What is Addiction?

what is addiction?

Defining Addiction

Addiction is a term that is loaded with stigma, preconceived notions, shame, guilt and misunderstanding. In order to treat addiction effectively, we first have to define it clearly, so that our judgement is not clouded by the baggage that is usually associated with the term. As per the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), what is commonly referred to as addiction is medically termed Substance Use Disorders (SUDs)1. This classification includes both substance abuse and substance dependence. The American Psychiatric Association (APA), the publisher of the DSM-5, defines SUD as “a complex condition in which there is uncontrolled use of a substance despite harmful consequences.”2 While this definition covers the crux of substance-related addiction, such as alcoholism or drug addiction, it does not address behavioural addictions. The underlying structure, however, is the same. Behavioural addiction refers to the compulsive engagement in an activity in spite of negative consequences. Almost any behaviour can become an addiction. However, the most common behavioural addictions we encounter in a clinical setting here at Journey are: – Porn Addiction – Sex Addiction – Gambling Addiction – Gaming Addiction – Shopping Addiction – Food Addiction Simply put, addiction can be defined as the inability to stop a certain behaviour, or the consumption of a substance, in spite of any resulting detrimental effects.

what constitutes compulsion?

A common misconception in the classification of addiction is that someone needs to be using a substance or engaging in a behaviour on a daily basis in order to be classified as an addict. This is an untrue and harmful belief as it regularly causes denial, which in turn impedes one’s process of recovery. This is not to say that some addicts do not use almost constantly, but the majority of individuals who suffer with either an SUD or a behavioural addiction do not.

A telling sign in the diagnosis of an SUD is the cyclical nature of how a patient uses. If an individual only drinks alcohol on the weekends, but does so on most or all weekends, and to the point whereby negative effects begin to creep into their life, this is indicative of an SUD. Similarly, if an individual only bets when a certain sporting event is on but bets whenever it is on and in a manner that detrimentally affects their life, they can be considered to be suffering from a behavioural addiction, more specifically a gambling addiction.

This cycle does not only follow a periodic pattern in a time sense. Instead, the impetus for an individual’s use of a substance or participation in an activity, can take the form of people, places and things. These are colloquially referred to as “triggers.”3 When exposed to a trigger, an individual undergoes an emotional response that may lead to substance or behavioural misuse. For example, an individual who suffers from porn addiction may be triggered by seeing a scantily-clad person. In turn, the emotional response to this visual stimulus would cause the individual in question to watch porn.

The permutations of this process are nearly endless and as a result an important part of addiction treatment is the identification of an individual’s triggers and creating coping strategies for them.

dimensions of consequence

The consequences or negative effects that are referenced in the definition of addiction can take many forms. A common source of denial for patients in early recovery lies in their belief that their problem is non-existent, or not severe enough to warrant concern. To justify this, they might point to the fact that they are still employed and/or that they are financially stable. However, these justifications do not acknowledge there are many facets that comprise a healthy and functional lifestyle. Below are some of the dimensions of one’s life that consequences can affect along with examples of how they can be affected:
– Academic (Non-attendance, lower grades, late submissions)
– Career (Late for work, non-attendance, pushing back deadlines)
– Community (Decreasing the overall sense of security in one’s neighbourhood)
– Emotional (Unstable moods, reduced empathy)
– Family (Lying to family members, not meeting commitments, worsening relations)
– Financial (Spending beyond one’s means, taking out debt) 
– Hobbies (Loss of interest in previously enjoyable activities)
– Mental (Decreased cognitive ability and attention span)
– Physical (Abnormal sleeping patterns, increased risk of certain conditions and death)
– Self-Care (Neglecting personal hygiene, such as not shaving and bathing)
– Sexual (Engaging in risky and reckless sexual behaviour) 
– Social (Isolating and spending less time socialising with others)
– Spiritual (Loss of a sense of peace)

Link between addiction and dependence

The DSM-5 combines the previously separated disorders of substance abuse and substance dependence into one unified SUD. However, it is still useful to explore the differences between addiction and dependence. Dependence refers to the physiological and/or psychological phenomenon in which an individual experiences withdrawal symptoms upon the cessation of use of a substance. This in turn leads to the repeated use of the substance in question in order to avoid the symptoms of withdrawal. For example, an individual who is dependent on alcohol and suddenly ceases to drink may experience psychological withdrawal in the form of increased anxiety and irritability and physiological withdrawal in the form of an increased heartrate and sweating. Dependence on a substance can lead to addiction and vice versa, but it is important to note that neither of these conditions is dependent on the other for a diagnosis to be made. 

bio-psycho-social model of addiction

It is important to note that addiction is a brain disorder and not, as some might claim, a moral failing or lack of willpower. Addiction both stems from and causes structural changes in the brain. While we must recognise addiction as a disease in order to treat it successfully, it cannot simply be viewed through a medical lens. Addiction is referred to as a bio-psycho-social disorder. This means that its causes, symptoms and remedies can be found in biological, psychological and sociological spheres.

Causes Alex has a genetic predisposition to addiction (biological), is high in trait neuroticism (psychological) and lives in a community with high rates of alcohol consumption (sociological). As a result of these factors, Alex develops alcoholism. 

Symptoms – As a result of their alcoholism, Alex develops delirium tremens (biological), becomes extremely anxious (psychological) and starts to have arguments with their family (sociological)

Remedies – To treat Alex’s alcoholism, abstinence is required to allow their brain and body to recover from their alcohol abuse (biological), psychotherapy, such as group therapy and individual counselling, is required to change their behaviour (psychological) and family therapy is required to improve and stabilise their home life (sociological).

At Journey, our approach to treating addiction, and other mental health disorders, is holistic because we understand how broad the causes and symptoms of mental health disorders can be. 

what causes addiction?

Addiction is a complex disorder that is caused by a multitude. 

what causes addiction?

Addiction is a complex disorder that is caused by a multitude.