Defining Addiction

I read this on the Castle Craig blog and really liked it as it blends older beliefs from older recovery methods with some of the newer knowledge on the subject and is written by Dr Margaret McCann CEO and founder of Castle Craig Hospital, an alcohol and drug rehab clinic in Scotland.Β  It is how she defines addiction.

The view I have taken for many years is that addiction is a complex illness involving many factors.

These factors include:

  • the effects of the drug itself;
  • the response of the brain to the drug – with resultant neurochemical and biological changes after prolonged exposure;
  • the hereditary and genetic makeup of the individual – there is strong evidence that genetic factors predispose an individual to addiction and increase the person’s vulnerability;
  • psychological factors;
  • and socio-cultural factors.Β 

In order to simplify the message, I think of a triangle where the three points are the drug, the person (biology; psychology) and the environment (price; availability; peer influences; education; occupation).

In this way, according to a previous definition, addiction is a biopsychosocial disease. I think there is no doubt that it also has a spiritual dimension (dishonesty, selfishness, the moral and spiritual consequences of the lifestyle).

Understanding addiction as a disease is not a cop-out for taking responsibility for one’s recovery. In fact because it is a chronic progressive and potentially fatal condition it is all the more necessary that the individual take full responsibility.

Alcoholics Anonymous itself has always spoken of an illness but there is a greater understanding now of how the brain’s reward centre’s and neural circuits are hijacked by long exposure to significant drug levels.

So to summarise:

  • Addiction is a biopsychosocial disease.
  • “I think of a triangle where the three points are the drug, the person and the environment.”
  • Understanding addiction as a disease is not a cop-out for taking responsibility for one’s recovery.

For further reading on this subject I recommend the American Society of Addiction Medicine’s definition of addiction.

12 thoughts on “Defining Addiction

  1. well I wonder whether I can fit the phrase ‘biopsychosocial’ into my everyday conversation today?! ten Johnny Depp points if I do?!

    looking it up on Wiki I found this paragraph –

    ‘The model was theorized by psychiatrist George L. Engel at the University of Rochester, and putatively discussed in a 1977 article in Science,[2] where he posited “the need for a new medical model.” He discusses his model in detail in his paper in the American Journal of Psychiatry [4] where he discusses the fate of a hypothetical patient, a 55 year old man who has a second heart attack six months after his first.

    Engel elegantly indicates that the patient’s personality helps to interpret his chest pain, that he is in some degree of denial and that it is only the intervention of his employer that gives him permission to seek help. Whereas reductionistically his heart attack can be understood as a clot in a coronary artery, the wider personal perspective helps to understand that different outcomes may be possible depending on how the person responds to his condition.

    Subsequently, the patient in the emergency room develops a cardiac arrest as a result of an incompetent arterial puncture. Once again systems theory can analyse this event in wider terms than just a cardiac arrhythmia. It sees the event as due to inadequate training and supervision of junior staff in an emergency room. Thus while there may be “no single definitive, irreducible model has been published,” [5] Engel’s elegant exposition of his model in this paper gives plenty of scope for this broader understanding of clinical practice.’

    the key bit for me of which is: ‘different outcomes may be possible depending on how the person responds to his condition.’ which is another way of putting what you say about taking responsibility for one’s own recovery.

    there sometimes seems to be a vast argument about why addiction arises, whether it is down to the chemical effect of the drug, brain science, or childhood experience, or society… all that three points on the triangle. and arguing about the why can mask the key fact of its consequences…

    whereas that ‘why’ for me is not so important as the ‘what’. what my life becomes if I drink – and what it becomes if I don’t.

    on that empirical evidence I am an emphatic non-drinker!

    1. Morning Prim! Sober buzzword bingo – I like the sound of that. That will earn you 100 Johnny Depp points πŸ˜‰ Psychologists like reductionist theories as they are simpler to explain but unfortunately us humans are not that simple and Engel’s theory beautifully explains this. I agree with you but for many getting stuck in the ‘why’ stops them from actually moving on to the ‘what’. It is a way of intellectualising the issue and I speak as one who is very good at doing that! πŸ˜€ In the end does it really matter? If what you are doing makes you feel like sh*t and when you stop you don’t feel like sh*t then it is probably better for you if you don’t do it. End of πŸ™‚

      1. intellectualising an issue in preference to addressing it? I’m answering ‘present’ to that one too….

        PS glad to see from your blog header that spring has arrived πŸ™‚ xx

      2. Inspired by this morning’s run and Daisy’s blog post πŸ™‚ xx

  2. Sober Buzzword Bingo πŸ™‚ Thanks again for sharing more interesting links. I agree, the “why” is not as important as the “what” xx

  3. I would put the majority of the weight on the ideas of environment and in the user’s thoughts about / expectations of the substance.

    The chemistry of the substance itself is just a small part of it. Most people given diamorphine while in the hospital don’t suddenly try to score heroin on the street when they’re released, even though it’s the same chemical.

    And the vaunted idea of “brain hijacking” doesn’t pull its own weight, either. For example, some addicts in China had those ‘hijacked’ pleasure centers of their brains burned away in an effort to cure them from wanting to use. Five years later, more than half were back to using.

    People use because they believe their substance of choice will make them feel a certain way. They tend to overemphasize the positives and dismiss the negatives. In scientific terms, it’s a huge confirmation bias. In short, they use because they think it’s their best (or least-worst) option at any given time, and they quit for the same reasons.

    1. Hey SC Congrats on 100 days! The diamorphine in hospital argument – having given plenty to patients myself I can argue that they can get addicted. If they are in pain and the drug is being used in it’s primary treatment modality then no they will not become addicted however if the pain begins to subside and the euphoric effects are felt then it can become addictive. There are many prescription opiate addicts in the US now because of the over-prescription of Oxycontin and Oxycodone (hillbilly heroin) for injuries that have now healed and left them needing to continue to use. I read your post about the Chinese example and it’s results were interesting that’s for sure. As for whether it is as straightforward as just confirmation bias I’m not qualified to say so for me the jury’s still out πŸ™‚

      1. Thank you!

        Yes, of course diamorphine *can* become addictive. My point is that even though it’s the same as heroin, which is seen as the most devilishly addictive of all drugs, it is not *automatically* addictive.

        I once was prescribed vicodin after dental work. I took ONE, and while I definitely felt the floaty warm sensation, it was more like fever, vertigo, and nausea than a pleasant escape. I hated it, and after that one pill, I tossed the rest.

        My FIL was prescribed oxy for a serious and chronic pain condition, and when he decided that the effects of the oxy were worse than the level of pain he was experiencing, he simply stopped taking them.

        People who WANT the warm floaty escape that substances provide will continue to use. People who prefer reality and awareness will find the warm floaty escape obnoxious and unpleasant.

      2. Ah so you have personal experience SC. Yes I guess there will be those who ‘like’ the feeling and those who don’t πŸ™‚

  4. I like this triangle! I mean I don’t LIKE it, but I get it!
    It makes a lot of sense!
    Happy almost Friday!

    1. I knew what you meant Wendy πŸ™‚ Happy almost Friday to you too!

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