Originally published by Mark Brouwer at sexualsanity.com
Getting clarity about an important – and often misunderstood – issue
What is addiction? In the church, in counseling, and even in the field of recovery, this deceptively simple question gets really confusing really fast.
Susan Cheever, in her wonderful book Desire, has this to say about the challenge of getting clarity about addiction:
“For all the definitions that have been written by the hundreds of addiction specialists and doctors, addiction is still mysterious and baffling. In many cases it’s hard to tell if someone is an addict or just a passionate amateur.”
In order to overcome addiction, we need to have a clear understanding of what it is, exactly. How is a doctor supposed to treat people for illness if she doesn’t know what these illnesses look like?
We dismiss it because we don’t understand it
Related to the confusion about what addiction is — and maybe in part because of that confusion — some people are dismissive of the concept itself. I’ve heard people complain that it’s a modern invention, compared to the (idealized) past, where people seemed to just “deal with” their problems. “If someone drank too much, they just stopped” (did that ever really work?).
Today addiction is used to describe almost any kind of negative, compulsive habit. Some people feel it has become a cop-out, an excuse to shift the blame from oneself to the vague and ambiguous culprit we call “addiction.”
While it may be true that we talk more about addiction today than in previous generations, it is by no means a new word or modern concept. Historians have noted that there has been an ebb and flow of addiction across societies and time periods. Societies have existed with very little addiction among them for generations, only to be seized by widespread addiction later.
This happened, for example, with Native Americans after European colonization. Before the Europeans came, there is little evidence of substance abuse among most native peoples. But after their land was taken, the cornerstones of their society were dismantled, and they were moved into reservations, alcoholism emerged as a huge problem. (For more detailed information about this, including data sources, see “The Globalization of Addiction,” by Bruce Alexander.)
“Addiction” is not a new word
Addiction isn’t a new word in the English language. The Oxford English dictionary held an entry for the word as early as 1884: “The giving of oneself to a pursuit.” For a long time, the word was used to describe dedication and commitment, usually to something worthy and good. That changed in the late nineteenth and twentieth centuries with the Temperance Movement, when writers and speakers began using the word in relation to alcohol and other drugs.
Since then, the word has morphed into one of those confusing concepts with multiple meanings. Even psychologists can’t agree on the concept, as evidenced by the ongoing discussions about using this term in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses.
The committee writing the latest draft of the DSM (the DSM V) announced that it will include updated definitions of substance abuse and addiction, including a new category of “behavioral addictions.” For years, as addiction researcher Stanton Peele notes, the American Psychiatric Association (APA) has gone back and forth between use of the terms “addiction” and “dependence” to describe alcohol and other drug problems. Now it appears there is a growing consensus around accepting “addiction” as a diagnosable – and treatable – disorder, and expanding it usage to include behaviors, not just substances.
Today we use the term in four distinct ways. Maybe it would be helpful to create subcategories. In his great book “The Globalization of Addiction,” addiction researcher Bruce Alexander does exactly that. In the book, he outlines four types of addiction, giving them the names “addiction 1” “addiction 2” “addiction 3” and “addiction 4.” I’m going to give them different names, which might help clarify the distinctions.
1. Chemical Addiction
The first of Alexander’s categories of addiction is the traditional view: “An overwhelming involvement with alcohol or drugs.” This is one of the most common understandings of the word, with its focus limited to chemical dependence — drug addiction and/or alcoholism.
The keyword here is “overwhelming.” This word is important — this is not simply involvement with alcohol or drugs, but overwhelming involvement. This is when drugs are a significant (and destructive) part of one’s life. Estimates vary today about how prevalent chemical addiction is in our society. Estimates are that 5-10% of Americans are addicted to alcohol in this way, and about 5-8% are addicted to illegal drugs, meaning 12-15% of Americans suffer this kind of addiction … chemical addiction.
2. Chemical Use/Abuse
This usage of the term addiction is more controversial. It refers to the ongoing use of “harmful” substances of any kind. This understanding of addiction is at play, for example, when a person goes to rehab for ongoing marijuana use. Some people say that since marijuana is illegal, a person who uses it at all must have a problem with it.
The challenge here is that the line between what constitutes the “use” and “abuse” of a substance can be very hard to determine. When does a recreational drug user become an addict? At what point does someone’s participation with a drug become “overwhelming?” In the minds of many people, some drugs are so destructive to users’ well-being that it’s best to treat even their occasional use as an addiction.
3. Behavioral Addiction
Behavioral addiction is “overwhelming involvement in something that affects one’s life negatively.” This obviously applies to the abuse of alcohol and other drugs (“chemical addiction”), but this use of “addiction” is more broad. The focus here is on processes or behaviors: things like food, sex, gambling… things that take control of a person’s life and become destructive for them.
The argument could be made that this type of addiction is still chemically-based. For example, in sex addiction, a person gets addicted to the chemical reaction that takes place in the brain during a sexual experience. This is the case with food, gambling, shopping, video games, work, and so on. But the key here is the broad understanding of the sources or objects of addiction. In this understanding, object of the addiction is not a chemical, it is an activity or behavior.
4. Positive Addiction
Addiction four is “strong dedication to a pursuit or cause that is helpful and constructive … but may become so absorbing that other aspects of life are neglected.” This goes back to the 1884 definition, “the giving over of oneself to some pursuit.” It might include things like being really into fitness or some sport, or hyper devotion to a certain cause. The activity or focus of attention is actually good and healthy, but it may be that our involvement with it gets to be so great that we are neglecting other things in life.
A positive addiction may seem similar to a behavioral addiction — the difference is whether or not the object is a good and worthy pursuit, and whether or not its pursuit is destructive to us. Think of the difference, for example, between someone “addicted” to pornography and someone “addicted” to running.
The lack of consensus on what addiction really is makes it difficult to help those who suffer from it. I feel that the most helpful and most accurate way of looking at addiction is the third definition, an overwhelming involvement in something that is destructive. This still leaves room for confusion and disagreement about what constitutes “overwhelming” involvement, but at least it gets us started.
What do you think?
