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Problem 1. What is addiction?
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GGZ2029. Addiction. Problem 1 elaborated: What is addiction?. The notes from the tutorial are added with green. For all tasks, see the bundle.
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Problem 1: What is “addiction”?Learning goals
What aspects are central in defining addiction?
Sinnott-Armstrong, W., & Pickard, H. (2013). What is addiction? Oxford Handbook of
Psychiatry (pp.851-864).
It’s not easy to define addiction, because it takes many forms. Paradigmatic addictive
substances are illegal drugs, including heroin, cocaine, morphine, barbiturates, and
amphetamines. People can also become addicted to legal drugs, including alcohol, nicotine,
caffeine, and prescribed medications, such as benzodiazepines and hypnotics. In addition,
popular culture and expert opinion increasingly count forms of behavior as addictions: for
instance, gambling, sex, work, food, shopping, and Internet surfing or gaming.
Müller and Schumann (2011) identify the following eight goals of non-addictive
consumption: (1) improved social interaction, (2) facilitated sexual behavior, (3) improved
cognitive performance, (4) coping with stress, (5) alleviating psychiatric symptoms, (6) novel
perceptual and sensory experiences, (7) hedonia or euphoria, and (8) improved physical and
sexual appearance. Many of these motivations may survive once consumption becomes
addiction. Further, once addicted, people may use drugs to maintain normal functioning and
avoid withdrawal.
Definitions
Just as there are various kinds of addiction, so too there are various kinds of definition. A
precising definition is needed. It picks out a relatively precise class of conditions that lies
within the limits of common usage but does not reflect all the vagueness of common usage.
The goal of precising definitions is to be useful, either theoretically or practically. Precising
definitions cannot stray too far from common usage if they are not to mislead. Nor should
they conflict with our best scientific or theoretical understanding of the subject matter if
they are to be accurate. But they are judged in large part by their usefulness, relative to a
particular purpose.
A precising definition of addiction should serve several purposes. Clinicians need to decide
whom to treat. They need a definition of addiction that is relevant to that aim. As a result,
there may be multiple definitions of addiction, each appropriate to different purposes and
contexts. Or, if there is a single definition, it will need to include a variable term like
“significant” that gets filled in differently in different contexts.
Appropriate treatment is symptom dependent.
Appetite
Philosophical definitions of addiction tend to be pithy. Foddy and Savulescu define it thus:
“An addiction is a strong appetite”. They define an appetite as: “a disposition that generates
desires that are urgent, oriented toward some rewarding behavior, periodically recurring,
often in predictable circumstances, sated temporarily by their fulfilment, and generally
provide pleasure.” This could be for gambling, sex, work, shopping or the Internet, it does
not restrict addiction to substances. But, their definition hides important differences and
, does not capture the core of our common understanding of addiction, for it allows far too
much to count.
Control
The difference between heavy use and addiction is control. The importance of control in
understanding addiction is reflected in three of the diagnostic criteria of the DSM-IV
definition given earlier: (3) using more than was intended, (4) persistent desire or
unsuccessful efforts to control use, and (7) continued use despite knowledge of resulting
persistent or recurrent physical or psychological problems.
Addicts lack the ability to stop or they cannot stop taking drugs. The physical and
psychological ability to control the use is reduced: the individual lacks the degree of control
that we normally expect to have over our behaviour.
Two account of control are common. One focuses on wants and claims that an agent has
control over a type of action if and only if:
1. If they want overall to perform that type of action, then usually they do it; and
2. If they want overall not to perform that type of action, then usually they don’t do it.
Want-based accounts of control contrast with reasons-responsiveness accounts. On this kind
of account, an agent has control over a type of action if and only if:
1. If they have a strong overall reason to perform that type of action, then usually they do
it; and
2. If they have a strong overall reason not to perform that type of action, then usually they
don’t do it.
These accounts come apart in various cases that are relevant to addiction. First, if agents
have no reason to fulfill some desires, then those agents can act on their desires without
being responsive to reasons. For example, some heavy users claim that they want drugs in
the sense of having a strong desire even though they no longer like them or get any pleasure
from them. So, these users might have control over their drug use on the want-based
account because they take drugs when they want to and cease when they want not to.
However, such users would lack control on reasons-responsiveness accounts if they continue
to use drugs because of their strong wants even when they know that they have little or no
reason to use drugs and strong reason not to use drugs. It is not completely clear which of
these accounts of control is most appropriate for a definition of addiction. There will be
usually spoken in terms of what the agent wants overall.
These factors correspond to the kinds of factors that reduce control over drug use:
1. The desire to use drugs can become strong and habitual. Long-term drug use can affect
neural mechanisms. If they want overall not to perform that type of action, then usually
they don't do it.
2. It takes effort and resolve to keep exercising willpower. Exercising willpower depletes its
strength in the short term but can increase it in the long term. The longer willpower is
exercised, the more depleted resources may become. So, the need for addicts to
persevere in resisting the desire to use drugs may weaken their willpower, potentially to
depletion.
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