Addiction

Etymology and History

The original Latin words addicere (verb) and addictionem (noun) were legal terms that referred to sentencing someone to be a bond slave. In modern English, the term was commonly used to designate either a positive or a negative devotion to a belief or an activity. In the early nineteenth century, it gained a strongly negative meaning, first as excessive [Page 6]attachment to drinking alcohol, then to other intoxicating substances. This is the dominant meaning still today, but in recent decades the common usage has come to cover a wide range of behaviors, including smoking, gambling and gaming, sexuality, eating, shopping, television viewing, sports and exercise, and so on. Typical characteristics of addiction (besides difficulty abstaining) are: withdrawal effects (ill-feeling caused by the absence of the substance from the body), tolerance (the need to increase dose to get the same effect), relapses (resuming the habit after even long periods of abstinence), and loss of control (incapacity to stop once begun, e.g., to take only one or two drinks of alcohol).

Realism and Constructivism

There is no generally accepted scientific view of what addictions are or what causes addictive behaviors. Theories oscillate between biological dependency on a substance (realism) and social definitions of repetition as dependence (constructivism). Realistic theories seek causal explanations from neuroadaptations in the brain or from learning and other psychological processes. Rational choice theories explain addictive behaviors as elevated preference for immediate pleasure, whereas negative consequences lose their subjective importance (this is called hyperbolic discounting). Constructivist theories look at societal reactions not necessarily related to a specific substance. According to constructivism, similar behaviors may be labeled as addictions in some cultures but understood in different terms in other contexts. Many constructivists argue that the concept of addiction reflects a cultural shift from external control to self-discipline in modern societies, which means that problems are no longer defined in terms of sin, crime, or deviance but as a failure of self-control, that is, as a disease of the will. The nineteenth-century American physician Benjamin Rush was the founder of this view. The Scottish medical doctor Thomas Trotter and the Swedish clinician Magnus Huss emphasized physical damage caused by alcohol, as well as the social environment leading to excessive consumption. Temperance movements in North America adapted the Rushian understanding of alcohol as a mental poison, later incorporated into the Alcoholics Anonymous (AA) movement. European temperance movements have stressed environmental factors in controlling the problem and the role of social assistance in recovery.

Current Medical Practice

Current medical practice operates with a pragmatic syndrome theory. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, and the International Classification of Diseases (ICD-10), published by the World Health Organization, do not currently include the category addiction. Specific addictive behaviors are classified in other categories, for example, pathological gambling (PG) is included in the DSM-IV under the section Impulse Control Disorders. In ICD-10, it is included in the category Disorders of Adult Personality and Behaviour. Together with anorexia—the other “dependency” that does not involve an addictive substance—PG was first diagnosed in the 1970s and included in DSM-III in 1980. There is no etiological theory underlying the definition, and the diagnosis is based on a checklist of behavioral symptoms that together form a “dependency syndrome.” According to Jim Orford, most clinicians consider addiction to be a syndrome of varying degrees rather than as a typological (yes-or-no) condition, or as a behavioral pattern resulting from a combination of factors.

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