillomania may be related to
mood disorders, alcohol and psychoactive
substance abuse, and
anxiety disorders (especially
obsessive–compulsive
disorder)." However, such disorders are classified by the
American
Psychological Association as
impulse control disorders and
therefore not as addictions.
Many people, both psychology professionals and laypersons, now feel
that there should be accommodation made to include psychological
dependency on such things as
gambling,
food,
sex,
pornography,
computers,
work,
exercise, spiritual
obsession (as opposed to religious devotion),
cutting and
shopping so
these behaviors count as 'addictions' as well and cause
guilt,
shame,
fear,
hopelessness,
failure,
rejection,
anxiety, or
humiliation symptoms associated with, among
other medical conditions,
depression and
epilepsy. Although, the above mentioned are things
or tasks which, when used or performed, do not fit into the
traditional view of addiction and may be better defined as an
obsessive–compulsive
disorder, withdrawal symptoms may occur with abatement of such
behaviors. It is said by those who adhere to a traditionalist view
that these withdrawal-like symptoms are not strictly reflective of
an addiction, but rather of a behavioral disorder. However,
understanding of
neural science, the
brain, the nervous system, human behavior, and
affective disorders has revealed "the
impact of molecular biology in the mechanisms underlying
developmental processes and in the pathogenesis of disease". The
use of thyroid hormones as an effective adjunct treatment for
affective disorders has been studied over the past three decades
and has been confirmed repeatedly. Modern research into addiction
is generally focused on
Dopaminergic pathways. There is great
and sometimes heated debate around the definition of addiction with
parties falling into two main camps the
Disease model of addiction and
the behaviorists, explanations of various models can be found in
the article on
Drug
rehabilitation.
Signs and symptoms
Varied forms of addiction
In the
United
States
, physical
dependence, abuse of, and withdrawal from drugs and
other substances is outlined in the
Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV TR).
It does not use the word 'addiction' at all. It has instead a
section about
Substance
dependence:
"Substance dependence When an
individual persists in use of alcohol or other drugs despite
problems related to use of the substance, substance dependence may be
diagnosed.
Compulsive and repetitive use may result in tolerance
to the effect of the drug and withdrawal symptoms when use is
reduced or stopped.
This, along with Substance
Abuse are considered Substance Use Disorders..."
Terminology has become quite complicated in the field.
Pharmacologists continue to speak of
addiction from a physiologic standpoint (some call this a
physical dependence); psychiatrists
refer to the disease state as
psychological dependence; most
other physicians refer to the disease as addiction. The field of
psychiatry is now considering, as they move from DSM-IV to DSM-V,
transitioning from "substance dependence" to "addiction" as
terminology for the disease state.
The medical community now makes a careful theoretical distinction
between
physical dependence (characterized by symptoms of
withdrawal) and
psychological
dependence (or simply
addiction). Addiction is now
narrowly defined as "uncontrolled, compulsive use"; if there is no
harm being suffered by, or damage done to, the patient or another
party, then clinically it may be considered
compulsive, but to the definition of some it is
not categorized as 'addiction'. In practice, the two kinds of
addiction are not always easy to distinguish. Addictions often have
both physical and psychological components.
There is also a lesser known situation called
pseudo-addiction. A patient will exhibit
drug-seeking behavior reminiscent of psychological addiction, but
they tend to have genuine pain or other symptoms that have been
under-treated. Unlike true psychological addiction, these behaviors
tend to stop when the pain is adequately treated.The obsolete term
physical addiction is deprecated, because of its connotations. In
modern pain management with opioids physical dependence is nearly
universal. While opiates are essential in the treatment of acute
pain, the benefit of this class of medication in chronic pain is
not well proven. Clearly, there are those who would not function
well without opiate treatment; on the other hand, many states are
noting significant increases in non-intentional deaths related to
opiate use. High-quality, long-term studies are needed to better
delineate the risks and benefits of chronic opiate use.
Physical dependency
Physical dependence on a
substance is defined by the appearance of characteristic
withdrawal symptoms when the substance is
suddenly discontinued.
Opiates,
benzodiazepines,
barbiturates,
alcohol and
nicotine induce physical dependence. On the
other hand, some categories of substances share this property and
are still not considered addictive:
cortisone,
beta
blockers and most
antidepressants
are examples. So, while physical dependency can be a major factor
in the psychology of addiction and most often becomes a primary
motivator in the continuation of an addiction, the initial primary
attribution of an addictive substance is usually its ability to
induce pleasure, although with continued use the goal is not so
much to induce pleasure as it is to relieve the anxiety caused by
the absence of a given addictive substance, causing it to become
used compulsively.
Some substances induce physical dependence or
physiological tolerance - but not
addiction - for example many
laxatives,
which are not psychoactive; nasal
decongestants, which can cause rebound
congestion if used for more than a few days in a row; and some
antidepressants, most notably
venlafaxine,
paroxetine and
sertraline, as they have quite short
half-lives, so stopping them abruptly causes a
more rapid change in the neurotransmitter balance in the brain than
many other antidepressants. Many non-addictive prescription drugs
should not be suddenly stopped, so a doctor should be consulted
before abruptly discontinuing them.
The speed with which a given individual becomes addicted to various
substances varies with the substance, the frequency of use, the
means of ingestion, the intensity of pleasure or euphoria, and the
individual's genetic and psychological susceptibility. Some people
may exhibit alcoholic tendencies from the moment of first
intoxication, while most people can drink socially without ever
becoming addicted. Opioid dependent individuals have different
responses to even low doses of opioids than the majority of people,
although this may be due to a variety of other factors, as opioid
use heavily stimulates pleasure-inducing neurotransmitters in the
brain. Nonetheless, because of these variations, in addition to the
adoption and twin studies that have been well replicated, much of
the medical community is satisfied that addiction is in part
genetically moderated. That is, one's genetic makeup may regulate
how susceptible one is to a substance and how easily one may become
psychologically attached to a pleasurable routine.
Eating disorders are complicated
pathological mental illnesses and thus are not the same as
addictions described in this article. Eating disorders, which some
argue are not addictions at all, are driven by a multitude of
factors, most of which are highly different than the factors behind
addictions described in this article. It has been reported,
however, that patients with eating disorders can successfully be
treated with the same non-pharmacological protocols used in
patients with chemical addiction disorders.Gambling is another
potentially addictive behavior with some biological overlap.
Conversely gambling urges have emerged with the administration of
Mirapex (pramipexole), a dopamine
agonist.
The DSM definition of addiction can be boiled down to compulsive
use of a substance (or engagement in an activity) despite ongoing
negative consequences—this is also a summary of what used to be
called "psychological dependency." Physical dependence, on the
other hand, is simply needing a substance to function. Humans are
all physically dependent on oxygen, food and water. A drug can
cause physical dependence and not addiction (for example, some
blood pressure medications, which can produce fatal withdrawal
symptoms if not tapered) and can cause addiction without physical
dependence (the withdrawal symptoms associated with cocaine are all
psychological, there is no associated vomiting or diarrhea as there
is with opioid withdrawal).
In the now outdated conceptualization of the problem, psychological
dependency leads to psychological withdrawal symptoms (such as
cravings,
irritability,
insomnia,
depression,
anorexia, etc). Addiction can in theory
be derived from any rewarding behaviour, and is believed to be
strongly associated with the
dopaminergic
system of the
brain's
reward system (as in the case of
cocaine and amphetamines). Some claim that it is a
habitual means to avoid undesired
activity, but typically it is only so to a clinical level in
individuals who have emotional, social, or
psychological dysfunctions (psychological
addiction is defined as such), replacing normal positive stimuli
not otherwise attained.
A person who is physically dependent, but not psychologically
dependent can have their dose slowly dropped until they are no
longer physically dependent. However, if that person is
psychologically dependent, they are still at serious risk for
relapse into abuse and subsequent physical dependence.
Psychological dependence does not have to be limited only to
substances; even activities and behavioural patterns can be
considered addictions, if they become uncontrollable, e.g.
problem gambling,
Internet addiction,
computer addiction,
sexual addiction /
pornography addiction,
overeating,
self-injury,
compulsive buying, or work
addiction.
Management
Early editions of the
American Psychiatric
Association's Diagnostic
and Statistical Manual of Mental Disorders (DSM) described
addiction as a physical dependency to a substance that resulted in
withdrawal symptoms in its absence. Recent editions, including
DSM-IV, have moved toward a diagnostic instrument that classifies
such conditions as dependency, rather than addiction. The
American Society of
Addiction Medicine recommends treatment for people with
chemical dependency based on
patient placement criteria
(currently listed in PPC-2), which attempt to match levels of care
according to clinical assessments in six areas, including:
- Acute intoxication and/or withdrawal potential
- Biomedical conditions or complications
- Emotional/behavioral conditions or complications
- Treatment acceptance/resistance
- Relapse potential
- Recovery environment
Some medical systems, including those of at least 15 states of the
United States, refer to an
Addiction Severity Index to assess
the severity of problems related to substance use. The index
assesses problems in six areas: medical, employment/support,
alcohol and other drug use, legal, family/social, and
psychiatric.
While addiction or dependency is related to seemingly
uncontrollable urges, and arguably could have roots in genetic
predispositions, treatment of dependency is conducted by a wide
range of medical and allied professionals, including
Addiction Medicine specialists,
psychiatrists, psychologists, and appropriately trained nurses,
social workers, and counselors. Early treatment of acute withdrawal
often includes medical
detoxification, which can include doses of
anxiolytics or narcotics to reduce
symptoms of withdrawal. An experimental drug,
ibogaine, is also proposed to treat withdrawal and
craving. Alternatives to medical detoxification include
acupuncture detoxification. A
wide variety of controlled clinical trials, outcome summaries and
anecdotal reports about the use of acupuncture in addiction
treatment have been appearing since the 1970s in journals
specializing in addictions, mental health, public health, criminal
justice and acupuncture. These reports differed vastly in terms of
methodology, populations studied, statistical sophistication and
clinical relevance as well as in their findings about the value of
acupuncture. A sub-category of this published work has focused
specifically on acupuncture detoxification. In chronic opiate
addiction, a surrogate drug such as
methadone is sometimes offered as a form of
opiate replacement
therapy. But treatment approaches universal focus on the
individual's ultimate choice to pursue an alternate course of
action.
Therapists often classify patients with chemical dependencies as
either interested or not interested in changing. Treatments usually
involve planning for specific ways to avoid the addictive stimulus,
and therapeutic interventions intended to help a client learn
healthier ways to find satisfaction. Clinical leaders in recent
years have attempted to tailor intervention approaches to specific
influences that affect addictive behavior, using therapeutic
interviews in an effort to discover factors that led a person to
embrace unhealthy, addictive sources of pleasure or relief from
pain.
Treatment Modality Matrix |
Behavioral Pattern |
Intervention |
Goals |
Low self-esteem, anxiety, verbal
hostility |
Relationship therapy, client centered approach |
Increase self esteem, reduce hostility and anxiety |
Defective personal constructs, ignorance of interpersonal
means |
Cognitive restructuring including directive and group
therapies |
Insight |
Focal anxiety such as fear of crowds |
Desensitization |
Change response to same cue |
Undesirable behaviors, lacking appropriate behaviors |
Aversive conditioning, operant conditioning, counter
conditioning |
Eliminate or replace behavior |
Lack of information |
Provide information |
Have client act on information |
Difficult social circumstances |
Organizational intervention, environmental manipulation, family
counseling |
Remove cause of social difficulty |
Poor social performance, rigid interpersonal behavior |
Sensitivity training, communication training, group
therapy |
Increase interpersonal repertoire, desensitization to group
functioning |
Grossly bizarre behavior |
Medical referral |
Protect from society, prepare for further treatment |
Adapted from: Essentials of Clinical Dependency
Counseling, Aspen Publishers |
From the
applied behavior
analysis literature and the
behavioral psychology literature
several evidenced based intervention programs have emerged (1)
behavioral maritial therapy (2) community reinforcement approach
(3) cue exposure therapy and (4) contingency management strategies.
In addition, the same author suggest that Social skills training
adjunctive to inpatient treatment of alcohol dependence is probably
efficacious.
Causes
Several explanations (or "models") have been presented to explain
addiction. These divide, more or less, into the models which stress
biological or genetic causes for addiction, and those which stress
social or purely psychological causes. Of course there are also
many models which attempt to see addiction as both a physiological
and a psycho-social phenomenon.
- The disease model of
addiction holds that addiction is a disease, coming about as a result of either the
impairment of neurochemical or
behavioral processes, or of some
combination of the two. Within this model, addictive disease is
treated by specialists in Addiction
Medicine. Within the clinical field, the American Medical Association,
National Association of Social Workers, and American Psychological
Association all have policies which are predicated on the
theory that addictive processes represent a disease state. Most
treatment approaches, as well, are based on the idea that
dependencies are behavioral dysfunctions, and, therefore, contain,
at least to some extent, elements of physical or mental disease.
Organizations such as the American Society of
Addiction Medicine believe the research-based evidence for
addiction's status as a disease is overwhelming.
- The pleasure model proposed by
professor Nils Bejerot. Addiction "is
an emotional fixation (sentiment) acquired through learning, which
intermittently or continually expresses itself in purposeful,
stereotyped behavior with the character and force of a natural
drive, aiming at a specific pleasure or the avoidance of a specific
discomfort." "The pleasure mechanism may be stimulated in a number
of ways and give rise to a strong fixation on repetitive behavior.
Stimulation with drugs is only one of many ways, but one of the
simplest, strongest,and often also the most destructive" "If the
pleasure stimulation becomes so strong that it captivates an
individual with the compulsion and force characteristic of natural
drives, then there exists...an addiction" The pleasure model is
used as one of the reason for zero
tolerance for use of illicit drugs.
- The genetic model posits a
genetic predisposition to certain behaviors. It is frequently noted
that certain addictions "run in the family," and while researchers
continue to explore the extent of genetic influence, many
researchers argue that there is strong evidence that genetic
predisposition is often a factor in dependency.
- The experiential model
devised by Stanton Peele argues that
addictions occur with regard to experiences generated by various
involvements, whether drug-induced or not. This model is in
opposition to the disease, genetic, and neurobiological approaches.
Among other things, it proposes that addiction is both more
temporary or situational than the disease model claims, and is
often outgrown through natural processes.
- The opponent-process
model generated by Richard Soloman states that for every
psychological event A will be followed by its opposite
psychological event B. For example, the pleasure one experiences
from heroin is followed by an opponent
process of withdrawal, or the terror of jumping out of an airplane
is rewarded with intense pleasure when the parachute opens. This
model is related to the opponent process color theory. If you look
at the color red then quickly look at a gray area you will see
green. There are many examples of opponent processes in the nervous
system including taste, motor movement, touch, vision, and hearing.
Opponent-processes occurring at the sensory level may translate
"down-stream" into addictive or habit-forming behavior.
- The allostatic (stability through
change) model generated by George
Koob and Michel LeMoal is a
modification of the opponent process theory where continued use of
a drug leads to a spiralling of uncontrolled use, negative
emotional states and withdrawal and a shift into use to new
allostatic set point which is lower than that maintained before use
of the drug.
- The cultural model recognizes
that the influence of culture is a strong determinant of whether or
not individuals fall prey to certain addictions. For example,
alcoholism is rare among Saudi Arabians
, where obtaining alcohol is difficult and using
alcohol is prohibited. In North America, on the other hand,
the incidence of gambling addictions soared
in the last two decades of the 20th century, mirroring the growth
of the gaming industry. Half of all patients diagnosed as alcoholic
are born into families where alcohol is used heavily, suggesting
that familiar influence, genetic factors, or more likely both, play
a role in the development of addiction. What also needs to be noted
is that when people don't gain a sense of moderation through their
development they can be just as likely, if not more, to abuse
substances than people born into alcoholic families.
- The moral model states that
addictions are the result of human weakness, and are defects of
character. Those who advance this
model do not accept that there is any biological basis for
addiction. They often have scant sympathy for people with serious
addictions, believing either that a person with greater moral
strength could have the force of will to break an addiction, or
that the addict demonstrated a great moral failure in the first
place by starting the addiction. The moral model is widely applied
to dependency on illegal substances, perhaps purely for social or
political reasons, but is no longer widely considered to have any
therapeutic value. Elements of the moral model, especially a focus
on individual choices, have found enduring roles in other
approaches to the treatment of dependencies.
- Similarly, the rational
addiction model hypothesizes that addictions (to heroin,
tobacco, television, etc.) can be usefully modeled as specific
kinds of rational, forward-looking, optimal consumption plans. In
other words, addiction is perceived as a rational response to
individual and/or environmental factors.
- Finally, the blended model attempts to consider
elements of all other models in developing a therapeutic approach
to dependency. It holds that the mechanism of dependency is
different for different individuals, and that each case must be
considered on its own merits.
Neurobiological basis
The development of addiction is thought to involve a simultaneous
process of 1) increased focus on and engagement in a particular
behavior and 2) the attenuation or "shutting down" of other
behaviors. For example, under certain experimental circumstances
such as social
deprivation and boredom,
animals allowed the unlimited ability to self-administer certain
psychoactive drugs will show such a strong preference that they
will forgo food, sleep, and sex for continued access. The
neuro-anatomical correlate of this is that the brain regions
involved in driving goal-directed behavior grow increasingly
selective for particular motivating stimuli and rewards, to the
point that the brain regions involved in the inhibition of behavior
can no longer effectively send "stop" signals. A good analogy is to
imagine flooring the gas pedal in a car with very bad brakes. In
this case, the limbic system is thought to be the major "driving
force" and the orbitofrontal cortex is the substrate of the
top-down inhibition.
A specific portion of the limbic circuit known as the
mesolimbic dopaminergic system is
hypothesized to play an important role in translation of motivation
to motor behavior- and reward-related learning in particular. It is
typically defined as the
ventral
tegmental area (VTA), the nucleus accumbens, and the bundle of
dopamine-containing fibers that are
connecting them. This system is commonly implicated in the seeking
out and consumption of rewarding stimuli or events, such as
sweet-tasting foods or sexual interaction. However, its importance
to addiction research goes beyond its role in "natural" motivation:
while the specific site or mechanism of action may differ, all
known drugs of abuse have the common effect in that they elevate
the level of dopamine in the nucleus accumbens. This may happen
directly, such as through blockade of the dopamine re-uptake
mechanism (see
cocaine). It may also happen
indirectly, such as through stimulation of the dopamine-containing
neurons of the VTA that synapse onto neurons in the accumbens (see
opiates). The euphoric effects of drugs of
abuse are thought to be a direct result of the acute increase in
accumbal dopamine.
The human body has a natural tendency to maintain
homeostasis, and the central nervous system is
no exception. Chronic elevation of dopamine will result in a
decrease in the number of dopamine
receptors available in a process
known as
downregulation. The
decreased number of receptors changes the permeability of the cell
membrane located post-synaptically, such that the post-synaptic
neuron is less excitable- i.e.: less able to respond to chemical
signaling with an electrical impulse, or
action potential. It is hypothesized that
this dulling of the responsiveness of the brain's reward pathways
contributes to the inability to feel pleasure, known as
anhedonia, often observed in addicts. The
increased requirement for dopamine to maintain the same electrical
activity is the basis of both
physiological tolerance and
withdrawal associated with addiction.
Downregulation can be classically conditioned. If a behavior
consistently occurs in the same environment or contingently with a
particular cue, the brain will adjust to the presence of the
conditioned cues by decreasing the number of available receptors in
the absence of the behavior. It is thought that many drug overdoses
are not the result of a user taking a higher dose than is typical,
but rather that the user is administering the same dose in a new
environment.
In cases of physical dependency on
depressants of the
central nervous system such as
opioids,
barbiturates, or alcohol, the absence of the
substance can lead to symptoms of severe physical discomfort.
Withdrawal from alcohol or sedatives such as barbiturates or
benzodiazepines (valium-family) can
result in seizures and even death. By contrast, withdrawal from
opioids, which can be extremely uncomfortable, is rarely if ever
life-threatening. In cases of dependence and withdrawal, the body
has become so dependent on high concentrations of the particular
chemical that it has stopped producing its own natural versions
(endogenous ligands) and instead produces opposing chemicals. When
the addictive substance is withdrawn, the effects of the opposing
chemicals can become overwhelming. For example, chronic use of
sedatives (alcohol,
barbiturates, or
benzodiazepines) results in higher chronic levels of stimulating
neurotransmitters such as
glutamate. Very high levels of glutamate kill nerve cells, a
phenomenon called excitatory neurotoxicity.
Epidemiology
[[Image:Drug use disorders world map - DALY -
WHO2002.svg|thumb|
Disability-adjusted life year
for drug use disorders per 100,000 inhabitants in 2002.
]]
In society
The word
addiction is also sometimes used colloquially to
refer to something for which a person has a passion, such as
books,
chocolate,
work,
the web, running, postage stamp
collecting, marijuana, or eating - although
eating disorders are a genuine health risk,
unlike most so-called casual addictions.
Addiction and drug control legislation
Most countries have legislation which brings various drugs and
drug-like substances under the control of licensing systems.
Typically this legislation covers any or all of the opiates,
amphetamines,
cannabinoids,
cocaine,
barbiturates,
hallucinogens (
tryptamines,
LSD,
phencyclidine, and
psilocybin) and a variety of more modern
synthetic drugs, and unlicensed production, supply or possession
may be a criminal offense.
Usually, however, drug classification under such legislation is not
related simply to addictiveness. The substances covered often have
very different addictive properties. Some are highly prone to cause
physical dependency, whilst others rarely cause any form of
compulsive need whatsoever.
Also, although the legislation may be justifiable on moral grounds
to some, it can make addiction or dependency a much more serious
issue for the individual. Reliable supplies of a drug become
difficult to secure as illegally produced substances may have
contaminants. Withdrawal from the substances or associated
contaminants can cause additional health issues and the individual
becomes vulnerable to both criminal abuse and legal punishment.
Criminal elements that can be involved in the profitable trade of
such substances can also cause physical harm to users.
Opposition to common views
Thomas Szasz denies that addiction is a
psychiatric problem. In many of his works, he argues that addiction
is a choice, and that a drug addict is one who simply prefers a
socially taboo substance rather than, say, a low risk lifestyle. In
Our Right to Drugs, Szasz cites the biography of
Malcolm X to corroborate his economic views
towards addiction: Malcolm claimed that quitting cigarettes was
harder than shaking his
heroin addiction.
Szasz postulates that humans always have a choice, and it is
foolish to call someone an 'addict' just because they prefer a
drug induced
euphoria
to a more popular and socially welcome lifestyle.
Professor John Booth Davies at the
University of Strathclyde has
argued in his book
The Myth of Addiction that 'people take
drugs because they want to and because it makes sense for them to
do so given the choices available' as opposed to the view that
'they are compelled to by the pharmacology of the drugs they take'.
He uses an adaptation of
attribution
theory (what he calls the theory of functional attributions) to
argue that the statement 'I am addicted to drugs' is functional,
rather than veridical.
Stanton Peele
has put forward similar views.
Experimentally, Bruce K. Alexander used the classic experiment of
Rat Park to show that 'addicted' behaviour
in rats only occurred when the rats had no other options. When
other options and behavioural opportunities were put in place, the
rats soon showed far more complex behaviours.
See also
Notes
- Consensus Document: The American Academy of Pain Medicine, The
American Pain Society, The American Society of Addiction Medicine,
2001
- Consensus Document: The American Academy of Pain Medicine, The
American Pain Society, The American Society of Addiction Medicine,
2001
- DSM-IV & DSM-IV-TR:Substance Dependence
- AJ Giannini, M Keller, GC Colapietro, SM Melemis, N Leskovac, T
Timcisko. Comparison of alternative treatment techniques in
bulimia: The chemical dependency approach. Psychological Reports.
82(2):451-458, 1998.
- AJ Giannini. Drugs of Abuse--Second Edition. Los Angeles,
Practice Management Information Corporation, 1997.
- Butler SF, Budman SH, Goldman RJ, Newman FL, Beckley KE,
Trottier D. Initial Validation of a Computer-Administered Addiction
Severity Index: The ASI-MV Psychology of Addictive Behaviors 2001
March
- Nils Bejerot in Theories of Drug abuse, Selected
contemporary perspectives, page 246-255, NIDA, 1980
Further reading
External links