Laymen and professionals alike often ask for a quick synopsis of what causes addiction—a succinct summary resolved down to 25 words or less. The problem is that addiction, like many behaviors, is far too complex for such a simple rendering that is easily understood beyond its most superficial context (see the closing remark for a brief, 25-word summary of the cause of addiction). And ironically, what is perhaps the most complex endeavor of science (i.e., the study of human behavior) is usually considered so simple by most people that anyone without proper training should be able to grasp instantly its most complex principles and corresponding explanations of behavior. So goes the science of addiction.
One of Einstein's most famous formulations in theoretical physics is expressed simply as E=mc(2). This elegantly illustrates how complex theories in science can sometimes be resolved down to very simple expressions. And while most well-educated students may be able to recite the terms in this equation (i.e., "the amount of energy released equals the mass times the speed of light squared"), few really comprehend its meaning beyond the most superficial terms.
Psychology is far more complex than theoretical physics. Not because of the detailed mathematical derivations upon which it is based nor even the I.Q. points necessary to seriously ponder its most advanced principles, but because of the number of variables that must be considered with even a seemingly simple behavior. (In physics, this is analogous to the number of simultaneous equations that must be solved to resolve the problem.) Einstein is reported to have considered physics relatively simple (pun added , apologies to Prof. Einstein), but he considered behavior complicated. So if Einstein considered what most of us consider complex as simple and what most people consider simple as complex, how confused is the state of science today?
Understanding drug addiction, like understanding most aspects of psychology, requires years of careful study which builds upon certain elementary principles and extends to theoretical formulations which fill the gaps in present knowledge. Some topics like drug addiction require additional training in behavioral neuroscience and in psychopharmacology to really understand 'how drugs work in the brain' to produce the strong motivational effects that define addiction. One of the most surprising aspects of my course on Drug Addiction for many undergraduate psychology majors is that "drug addiction involves the action of certain drugs on the brain!" And may the gods of knowledge protect the educator who attempts to explain to the average drug addict that THEY are not the ultimate expert on their addiction: people like to retain the misbelief that they somehow understand and control their own behavior even when faced with overwhelming evidence to the contrary. (Considering addicts, or any other individual for that matter, to have a real understanding of the causes of their own behavior derived from an amateurish 'self-examination' is tantamount to returning the pre-20th Century psychology of introspectionism. Regression is one thing, but losing over 100-years of progress in the field of psychology is inexcusable.)
The tele-psychologists pander to this desire for a quick and simple explanation to a rather complex behavior. The attention span of their audiences, and indeed the attention span of many tele-psychologists themselves, does not permit a more detailed, scientific explanation of the behavior, and it profoundly objects to the notion that some basic understanding of fundamental principles of psychology and psychopharmacology are requisites for understanding why people take drugs. By seeming to provide quick and easy explanations for drug addiction, they do a considerable disservice to the science of addiction and to the addicts themselves (See Dr. Phil’s “Addiction”.).
True drug addiction is relatively simple to understand for those with the appropriate training. The many causes of drug abuse and misuse are more varied and are therefore much more complex. (This is one of the reasons distinguishing between drug abuse and drug addiction is important.) Even alcohol addiction is more complex than addiction to other drugs. And experimental drug use (to a limited degree) is too often seemingly a 'normal' part of adolescent behavior. The desire to understand complex behavior often exceeds the empirical database for establishing cause-and-effect by traditional scientific criteria. The extension of 'understanding' into the realm of the unknown requires sound logic based upon careful examination of the available empirical evidence and systematic theory development; such constitutes the science of addiction today. An understanding of this process simply cannot be conveyed meaningfully in a concise 25-word summary to those not adequately trained in the field, much to the frustration of the specialists, laymen and ‘professionals’ alike.
In conclusion, addiction involves differential perturbations in mesolimbic dopamine and other neural systems mediating incentive motivational processes that produce a profound incentive contrast with consequential motivational toxicity. Or stated even more simply, E=mc(2)!
For those who are still not getting the point of the commentary let me add one last explanation of what I'm trying to convey: if I do give you the succinct, 25-word or less reply to your question that you demand, you simply won't understand the answer! Now get it? E = MC(2), a nice, succinct explanation that tells a lot in a few words or symbols but which relatively few people truly understand.
The above commentary is my response to those who ask for a quick and simple explanation of what causes drug addiction. Really, would anyone expect to actually understand how two little acetyl groups substituted for a couple of hydroxls on a morphine molecule makes heroin which is preferred over morphine in choice tests without having first taken organic chemistry or studied a bit on their own?! But in psychology, everybody thinks they can understand what we've spent years studying summarized in a simple, 25-word or less explanation. So what causes drug addiction?
Brain + (the right) drug x enough exposure = addiction.
Hey, I kind of like that! It's sort of Clark Hullian and I liked that dude (viz., the dominant force in mid-20th Century experimental psychology that you've probably never heard of). If you recall his equation describing motivated behavior, then you likely understand mine too.
Dr. Phil and other tele-psychologists promote fundamental misunderstandings about addiction. Playing out in a type of public psychodrama, the inflicted guest is usually told how the problem is easily solved “if you only . . .” as the ‘all-knowing sage’ offers insight (and often resolution) within a single 60-minute episode. This kind of 'pop psychology' is replete with misinformation about addiction—what it is, its nature, and its treatment. Increased sensitivity to the problem of addiction notwithstanding, the misinformation promoted on such popular television programs as Dr. Phil and Oprah does a considerable disservice to addiction science as well as to the addicts themselves. Much of the misinformation may be promoted out of ignorance but some is motivated by commercial interests. The sad fact is that the pain and misery of addiction ‘sells’ and the turmoil of those affected both directly and indirectly is commonly exploited by the popular media: rating points go up as the tissues come out.
Addiction technology transfer attempts to narrow the gap between what is known from the science of addiction and what is commonly practiced in the clinic, promoted on talks shows, and believed by laymen in general. A primary mission of the ASNet is to help narrow this gap through its addiction technology transfer initiative. Indeed, this ‘thread’ is part of that effort. Other efforts include the Addiction Science Network website, university courses, and public lectures. And although this work may seem to have a small impact against the rising tide of tele-psychologists exploiting addiction for rating points, “it’s better to light a single candle than to curse the darkness.” So here’s a flicker of a flame which hopefully contributes to the work of others slowly narrowing the gap between knowledge and ignorance.
Some of the common fallacies promoted by 'talk show' psychologists and other popular media include the following.
Addiction describes any obsession with something that is stronger than the desire most people experience. This type of fixation can occur to almost anything because it is an attribute of the individual and not related to the actual object being desired.
This is one of the most fundamental misunderstandings about addiction and the proper use of this term. There is a wide range of motivational levels individual people express for normal rewards. Being on the upper tail of a normal distribution remains part of that NORMAL distribution. For example, a particularly strong desire to improve ones life by attending college despite personal hardships may be atypical but it is not pathological!Addiction describes a behavioral syndrome where the use of a substance seems to dominate the individual’s motivation and where the normal constraints on the individual’s behavior seem largely ineffective. This is caused by disturbances in normal brain chemistry that can be produced by the use of certain types of drugs (i.e., addictive drugs) and may also occur with the use of some other substances and even with non-chemical rewards in some people predisposed to developing an addiction. It does not involve any kind of psychological fixation caused by arrested psychosexual development in the Freudian sense nor does it involve the same process as that found with obsessive-compulsive disorders. Addiction is distinctively different from normal motivation and from other mental illnesses and therefore merits its own unique classification as a behavioral disorder. The single most prominent feature of addiction is the intense motivation to take the drug, motivation that exceeds the motivational level seen for most natural rewards. Consequential to this is a disruption of the individual’s normal motivational priorities (i.e., motivational toxicity) which is subjectively experienced typically as a sense of “loss of control” over ones own behavior.
Common gateway drugs propel the individual to seeking stronger and stronger psychoactive substances to escape reality or to self-medicate some underlying psychological disorder. Use of marijuana or even tobacco products is a necessary step in developing an addiction and suppressing the use of these substances would prevent most cases of addiction.
A corollary of this premise is that the distinction between hard and soft drugs becomes blurred because soft drugs are actually just one step below the use of hard drugs in the genesis of an addiction. And it also follows that the medicinal use of marijuana is unacceptable (despite its demonstrated effectiveness in certain disorders) because it will lead not only to marijuana addiction but addiction to hard drugs such as cocaine and heroin as well. Of course most people who experiment with hard drugs have first experimented with soft drugs, but this is no reason to assume that soft-drug use was a necessary first step or that it somehow goaded the individual into using hard drugs. (For another example of falsely attributing cause-and-effect from similar data, see The Power of the Blog: We did It—Medical Marijuana is Almost Here!) People who experiment with drugs tend to ‘experiment with drugs!' This leads to an increased likelihood of trying a highly addictive drug and developing an addiction. However, people can easily side-step experimentation with soft drugs and begin experimentation with heroin or cocaine if those are the only drugs available. The use of soft drugs such as marijuana in no way ‘propels’ most individuals into hard drug use. It’s even possible many that people who experiment with soft drugs somehow satisfy some adolescent need to try drugs as an expression of independence and social defiance, and if only hard drugs were available the incidence of drug addiction would be even higher.
This and the following false premise are related to the "denial of brain disorder" problem addressed by ASNet's addiction treatment-facility rating project. Part of the problem may be one of semantics and failing to distinguish drug abuse from drug addiction. But this distinction is often deliberately blurred to incorporate the severe emotional and behavioral turmoil of addiction with simple cases of drug abuse which are more easily remediated.
The notion of the curative power of 'insight' is used to justify the seemingly endless 'psycho-rumination' which discusses over-and-over the addiction in telling emotional terms until the 'flash of light' illuminates the true source of the problem and the desire for drug use stops. There are cases where this type of 'psychotherapy' may be useful, but it has little impact on true drug addiction which has a biological basis.
Most addicts relapse to using drugs. If this were the sole criterion for treatment effectiveness, drug addiction treatment would be deemed ineffective. But effective treatment does increase the time before relapse, and drug addicts often re-enter treatment making progress each time towards eventually remaining drug abstinent for a sufficiently long period to consider the treatment overall effective if not 'perfect.' So treatment does work even though addicts typically relapse, but there's no 28- or 90-day program that magically saves the addict from their addiction. Too many treatment facilities promise unrealistic results and focus on treatment approaches that are known to be ineffective while enhancing the psychodrama aspects of addiction.
On the positive side, the portrayal by tele-psychologists often promotes:
So the question open for comment is:
Do tele-psychologists like Dr. Phil do more harm than good for understanding and treating drug addiction?
And subtopics include specific examples where the popular portrayals of addiction help and hinder a better understanding of this disorder. Of course general comments on "Dr. Phil's [portrayal of] Addiction" are also welcomed.
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