Addiction In Society: Blinded by Biochemistry

[MajestyJo]

Addiction In Society: Blinded by Biochemistry

Scientists have been talking about addiction for a hundred years. Amazingly, they’re still trying to define just what the problem is.
By Stanton Peele, published on September 01, 2010 - last reviewed on October 30, 2010
The latest occasion for thinking about addiction is the approaching publication of the American Psychiatric Association’s Diagnostic and Statistical Manual, DSM-5. In February, the APA issued a draft of DSM-5, which is scheduled for publication in May 2013. The DSM is a crucial cultural document because it not only defines disorders for which people—including, increasingly, children—are diagnosed, treated, and medicated, but, even more crucially, it creates templates for how we think about ourselves.
I have been researching, treating, and writing about addiction all my professional life. In over 200 professional publications and books, I have grappled with what addiction is. Based on my work, I was an advisor for the substance abuse disorders section of the current version of the DSM, DSM-IV, first published in 1994. DSM-IV didn’t even use the term addiction, but instead referred to dependence.

I am not part of the new DSM-5 Substance-Related Disorders Work Group, but take a vital interest in its conclusions. The group is recommending significant changes. Chief among them is a return to the term addiction.

The current work group argues that “dependence” is inadequate because symptoms of dependence, such as tolerance and withdrawal, occur with repeated use of any powerful medicine. As I wrote in 1985 in The Meaning of Addiction, “withdrawal is nothing more than a homeostatic readjustment to the removal of any substance—or stimulation—that has had a notable impact on the body.” Since virtually all drugs create such effects, withdrawal and tolerance can’t possibly define addiction. Instead, addiction derives from how damaging people’s drug use is, and how unwilling they are to withdraw from that experience.

DSM-IV lists seven criteria for dependence. In addition to withdrawal and tolerance, five others address how socially, physically, and psychologically destructive people’s use is, and yet how incapable they are of cutting back or stopping. The new addiction category also emphasizes the destructiveness of substance abuse, but suggests there is something biochemically special about addictive agents.

At issue is not just how we should refer to compulsive, damaging drug and alcohol use, but whether addiction is limited to drugs and alcohol. And while we’re at it, just what does addiction refer to? Is it a brain disease? A behavioral pattern? Or is it a larger experiential pattern?

The view of addictive agents has shifted in different eras. Until the 1980s, pharmacologists classified cocaine as nonaddictive. Of course, cocaine had already been used for a century in and out of medicine (think: Freud, Coca-Cola); how was the “fact” of its addictiveness missed all those years?

Redefining cocaine as addictive demonstrates the constant evolution of the concept—one based not on biology but on culture and history. Cocaine is not the only agent recently reclassified as addictive; nicotine and marijuana have been, too. Such changes suggest that the addiction category is expanding. But that is not the case. Throughout history, “addiction” has been used as a general term, which has included habits such as tobacco, rum, and, yes, love. Only in the 20th century was it narrowed and restricted to the use of narcotics, specifically heroin. Any “expansion” is thus a return to addiction’s traditional meaning.

After deciding that compulsive drug use is addictive, the DSM-5 work group has decreed that gambling can be addictive, too. But stuck in a biochemical view of addiction, they wound up creating a new category for pathological gambling—behavioral addiction. And gambling is the only behavior so designated—not sex, not video games. According to University of Pennsylvania psychiatrist Charles O’Brien, chair of the work group, gambling deserves the designation of “addiction” because “substantive research” indicates that “pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system.”

O’Brien’s statement represents a rear-guard effort to frame addiction as a brain disease. There is, indeed, imaging research on the ways various drugs affect the brain. But that’s not the key to addiction. I designed and administer an addiction treatment program, and I can assure you that not one person is sent to our program—or any other program—because of a PET scan. People enter rehab because of regular, habitual screwups connected to substance use—compulsive involvement and continued use of a drug (or other involvements) despite chronic harm.

Indeed, as O’Brien points out, powerful experiences like gambling impact the same “neurological reward system” that drugs do. But so do many other rewarding activities. If there is some such higher level “neurological reward system,” then it can’t be said to exclude anything, from sex to food to gambling to video games.

Nor is O’Brien correct in suggesting that cocaine, nicotine, alcohol, and marijuana follow the same neurological pathways in the brain. Each substance has a very different chemical profile, including the timing of effects and the rewards people derive.

And if gambling affects the same brain reward system as substances, as O’Brien claims, why is it a “behavioral” addiction and not simply an addiction? DSM-5 further muddies understanding of addiction in its handling of two other non-drug appetites—“hypersexuality” and “binge-eating.” Neither is regarded as an addiction. Is this because they do not follow the same “neural reward pathways” as drugs and gambling? Binge-drinking can bring on addiction, but not binge-eating? How come? And is gambling really more neurologically, or intensely, rewarding than sex?
The problem with the DSM-5 approach is in viewing the nature of addiction as a characteristic of specific substances (now with the addition of a single activity). But think about obsessive-compulsive disorder (OCD): People are not diagnosed based on the specific habit they repeat—be it hand-washing or checking locked doors. They are diagnosed with OCD because of how life-disruptive and compulsive the habit is. Similarly, addictive disorders are about how badly a habit harms a person’s life. Whether people use OxyContin or alcohol, people aren’t addicted unless they experience a range of disruptive problems—no matter how addictive the same drug may be for others.

One fact that gives the lie to the idea that people become addicted to a specific chemical structure or neural pathway is that people rarely become dependent on a single substance. People usually display susceptibility to diverse addictions, in sequence or simultaneously.

Addiction is the search for emotional satisfaction—for a sense of security, a sense of being loved, even a sense of control over life. But the gratification is temporary and illusory, and the behavior results instead in greater self-disgust, reduced psychological security, and poorer coping ability. That’s what all addictions have in common.

[MajestyJo]

What's your personality type?

Quite Often,Often,Sometimes,Rarely,Almost Never
1 2 3 4 5

1. I feel like I'm on an emotional roller coaster.

2. During tough times, I am more prone to unhealthy behaviors (abusing drugs or alcohol, eating unhealthy foods, getting less sleep).

3. I feel uneasy in situations where I am expected to display physical affection.

4. I present myself in ways that are very different from who I really am.

5. I procrastinate on matters relevant to work.

6. I break promises.

7. I lose important things/documents.

Strongly agree,Agree,Somewhat agree/disagree Disagree,Strongly disagree
1 2 3 4 5

8. I can calm myself down when I'm under stress.

9. I need someone to tell me that I have done a good job in order to feel good about my work.

10. I like to attend gatherings where I can meet new people.

11. When I meet someone new, it doesn't take me long to tell him/her a lot about myself.

12. I am a private person.

13. When I'm really sad or down, I seek the company of others.

14. I enjoy exploring new places.

15. I pride myself on being different.

16. I have a broad range of interests and hobbies.

17. I am good at thinking "outside the box".

18. I go out of my way to better myself.

19. It’s my way or the highway.

20. Most people are trustworthy.

21. I am easily distracted.

22. I am able to motivate myself to complete unpleasant but necessary tasks.

23. When I get angry, I have ________ self-control.

excellent

very good

good

little

no

24. Interaction with other people is…

what life is all about.

fun, but not all the time.

great on special occasions.

a necessary evil.

25. If you were seated on a crowded bus and noticed an elderly person standing, would you give up your place?

Of course

Probably

It would depend on how tired I was

Probably not

It wouldn't even occur to me


Quite Often,Often ,Sometimes,Rarely,Almost Never
1 2 3 4 5
26. I ____ lose my temper.

Strongly agree,Agree,Somewhat agree/disagree,Disagree,Strongly disagree
1 2 3 4 5
27. I find it difficult to function normally when I'm under pressure to meet a deadline.

28. I am suspicious when I receive an unsolicited favor.

29. Everybody has to fend for themselves; I cannot look out for others.

30. My work suffers when I have problems in my personal life.

31. I get angry over things that others consider minor.

32. Your pet is ill, you're moving to a new house, and things are crazy at work. How do you feel?

Just fine. I thrive on stress.

Not bad - stress gets me going.

I'm holding up all right, but I'll be glad when things settle down.

Tense and distracted.

Horrible - I'm unproductive and can't focus.

33. When is the last time you did something thoughtful for someone?

Within the past few hours

Within the past few days

Within the past few weeks

Within the past few months

I can't even remember

Based on the Five Factor Model credited to Goldberg, Costa and McRae, this test is designed to provide you with valuable insight into your character, aptitudes, and disposition. It is based on the theory that all human personality traits belong to one of five broad dimensions of personality. Each of the five main personality traits stretches along a continuum. The personality traits tested in the questionnaire are consistent cross-culturally, and are fairly stable over time, beginning in young adulthood. An understanding of your position on each dimension can provide you with valuable insight into your personality.

[MajestyJo]

We become blinded, we don't scare easily.

Saw this and thought of my dad. He use to smoke these or Buckinghams years ago when I was a kid. He died as a result of his alcohol addiction yet cigarettes were a contributing factor too. He had infosema. You can't scare an addict.

dcqna.com/diseases-conditions/53654-y61.html