What is an addiction?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Hands with pills

Photo courtesy of Pixabay

How many addictions are there?

More and more things seem to be getting labeled as addictions.  This mushrooming of addictions has resulted in a lot of skepticism about whether all these items are real addictions or just excuses by people who do too much of one thing or another.

The mental health professions don’t typically use the word addiction. We use other terms to help explain why what is commonly called an addiction may look so different in different people.

Let’s explore this problem by starting with the best known of all addictions, drug addiction, and then see what other things might qualify as addictions.

Drug addiction.

Most drugs, legal and illegal, result in two specific reactions in the body, tolerance, and withdrawal. Tolerance means that over time your body builds up a resistance to the drug so that it takes more and more of the same drug to get the same effect.

Physically addicting drugs all result in tolerance in the body.

Withdrawal is the phenomenon of symptoms that occur when the level of the drug in the bloodstream begins to drop. As many an alcoholic knows if you can keep the level of alcohol in the bloodstream up, you can hold off the hangover for a while. Eventually, you fall asleep or more precisely pass out, and then the blood alcohol level drops.

The drop in the level of drug in the bloodstream, not the absolute level is what is causing the withdrawal symptoms, sometimes also referred to as “abstinence syndrome.”

When someone has been abusing drugs, including alcohol, we take them to a detox. They go through a lot of symptoms, some very unpleasant, as the drugs leave their system. So after 3 days or so, defiantly in a week, almost all drugs (except marijuana) are out of the system.

The carvings problem.

No drug (alcohol) in the system, the hangover, or other withdrawal symptoms go away. In the case of heroin, the shakes, diarrhea, vomiting, goosebumps, and all the other classic symptoms of opiate withdrawal end, and the person, now with no detectable drugs in their system are discharged to go home.

The majority of all people who go through detox, somewhere over 90%, will relapse or use again in a month or so after the detox.

If the drugs are all out of their system why are they still exhibiting addictive behaviors?

The problem with addiction is not the chemical dependency in the body, as awful as that can be. The real problem of addiction is that it is a problem of the mind.

We might call this manifestation of addiction a psychological dependency on the drug to differentiate it from a physical addiction. Even when no drugs are in the body the cravings remain in the brain.

Behavioral Addictions.

So can people really be addicted to things like shopping, sex, or compulsive spending?

My belief is that these kinds of activities can also be addicting but are not automatically addiction.

Each activity produces thoughts, those thoughts move through the brain chemically. Change your thinking and your brain chemistry changes. Some experiences, falling in love, having sex, can produce chemical changes in the brain that can be like an addiction.

One key criterion for addiction is the loss of control, if you lose control of an activity you are approaching addiction land.

Continued use of a substance or continued repetition of a behavior despite negative consequences, loss of control over a behavior fits this pattern.

Hypothetical example.

A client says she is “addicted to poodles.” She has poodle skirts, poodle statues, and pictures all over her house. Her husband gripes about all these poodle things but they are still together after 25 years. She says she is “addicted to poodles.” I think she has an unusually large interest, even an obsession with poodles, but so far it does not sound like an addiction.

Let’s say she also has 25 live poodles in the one-room apartment and that she has spent all of their money on poodle stuff this month leaving them with no money for rent and food. Now has her poodle addiction crossed the line?

So while excessive involvement in many things might possibly reach the level of being an addiction the more strongly rewarding things like drugs, alcohol, sex or risk-taking (gambling) produce such high levels of chemicals in the brain that many people might become “Addicted” to these behaviors. Most people are not likely to develop an addiction to poodles. The internet on the other hand –

Let’s leave that for now.

So in many ways, I see addiction, to drugs or other things, as a special case of OCD. The person can’t stop thinking about the object of their addiction and with chemicals or behaviors like gambling once they start they lose control over the substance or the activity.

Most recently we are recognizing that it is possible to have a problem with a chemical or behavior way short of developing an addiction. We might call this a “Use Disorder” or with behaviors we might think of it as an impulse control problem.

However you see this, loss of control over a chemical or an activity can cause someone a lot of life problems and needs treatment.

Staying connected with David Joel Miller

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2 thoughts on “What is an addiction?

  1. Good news! Addiction is no more! The APA did away with it in DSM V. Now there are only substance use disorders. But, less facetiously, we need to remember that someone can have tolerance and withdrawal without addiction. If someone gets in a bad accident & goes on opiate pain killers, they will experience tolerance if they are on them long enough. Then when they go off them, they will experience withdrawal. Why is this not an addiction? No loss of control, no continued use despite adverse consequences (& other criteria). Despite all the justifiable concerns about over-use of opiate pain killers, the majority of people who get prescriptions for valid pain use them only for that. While addiction is a huge problem, people should not be denied proper treatment for pain– including denying themselves pain relief– out of fear of addiction.


    • Thanks for those thoughts. Actually addiction, as far as the DSM-4 was concerned never existed. Addiction was not a part of the DSM-4 framework. People either has a substance abuse disorder or a substance dependency disorder. So under the DSM-4 tolerance and withdrawal are characteristics of a substance dependence. That could include people taking prescribed pain management meds if they continued to need increasing doses to manage their pain.
      People in the substance abuse or addiction field were using the term addiction. Another case of two different professions using different terminology which does not always have the same meaning. Receiving narcotic meds in the hospital does not lead to addiction. We think of this as an example of set and setting. I agree that people in chronic pain need access to good treatment, but we tend to over rely on medication prescribed and over the counter for far too much. There are other ways other than narcotics to control pain.
      To look at this from another perspective, the overdose deaths from prescribed opiates, every year exceed the deaths from all illegal drugs combined. Way to much of these narcotic pain relievers are reaching people who want them to medicate emotional problems or for pleasure rather than for pain management.
      Thanks for your comments and keep them coming. I wonder what other readers think about this topic.


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