What is addiction?
The American Society of Addiction Medicine (ASAM) defines addiction as follows:
“Addiction is a disease characterized by continuous or periodic impaired control over the use of drugs or alcohol, preoccupation with drugs or alcohol, continued use of these substances despite adverse consequences related to their use, and distortions in thinking, most notably denial.”
This definition of addiction as a disease means that it has a fairly predictable course and a constellation of signs and symptoms, associated with a relatively defined pathophysiology and a scientifically validated treatment. With respect to the course of the disease, addicts typically begin by experimentation, evolve into regular but controlled use, and ultimately find themselves in periodic episodes of out of control use that causes impairment in various areas of their lives, either physically or socially. Despite these negative consequences, they continue to use.
Preoccupation with obtaining and using tobacco refers to the fact that the addictive substance plays a central part in their inner and/or outer lives, whether or not they are actively using it.
Thus, maintaining abstinence is only one element in one’s treatment, as the major struggle continues. Distortion in thinking includes, but is not limited to, denial. Also included are the litany of excuses for continued use, the blaming of others, particularly family members and caregivers, for one’s failure to maintain abstinence, and the frequently cited identification with some other emotional problem that really needs to be addressed rather than the drug itself.
The negative consequences play little if any role in modifying the continued use, which is the final aspect of addiction. From the ASAM’s perspective, addiction and dependence can be used interchangeably.
Addictive behaviors may include gambling, sex, drugs, and all of the variations on those themes, which recently include the use of the Internet and involvement with pornography.
From that simple definition, it appears that no biological or pathophysiological process must be invoked.
The addiction may result from the involvement or the pursuit of an activity rather than on what effect the pursuit of the activity may have on the brain.
How can gambling or the Internet have the same effects on the brain as nicotine or alcohol?
There is no receptor specific for gambling or the Internet like there is for nicotine or alcohol. Somehow the behavior and the pursuit of an activity take on a life of their own, to the exclusion of all other activities.
