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Addictions

Definiton of Addiction Continued

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D.

3. Definition of Addiction includes repeated involvement despite substantial harm.

The definition of addiction: Addiction is repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

depressed man smokingThe definition of addiction includes four key parts. In this section, we discuss the third part of the definition: repeated involvement despite substantial harm. You could experience significant negative consequences ("substantial harm") from substance use or an activity but we probably would not label your behavior an addiction unless it happened regularly. For instance, the first time someone gets drunk they might have serious car accident. We would probably not label the person an alcoholic, even though "substantial harm" occurred. Or let's imagine that your son, age 28, gets drunk at his younger sister's wedding. He throws up on the wedding cake. He calls his sister a whore. He drops Aunt Sally on the floor while he's dancing with her. Next, he proceeds to pass out on the dance floor. For the five years before this wedding day debacle, he consumed no more than 1-2 drinks, a few times a month. Are you ready to call him an alcoholic? Probably not. Are you upset? You might be very upset! It becomes evident that addiction refers to a repeated behavior despite negative consequences.

Ordinarily, once the costs of an enjoyable behavior pile up, people will begin to naturally restrict or quit that behavior. This is another fact that distinguishes addictive behavior, from merely "bad behavior." Many people temporarily indulge in pleasurable activities that we might term "bad behavior." These may include drinking, drugging, indiscriminate sex, gambling, excessive consumption of entertainment, and overeating. All addictions begin in this rather normal realm of the pursuit of pleasure. The problems of addiction do not develop because of these pleasurable activities. Addiction becomes evident when someone seems to be unable to limit or stop these pleasurable activities. They seemingly demonstrate a "loss of control." Thus, the problem of addiction is not that someone enjoys these pleasures. The problem of addiction is that they cannot seem to stop.

Imagine that someone goes gambling for the first time.  Win or lose, it's fun. Sometimes it's very fun. Not too much money gets spent. The experience is affordable, relative to that person's income.  What's the harm in that?   Now let's imagine that same person goes to a casino again, planning to spend  $100 dollars, just as they did the first time.  However, this time they keep getting credit card cash advances for much more than they can afford. By the end of the evening, they blew their entire paycheck. They may feel a lot of remorse and regret about what happened.  Most people would not wish to repeat that experience, and thankfully most do not.  However, people who develop addiction will repeat that experience and return to the casino, spending more than they can afford.   This occurs despite the commitments to themselves or to others to "never to do that again."  This quality of addiction bears further explanation.

As someone's addiction progresses (gets worse), that person feels "out-of-control" or "powerless" over their own behavior.   Despite their best intentions to remain in control of their behavior, there are repeated episodes with more negative consequences. Sometimes the person is aware of this reduced control.   Other times they may deceive themselves about how easy it would be to quit "anytime I want to." Ultimately everyone must make their own decision about whether to change a particular behavior.  But, the requirements for making changes to our behavior are frequently under-estimated. They often require a great deal more effort and determination than someone realizes.

Family and friends are less easily deceived. These episodes of reduced control are more obvious to other people. Family and friends often wonder, "Well since you seem to believe you can control this behavior, why don't you?!" A person in relationships with someone who is developing an addiction can feel betrayed. Their loved one seems so different. Their "choices" seem to be incompatible with their usual goals, commitments, and values. If a close friend or family member attempts to address this pattern ("Don't you realize you have a major problem and you need to quit?!") the result can just as easily become a major argument rather than a major change of behavior. People with addictive problems are rather adept at turning the tables, and blaming others. "I wouldn't have to drink so much if you weren't such a nag." Instead of admitting a problem exists, a person developing an addiction may deny the existence of any problems. On the other hand, they may suggest their "complaining" partner exaggerated the problem, or even caused the problem. It is often difficult to determine whether people genuinely believe these ideas, or are simply unwilling to face the frightening thought that they might have a problem.

In some cases, there may be sincere regret followed by a promise to change. After enough broken promises to change, promises are no longer believable. Family and friends settle into expecting the worst and trying to live with it. Alternatively, they may actively express their legitimate anger and frustration. The arguments and tension can be severe.

4. Definition of Addiction includes pleasure and/or value.

The definition of addiction: Addiction is repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

The definition of addiction includes four key parts. In this section, we discuss the fourth part of the definition: pleasure and/or value. You might begin to wonder why they begin in the first place. Why would someone want to do something that brings about harm? The answer is deceivingly simple: because at first it was pleasurable, or at least valuable. The addicted person might find it "valuable" because it reduced anxiety. Maybe it provided a temporary escape from dismal circumstances or sheer boredom. Perhaps it helped to briefly relieve depression. In fact, people are genetically predisposed to repeat things that are rewarding or bring about pleasure as this ensures our very survival. Without this genetic predisposition we would not eat or reproduce.

Therefore, only individuals with prior positive experiences with a substance or activity are vulnerable to developing an addiction. If you smoke pot a few times, and every time it makes you highly anxious and paranoid, you probably would not keep smoking. If you dislike the taste of alcohol and how it makes you feel, will you continue to drink? So, addiction begins because "it" was once pleasurable, rewarding, or valuable.

Notice our definition includes the concept that the substance or activity may no longer be pleasurable and/or valuable. In fact, over time many addictions become very unpleasant. Despite this fact, what usually remains pleasurable, valuable, and rewarding is the release from the powerful cravings that develop. Sometimes this is called cravings-use-pleasure-rest cycle.

 

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