Addiction: Physical Condition, Mental Illness, or Plain Old Character Flaw?

You’re probably not aware of this, but right now in various medical and psychology journals, experts are arguing about addiction.

You’re probably not aware of this, but right now in various medical and psychology journals, experts are arguing about addiction. With so many stakeholders involved in addiction and addiction treatment, it is difficult to find a consensus. Just exactly what is addiction?

One prevailing definition is that addiction is the persistent desire for something, usually accompanied by the sensation of “craving,” even though its use is harmful or carries with it negative consequences. In other words, addiction occurs when we strongly want something that we know is bad for us.

You can see the problems with that definition. By that definition, watching TV or eating bacon or staying up late are addictive disorders. When it comes to narcotic pain relievers, some organizations say that if you cannot stop the substance without going through withdrawal symptoms, then you are addicted. While opioid addicts are very familiar with withdrawal sickness, this definition falls apart because the long-term use of opioids causes something called physical dependence.

For instance, let’s say a man was in a serious accident and required narcotic pain relievers for six months during his healing. By that time, he would be physically dependent on them and he would need assistance from his doctor to taper off drug therapy so that he did not experience withdrawal. But he is not necessarily an addict. So another contingent has jumped into the fray and said addiction is not physical dependence, it’s psychological dependence. If that man who had taken narcotic pain relievers for six months could taper off the drugs physically but still craved them psychologically, he would be an addict. The problem with that definition is that addiction cannot be measured.

How can you assess psychological “wanting”? And what about addictions to gambling or shopping? Addiction is actually the intersection of a couple of important events. On the one hand, there is an absolute physical reaction to the substance or the behavior such that sets off the brain’s reward or pleasure center. Gambling addicts like gambling; drug addicts like drugs. (Interestingly, many people have an instinctive physical dislike of drugs.)

This is not simply a preference, there is a real pleasure to the object of their addiction that sets off areas of the brain near the amygdala. It is thought that this physical response is what triggers the intense cravings that make it so difficult to kick an addiction. Unfortunately, there is not a great deal known about the brain’s pleasure and reward centers, much less how to adequately turn them off or short-circuit them. Addiction to certain substances may involve a physical dependence that causes withdrawal symptoms when that substance is withheld.

This is the case with drugs, alcohol, and cigarettes. Cigarettes are a good example of an addiction that is far more physical than pleasure-centered. There are smokers who say they do not enjoy smoking but do so to get their nicotine fix.

Some addictions have little to no physical dimension, for instance, video game addictions. There is a psychological aspect to addiction that is often the most obvious component to the family and friends of the addict. Addicts may exhibit the so-called addictive personality, one that is self-absorbed, manipulative, and focused on getting their own needs met even if it comes at the expense of others.

Addicts may appear to others as immature or odd. It is not known if the psychology of addiction is based on physical determinants or whether addiction might be some kind of character flaw. Some people believe that addiction is a mental illness. The addict thinks in an abnormal way and comes to rely on a substance or behavior for comfort and pleasure.

Whereas many of us find support, peace, and happiness in our family, with our friends, or in pursuit of our passions, the addict looks to the object of his addiction. It is not clear to medical science whether or not addiction is a curable condition. It is certainly a survivable condition, but it takes a broad mind to understand all of the potential ingredients in addiction.