What is addiction?

The words addict and addiction are used thousands of times a day in newspapers and on TV and radio. At the same time it is both loaded with meaning, and virtually meaningless. It is a notion that is deeply embedded in our culture and is newly attached to different behaviours almost every week.

This article looks at the concept of addiction, and explains it's meaning and why different people mean different things when they use the term. We hope it will be useful for all those involved in drug and alcohol treatment, other health professionals, people who think of themselves as 'addicted', and those who live or have contact with someone who uses drugs (including tobacco) or alcohol.

Addiction is a pseudo scientific term used to describe (and sometimes label) people who are 'stuck' in a pattern of daily drug or alcohol use. The terms ‘addict’ and ‘addiction,’ in particular, are often used as shorthand labels to convey a number of stereotypical notions about people who take drugs. Even when not used as labels, they are terms that should be used with caution, because they are often understood by drug users and workers to imply belief in the notion of drug dependence as a ‘disease’.

This is mainly because the medical profession and advocates of the philosophy of Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) use the term ‘addiction’ in this way. NA and AA go further and believe addiction to be ‘a progressive and terminal disease’ which ‘can only be arrested by complete abstinence from all psychoactive substances.’ Although these beliefs have been helpful to many people in getting (and staying) off drugs and alcohol, the approach does not work for everyone and has little to offer those who do not want to consider stopping drug use.

Using the terminology of drug/alcohol 'dependence' can be more objective because it implies recognition that dependence on a substance involves a range of physical, psychological and social components.

The history of the idea of addiction
The psychological ‘compulsion’ to continue taking substances is central to the process of dependence. This is driven by a number of factors including the perceived benefits, as weighed against the costs, of continuing a given behaviour and the thought processes and beliefs that surround it. The psychological rewards offered by use of some substances mean that some people are prepared to tolerate enormous ‘costs’ as a consequence of their continued use.

Physical dependence is caused by the body becoming tolerant to a drug and compensating for its’ effects. This process cannot be instant and usually requires daily use over several weeks. If people then stop or greatly reduce their intake of a drug they are physically dependent on, their body will take time to adjust back to a normal state. In the mean time, the body continues acting as if it were there, and they will experience withdrawal symptoms. The substances which cause physical dependence are mainly depressants such as alcohol, opiates and benzodiazepines.

With some drugs, such as cannabis, amphetamine and cocaine, there is no physical dependence. However, people can develop a powerful dependence that is driven by psychological and social factors.

The social situation of a person is important in understanding their dependence, and what might be involved in trying to change it. Living amongst other drug users usually makes changing behaviour harder, as does homelessness and unemployment.

Why do people get addicted?
There is no single answer that explains why some people become dependent on drugs and others do not. The reasons people continue taking drugs are often different from the reasons why they started.

It is probably most helpful to understand dependence on an individual basis, weighing up the relative importance of factors to do with: the person - psychologically, the reasons can be either positive (seeking excitement, fun and being part of a group) or negative (using drugs to gain confidence, escape from problems and traumas); the drug - one reason for initially using a drug may have been because of perceived physical & psychological benefits; after tolerance has been developed, one of the reasons for continued use can simply be to avoid the physical effects of withdrawal; and society - the ease with which the drug can be bought, social status, attitude and behaviour of the person and their close associates.

Another important factor, often overlooked in the search for an understanding of drug dependence, is that of why people say or believe that they are ‘dependent on,’ or ‘addicted to’ drugs. The explanation of ‘being addicted’ is generally more socially acceptable than saying ‘because I like it.’

Consequently, drug users, when questioned by professionals and family, are more likely to use the ‘addiction’ explanation than they might when talking privately with other drug users.

The use of ‘I can’t help it I’m addicted’ as an explanation for behaviour that would otherwise be considered unacceptable, probably lies behind the growing number of things people claim to be ‘addicted’ to, which now include sex, chocolate and even the internet.

Focusing on ‘addiction’ rather than on choices, problems or harm related to drug use can be unhelpful because it limits dialogue and may reduce the choices people feel they have open to them.