Help sort out the meaning of "addiction."

Great Debates
1

In this thread, the topics of what constitutes alcoholism, what constitutes addiction, and what constitutes “a problem with drinking” have come up and become intertwined.

Triskadecamus has made a number of statements that I find very problematic, including:

While the thread in question concerns some rather alarming behavior on the OP’s part (sorry, but it is kind of worrisome to me!), I think that these statements are hyperbolic and grossly inaccurate, and misrepresent the meanings of alcoholism, substance abuse, and addiction.

At the same time, there’s a stigma on drinking and substance use in our society such that I’m afraid by contradicting these, I’m gonna get labeled as an alcoholic myself–because who but an alcoholic would argue against such ideas? (There, I said it, and that’s out of the way).

So let’s get to it. What are some useful definitions for “alcoholism,” “substance abuse,” and “addiction”? What other words do we need to define to discuss this subject meaningfully? Do these words have purely physiological definitions? Purely sociological definitions? Purely psychological definitions?

My off-the-cuff definitions, which I’ll probably revise as the thread goes on:
Substance Abuse: the use of a mind-altering substance in a manner that impairs the user’s ability to function in society.
Alcoholism: Let substance=alcohol; substance abuse.
Addiction: A developed psychological or physiological dependence on a substance or behavior.

This last one gives me the most trouble, because I’m apparently addicted to driving, to using electric light, to eating pasta, to cooking with spices, etc.

Daniel

2

This is what nagged me the most about Triskadecamus’s post as well. She says that if anyone drinks alcohol because buzzing is fun, they’re alcoholics. It doesn’t matter how rarely or how little they drink, alcoholics they are.

So if I play cards because it’s fun, I’m addicted to playing cards. Could I quit playing cards? Certainly. Will I? No, because it has no negative effects on my life. Would I if it did? Yep. Not much of an addiction, is it?

Calling occasional recreational drinking “alcoholism” leaves the word “alcoholism” meaningless.

3

Medically, Triskadecamus has made some errors.

Not even close. To be an alcoholic, I’d not have to consume alcohol for its recreational psychoactive effects, BUT ALSO do so in a way that significantly effects my health or normal life activities. It’s alcoholism if it causes liver damage. It is also alcoholism if it causes me legal problems (say, drunk driving), or otherwise impairs my life (say, I lose jobs because of drinking.) If I just one day drink to the point I am obviously tipsy on day while watching a sports game on TV with some friends, and then have a designated driver get my back home safe, this is nowhere near alcoholism. Mere harmless occasional use of alcohol != alcoholism per the DSM IV classification. Even AA wouldn’t consider that alcoholism.

Here he contradicts himself. “Continual abuse” is far different than occasional, harmless recreational use.

Basically, you are mostly correct in the rest of your post in terms of how medicine looks at things. More specifically:

Just add in also about materially harming one’s health. Some wealthy heroin addicts never have problems functioning in society. They can always afford their fix. However, if the OD and die one day…

This is correct. Note “substance abuse” != addiction. With certain drugs, opiates stand out here, one can be addicted and it never affects the ability to function is society. I’ve known a doctor with a long term addiction to medically pure opiates who never had trouble functioning in society. A doctor with access to medically pure opiates would be able to never risk an overdose. OD tends to be a problem when doses are uncertain (as in street heroin.)

4

Exactly.

5

For the record, I, a sober alcoholic, said:

I strongly disagree with Triskadecamus. I think that’s a very radical and subjective view on what constitutes alcoholism, one that I have not seen echoed by experts on addiction.

Going out for a drink with friends is social thing. People kick back and unwind, and ideally this creates a convivial atmosphere. (You can do this without alcohol, too.) But I hardly think that’s addictive behavior. It seems to me more of an occasional cultural ritual than a collective response to an addiction.

Emotional reasons: if you’re angry or anxious or otherwise upset about something, I also don’t think having a drink or two constitutes addictive behavior. Now, if your life is shit and the only thing you have left is a desire to completely escape (at least in your mind) by getting blotto, then there could be a problem.

A desire to feel the effects of the drug: Alcohol (at least in moderation) produces a pleasant sensation. We also seek out other forms of pleasure: food, chocolate, sex. Does indulging in your favorite dish, or having a good shag, mean you’re a food or sex addict?

I’d like to see cites that support Triskadecamus’s views. Again, I’ve never come across anything like this from reputable, recognized experts on addiction. I could be wrong.

6

Heh, turns out there may not be much of a debate here. (In case it’s not clear, Scott, I think your position both here and in the other thread is very reasonable).

I think of alcoholism like the lush in The Little Prince:

Why do you drink?
I drink to forget
To forget what?
To forget my sorrows.
What are your sorrows?
That I drink
Why do you drink?
I drink to forget…

Daniel

7

Thank you. In recovery I’ve encountered a few hard-liners – no, that’s not a strong enough term – fire-and-brimstone evangelical types who condemn pretty much all alcohol use. My personal opinion is people like that are really, really bitter and resentful about not being able to drink like a non-alcoholic, so deep down they start believing that no one should drink because they can’t. The ones who tell newcomers on psych meds to throw them away – more than stupid and irresponsible, but dangerous.

(Not that I’m a big AA-er anymore, but for the record, AA has no opinion on outside issues, and that includes meds.)

If you can drink “normally” (by that, I mean not in an alcoholic manner), more power to you. Consider yourself lucky. I wish I could, but I know I can’t, and my three-year slip more than proved that (while at the same time destroying my life).

I drank because I was depressed – or was I depressed because I drank? In the end, I just kept drinking, and became more depressed, so I drank more… I knew could get rid of at least one of those problems just like that, so I did. And what do you know, my mood improved within days.

8

Well, it wasn’t fire and brimstone, and I did not say everyone needs to be treated (or join AA) or even avoid alcohol. What I said was that if you drink alcohol for reasons that are different from your reasons for drinking lemonade, the difference is the nature of the drink. Alcohol is a drug. It is a drug the first time you use it, and every time you use it. Taking drugs for recreational reasons is addictive behavior. Every person who exhibits addictive behavior is not dysfunctional. But they are exhibiting addictive behavior.

I don’t condemn anyone for drinking. I don’t think it matters much if I do, or not, but I don’t. Alcoholism is not a problem for a lot of people. But it is a matter of degree, not a matter of actual definition. No one has a problem if you drink coffee every day. Coffee every day can kill you. But no one attends coffee anonymous meetings. There are no support groups, or on line discussion groups about coffee drinking. Nor for lemonade, or apple juice, or any of a thousand other beverages. Alcohol is unique in this.

Pretending that there is some “safe” level of use is ignoring the real nature of it. Can you drink without suffering from your addiction? Yes, you certainly can. Lots of people do. That doesn’t change the fact that the metabolic processes that make you become dependant on alcohol do take place with even moderate or infrequent use of alcohol. Now, that isn’t a condemnation of drinking for the buzz. Using some drugs “just for the buzz” will get you prison time. Alcohol has a better lobby, so it’s legal. Everyone makes choices. But thinking that your choice trumps chemistry is ignoring the truth. I drink, every now and then. But I don’t try to convince myself that my drinking is somehow better than someone else’s drinking. I don’t have a problem with addiction to alcohol. But the process of chemical dependence happens every time I drink. Once upon a time, that happened fairly often. Now it only happens a couple of times a year. I don’t have a problem with drinking. I don’t need to feel that I am not becoming addicted, or that I am somehow better than an alcoholic is. I drink because I like the taste. If I don’t like the taste, I stop drinking. So, in that respect, I am different from some alcoholics, since they drink in spite of the taste. But we both experience the same chemical effects, which include physical accommodation by our bodies to the use of a drug.

The only reason it’s a problem is that the judgement of how much is too much, and when to stop is being made by someone who is drunk, or at least intoxicated. Habit is both a repetitive learning method, and a name for addiction. Which one is the better definition is pretty unimportant, if you have a habit of using an addictive drug. If you drink by habit, or by social pressure, or whatever other reason that would sound ridiculous if applied to Kool Ade, then it’s about the drug, not the drink.

I think there is a strong feeling that I am condemning everyone that ever drinks. I am not. But I think it is a foolish thing to think that the addictive effects of alcohol are only present in the case of frequent or excessive drinking. I think it happens one drink at a time. I think it happens to everyone. I think a lot of people don’t have a problem with it. I think a lot of people don’t recognize it as a problem, and yet do have a problem.

Tris

By the way, Tris is a guy.

9

And yet, I have a physiological caffeine addiction.

10

Me too! And giving it up was the pits!

Tris

11

How do you figure?

12

The problem being, Tris, that you’re either seeing pathology where it doesn’t exist by any rational definition, or you’re redefining “addiction” to mean “using a mood-altering substance.” Those are both untenable. There are physicians who study addiction and specialize in its treatment; the definition used is based upon the consequences: if you continue using a substance in spite of serious consequences, you’re addicted. You can you hedging language like “addictive behavior” in order to semi-condemn recreational use of substances, but your use of the word “addictive” is most assuredly not consonant with the definitions used by experts. (Note also, and this is not relevant to the point, but it’s something that bugs me: the dichotomy many people seem to create between “physical” and “psychological” addiction is meaningless and has no relation to reality.)

Tris’s definition becomes even more difficult when you consider that many people become addicted to various thrill-seeking behaviors like sex, gambling, shoplifting, and so forth. Addiction doesn’t necessarily involve substance, and so Tris’s definition basically becomes “If you’re doing anything because you enjoy it, that’s addictive behavior.”

13

It’s the last three sentences that are a problem. Taking drugs for recreational reasons is addictive behavior? Then you need to define “addictive.”

I know you say it’s not a matter of definitions, but it really is: you’re using the word “addictive” in a fashion so far out of the mainstream that nobody here is clear what you mean by it. Worse, you don’t seem to realize that. That’s why I’m asking for a definition: I want to know what you mean by the word.

I don’t think anyone will deny anything in this paragraph except for the second sentence. Alcohol IS unique in terms of beverages that people commonly get addicted to and that people mess up their lives with. However, that’s not a matter of degree: there’s a qualitative difference, not a quantitative difference, between the guy who polishes off a bottle of vodka every night and the guy who enjoys a vodka martini or two on Saturdays when he goes down to the local jazz club. The former is very likely to be messing up his life with alcohol; the latter is having no more problems with his vodka martini than he’s having with the shrimp scampi he likes to eat on Wednesdays.

Yes, and it’s a name for what nuns wear, too. A single word may have multiple definitions; the fact that habit means “repetitive behavior” and “addiction” doesn’t mean those two things are the same, any more than it means that nuns like to wear addictions around the abbey. That’s a fallacy.

Daniel

14

I have very little interest in continuing this discussion. Everyone has assumed a condemnation from me that I have never states, including a “semi-condemnation” which I don’t even understand. You do what you want. You drink what you wish. If you want to believe that there is absolutely no difference in drinking milk, and drinking beer, I have a question. Would you give your baby a beer?

But, I only ask, I actually don’t want to hear the answer.

Tris

15

Some people are addicted to some activities or substances, exhibiting stress or discomfort when deprived of those activities or substances.

Does someone partaking of that substance or activity for the very first time “display addictive behaviour”, solely due to the fact that other people are addicted to it?

If so, the very existence of addiction to any activity renders it impossible to display anything but addictive behaviour.

16

No I wouldn’t. What does that have to to with alcoholism?

Of course you don’t; it is much easier maintain your air of superiority if you insulate your ignorance by shutting out any anything that might challenge it.

17

That is clearly true; you also don’t seem to be reading the responses to you.

Daniel

18

If there’s a requirement that an addiction be materially harming my health, then I couldn’t say that I’m addicted to caffeine. But I am addicted to caffeine, as I would discover if I tried to stop using (which thought strikes fear into my heart in a way that seems to demonstrate my addiction).

19

That would be entirely appropriate, since no one actually reads mine either. But I do read them. I just don’t agree with them. Alcohol is a drug. One use is only different from ten thousand uses in degree. It is still a drug. Using drugs for entertainment is addictive behavior. You might really hate that definition, but it is not untrue. How addicted is addicted? I don’t know. But never using something is far less likely to cause addiction than sometimes using it.

On the subject of the smug superiority I have demonstrated about drinking: I repeat, I drink. I have drunk to excess, and have done so on frequent occasions in times past. I had already said this. I still drink, when I want to have a drink. No one wanted to hear that part. It is so much easier to put me in a class of people condemning drinking. Denying that I condemn drinking is pointless, since you are all enjoying my smug superiority too much to actually listen to what I say.

Why is drinking beer different than drinking milk? Milk is not addictive.

If it were not different to drink a single beer, you would not have a real reason not to drink beer with breakfast, or share beer with your children. Yet you don’t. Because you know there is a difference, you just don’t want to consider it addictive behavior. OK, don’t. Define addiction any way you want. I define it as a dependency upon a drug, however slight, or mild.

By the way, I don’t limit that definition to alcohol. Taking one toke of pot is addictive behavior, as is smoking one cigarette. They are drugs. I was actually seriously addicted to both of those. So, if you want to feel smugly superior to me about something, that one would make more sense than feeling smugly superior to me for identifying one drink as a risk of addiction.

Why the furor? Why defend your desire to drink alcohol? Eat beets if you want. I hate them, but you don’t mind that. Beets are not a threat to you sense of self, but alcohol, or more accurately my opinion of the use of alcohol is somehow a threat to you.

Why the furor?

Tris

20

Milk might well be addictive for someone somewhere. The difference isn’t that beer is addictive. The difference is that beer is a drug. Some drugs are addictive, some are not. But all of them are drugs. Some non-drugs are addictive, some are not. But all of them are non-drugs.

You don’t give drugs to kids without a reason and there is no reason to give a kid a beer. You don’t drink beer with breakfast not because it’s addictive but because it’s a drug and it affects your brain and your body in detrimental ways (I fall asleep when I drink a bear). If I ate chiles for breakfast I’d be unable to cope with going to work (I have some pretty nasty reactions to chiles). That doesn’t mean that chiles are an addiction. It means that chiles affect me. If took Singulair before breakfast I’d be unable to cope with going to work (Singulair makes me incredibly sleepy). That doesn’t mean that Singulair, despite being a drug, is an addiction.

You keep conflating different aspects of alcohol use and it’s really frustrating. Just because something affects you doesn’t make in an addiction. It might make it a drug. Not all drugs are addictive. I’m repeating myself but this is important. Most people are getting the effects of the drug (alcohol) without the addiction to the drug (alcoholism).