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Defining Addiction: What are the necessary attributes?

09/15/12 | by the professor [mail] | Categories: General, Nomenclature

Link: http://AddictionScience.net

We have chosen to define “addiction” as a behavioral syndrome where drug use and procurement seem to dominate the individual’s motivation and where the normal constraints on behavior are largely ineffective. There are other important attributes of addiction that are usually included in various definitions of this term. The question of interest is whether other attributes are necessary components of a formal definition or whether they add needlessly to the number of terms used to define what we mean by “addiction.” Succinct definitions not only ‘save words,’ but they keep the focus on the primary variable(s) of interest and help to prevent confusing effects with causes in our definitions. The definition adopted here is less than 25 words, and there are definite advantages to keeping definitions sufficiently short so as to simply memorization and to facilitate accurate conveyance amongst those discussing the same phenomenon. One of the biggest challenges to any discourse, whether it be lay, academic or professional, involves semantics or making sure that all parties are actually discussing the same thing. Succinct, consensually accepted definitions facilitate conversations at all levels.

The “Pizza and beer” syllogism is perhaps the most famous example illustrating how a statement that seems logically correct leads to an erroneous conclusion.

  • Pizza and beer are better than nothing.
  • Nothing is better than going to heaven.
  • Therefore, pizza and beer are better than going to heaven!

The syntax is logically correct, but there is a breakdown in semantics involving the meaning of the word “nothing” that invalidates the apparent conclusion. In the first context “nothing” refers to “the absence of anything,” while in the second context it refers to “no-thing.” It is critically important to avoid these types of semantic breakdowns in discussions of addiction, and thus the need for a concise definition that identifies the defining attribute(s) of an addiction while relegating the others characteristics often included to descriptive text.

Addiction is often defined as “a chronically relapsing disorder” or “disease” (whether addiction is indeed a “disorder” or a “disease” is a point of considerable debate in itself; see Drug Addiction as a "Disease"). The phrase "chronically relapsing" certainly describes an important characteristic of an addiction, but is it necessary in a concise definition? The intense motivational strength of an addiction not only predicts the high relapse rates, but it also predicts other attributes of addiction such as motivational toxicity which describes the drug’s impact on normal motivated behaviors such as eating and sexuality. The fact that a single attribute (i.e., motivational strength) can predict from simple logical deduction several other characteristics that are commonly seen in addiction makes this single attribute more valuable as the defining characteristic than is compiling an unnecessarily longer list of characteristics for inclusion in the formal definition of addiction. These other commonly observed features are perhaps best considered simply “characteristics” of an addiction because they can all be derived from the single defining attribute (i.e., high motivation for drug administration). This same logic also applies to adding “motivational toxicity” to formal definitions of addiction. While it may appear to be a defining characteristic, the motivational toxicity inherent in an addiction can also be predicted by simply understanding that addictive drugs produce an intense motivational state and thus even if they lacked their ability to blunt the rewarding impact of natural rewards they would still seemingly overtake the normal motivations in the individual’s life. The same might be said for the second characteristic included in our definition, specifically, that “the normal constraints on behavior are largely ineffective,” but this phrase not only underscores the intense motivation to obtain the addictive drug but also reminds the reader that motivational strength is reflected not only in how hard one will work for the goal object but also by the willingness to overcome aversive conditions which might normally inhibit goal-directed behavior.

Other considerations for inclusion in a comprehensive definition of addiction include the addict’s perceived sense of a “loss of control.” Again, this variable might be deduced simply by considering that the normal choice perceived when several, closely competing goals which vie for the individual’s ‘attention’ and behavior are obviated by a single, overwhelmingly strong motivator—the addictive drug. In other words, the cognitions associated with classic approach-approach and approach-avoidance conflicts might give rise to a sense of ‘choice,’ and these conflicts are less prominent in cases where the motivation to ‘approach’ the goal object (in this case, use the drug) is so strong as to dominate unquestionably the other motivations. In such cases the perception of choice might be absent and the individual may feel that they no longer have control over their own behavior, but rather, that they are being driven by some external force. In a sense they are correct—the stimulus properties of the drug and other cues in conjunction with the (largely unconscious) anticipation of reward engage the individual’s behavior in a manner consistent with the notion of “enslavement” to the external agent (i.e., functionally the drug is serving as the ‘master’ and the addict as the 'slave'). As discussed elsewhere, this apparent “enslavement” is consistent with the etymology of the term “addiction” and adds credence to the use of the term in this fashion as opposed to the popular misconception of “addiction” as physical dependence upon a substance.

The last consideration that might be addressed by our definition of addiction is whether we consider it a disease or a disorder. The definition used here avoids this debate by simply defining “addiction” as a “behavioral syndrome.” Whether it is truly best considered a disease or a disorder is moot for our definition which emphasizes the behavior of the individual as being the primary descriptive variable and hence is consistent with the term’s etymology of "addiction" as "enslavement." As discussed elsewhere, the disease-disorder debate resolves down to one largely of who ‘owns’ the territory—the medical establishment or psychologists, counselors, and social workers (see Drug Addiction as a "Disease"). There are of course other important considerations for whether a pathology is considered a disease or disorder, such as locus of control—biological or more “psychological”—along with the ensuing implications of how to best approach treatment and the degree of individual responsibility for their own ‘problem’ (e.g., the use of the term “disease” implies that the individual has relatively little control over the course of the pathology and that some external treatment is necessary to remediate the problem). There would appear to be no advantages to including the term “disorder” in a formal definition of addiction, but additional characteristics conveyed by the use of the term “disease” merit further consideration for future revisions to our ‘working’ definition. On the other hand, the use of the term disorder would imply that addiction is not a disease, while the description as “a behavioral syndrome” avoids pronouncement on this hotly debated topic.

It is always tempting when formulating definitions to be all encompassing or at least to describe enough of the phenomenon under discussion to vividly illustrate its many facets. Indeed, the more one knows the more eagerly one tries to share their knowledge with anyone and everyone who will listen. Understanding the many aspects of addiction, something shared by more than a few researchers and clinicians, seemingly implores one to offer mini-lectures or tutorials at every opportunity. And when it comes to formal definitions, the desire to share all often gets the best of even academic scholars who should understand well the need for concise definitions devoid of superfluous adjectives. Nonetheless, multifaceted phenomena like addiction are often described from the perspective of individual disciplines studying only one or a few of its many features without trying to identify a common underlying variable responsible for the various attributes.

In this way most definitions focus too much on the vicissitudes of addiction which distract from the core phenomenon responsible for these other, secondary characteristics. Indeed, this often overshadows the primary characteristic of an addiction. In other words, the motivational characteristic of an addiction (which is used here as the basis for its definition) produces the other features such as “chronically relapsing disorder,” the addict’s “perceived loss of control,” and even the “motivational toxicity” inherent in an addiction. Inclusion of these other, secondary characteristics tends to obscure the primary characteristic of the addiction and in some respects seemingly confuses its effects with its cause (i.e., the intense motivational strength can be viewed as the cause and these other features as effects of the addiction!) This is an example of why good science strives to simplify things, to render them in their simplest, not most complex, terms; good definitions like good theories retain a vision of “the forest for the trees,” hence not letting the details obscure the bigger picture. In case anyone is still wondering whether a useful definition of addiction can be resolved down to just 25 words or less the answer is yes, indeed it can, and we are better off ‘keeping it simple stupid’ to ensure the semantic integrity of our discussion of this seemingly complex, multifaceted phenomenon.

So what do we have nearly 1400 words later when we’ve finished with this relatively brief examination of the terms frequently used to define addiction? We’re right back where we started: “addiction” can be defined as a behavioral syndrome where drug use and procurement seem to dominate the individual’s behavior and where the normal constraints on behavior are largely ineffective. The difference between the closing and beginning positions of this discourse lies in the certainly with which we succinctly define addiction—acknowledging the phenomenology of these other important attributes, but rendering their incorporation into a formal definition of addiction (albeit a ‘working’ one) unnecessary.

The podcast of this presentation can be downloaded from our ASNet Podcast Directory.

Click here to listen to the podcast without downloading (length: 11min48sec). Click on the ASNet podcast logo (Anpu) to pause the imbedded player.

Other related commentaries:
A Primer on Drug Addiction
Distinguishing Drug Abuse from Drug Addiction
Drug Addiction as a "Disease"

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