Is addiction real? Does it have a cause?

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

Cigarette smoking is addictive.
Photo courtesy of

Comments on the deltaFosB post and the causes of addiction.

Some comments came in on the DeltaFosB post I think need discussing.

Normally I do not answer or re-comment on comments on posts. If you like a post cool. I will thank the reader for the like and that is that. If you disagree, then you are entitled to your opinion. I reserve the right to be wrong and so should all of you. Further arguing with people about their comments is not likely to change their minds so I try to use as much of my time as productively as possible and move on to new things.

This time feels different. On the chance that there are others who drew the same conclusions from the post that one reader “Tom” drew, I thought it would be worth further discussion.  I posted the headline to the original post with a link to the post on google+ and this comment from Tom was received over there.

First Toms comment on the post and then my explanations of why I think Tom is off base here.

“…there really does seem to be a physical change in the brain that accounts for why some people become addicted to chemicals, drugs in particular, and behaviors…”

I think that’s confusing hypothesis with findings. No one is seriously reporting that they have found the cause of addiction. For one thing, there is seriously insufficient research to support a global generalization of that sort.

People have been trying to find this mythical organic cause of addiction, and failing, for decades. What you report does go beyond the speculative, although it surely is not pure speculation. The research we have only supports informed speculation, to my mind.

The ambiguity in this phrase – “…that accounts for why some people become addicted…” is dangerous. I think what you’re really trying to say is something like “…that accounts for why some addicts become addicts…” As written, you appear to be talking about all addicts, and that is far beyond what we can address with the research you review, I think.

The fact remains that most people who drink alcohol are not addicts. Most people who use heroin are not addicts (little-known fact). Most people given opiates for pain can’t wait to get off of them, because of their unpleasant cognitive side effects. Those who become addicted are a small minority, and they seem all to have something in common: a persistent uncomfortable mental state which psychoactive substances/behaviors moderates. Happy people do not become addicts.

This has been known for a long, long time. But people just don’t want to let go of the “demon dope” hypothesis. The reality is more complex.

My response to Tom’s comments:

It appears that you are reaching conclusions from what I wrote that is not what I was saying. I suspect we have some fundamental philosophical differences here. We seem to be using words differently also. Look up the word addiction in a number of dictionaries and you will get a variety of definitions. I am concerned that people are using the term Addict as a pejorative term. The homeless and the mentally ill get that treatment also. Asserting that “addicts” are in some fundamental way different from non-addicted people is reassuring to some. If you have a job and a home you can tell yourself that you are not an “addict.” This obscures the very real issue of a growing problem of substance use and behavior use disorders in our society.

Let me try to clarify what I was saying about the criticisms you raised of the blog post.

  1. The term “some people” was written because I believe that those who develop an addiction, chemical or behavioral are people. To argue that “addicts” are somehow different from other people is to blame the person with the disorder for their condition. This is often done with other social issues like homelessness, poverty, and crime.
  2. The research reported on was concerning epigenetics and gene expression. This suggests that something happens which turns people who are not addicted to a behavior or a substance into those who have a dependency or reliance on this as a way of functioning. Behavioral “addictions” remain controversial with only gambling having been added to the most recent DSM. This research point to changes in the brain functioning when people reach a point of losing control over their use of that behavior or substance.
  3. If we call “it” addiction we get one paradigm. If we refer to something as chemical dependency or having a substance use disorder we get another. As a society, we are moving towards a “doublethink” approach to this issue. People who take prescribed medications do develop tolerance and withdrawal. There has been some pressure to alter the description of chemical dependency (the new term for what used to be called addiction) by adding craving as a characteristic of addiction. This might lead to the conclusion that someone can be “addicted” to a medication and not be an addict. This simply changes the terms to define away the problem of what is causing this condition.
  4. Referring to the premise that behaviors and drugs can at some point, for some unknown reason take someone from experimentation or use to being addicted as a “demon dope” hypothesis is a stretch.

If we accept that addiction could be a disease then the disease model fits. Compare this to the “demon Bacteria” theory of tuberculosis. One way of determining if something is a disease is to ask three questions.

Is there a specific agent that may be causing this condition?

Is there a host that gets the disease?

Is there a way in which this agent gets into the host?

Does this “demon bacteria” cause tuberculosis?

There are people who are around some specific other but do not get the disease. Does this mean that the bacteria is not the cause and that people who get T.B want to have it?    “Bad air,” wearing dirty clothing, and failure to wash your feet, along with a raft of other behaviors, have been postulated as causing the thing that we now attribute to the disease tuberculosis.  You can be around someone with an infection, and you may or may not get the disease. Your immune system, the length, and severity of exposure the room size, and other factors can influence whether you get the disease.

Do addictions fit this model? Yes, mostly. There are agents, pornography, or a drug (alcohol and prescribed medications could be included here.) Yes, it is an individual host that gets the disease, though with what we are calling addictions, the family and society are also affected. Lastly, there has to be an exposure to the agent. Unless you view pornography, take drugs or drink, you will not develop an addiction to these behaviors or substances.

  1. Reporting “a cause” is not the same as reporting a one and only one cause. We are reasonably sure that faulty brakes can result in automobile accidents. Faulty brakes are not the only reason for auto accidents. It seems likely that further research will find other things occurring in the brain before, during, and after exposure to the behaviors or drugs which cause chemical dependency. My statement is further qualified by the statement “seems to be.” This hypothesis or theory needs more research and testing. What has emerged to my satisfaction is that there is some sort of actual brain change occurring in “Some” of these people we currently describe as having a substance use disorder, addiction, or as being “addicts.”

I am increasingly unconformable using the word “addict.” We do not describe people with other disorders as their disorder. We do not, or should not, refer to someone who has been diagnosed with cancer as “the Cancer.”

  1. Absolutely it is likely that this one pathway, the repeated exposure to a behavior or substance, is not the only possible mechanism or reason. Smoking is not the only cause of lung cancer but the connection seems far beyond any chance correlation. Early research on Alcoholism reported that many “problem drinkers” drank to unconsciousness or blackout the first time they drank. Additional research has pointed to a genetic risk factor as well as exposure to alcohol playing a role. Research on genetic causes of alcoholism has been inconsistent. One study reported having a bio parent who drank alcoholically increased the risk that a person would become an alcoholic by 400% even if they never met that bio parent. Other studies have pointed to the increased risk of the environment. None of this negates the probability that repeated exposure to a behavior or chemical could change the “default setting” in the brain and result in the use of substances being an automatic behavior.
  2. Your statement that “Happy people do not become addicts.” is on its face false for several reasons.
  3. No one is or should be happy all the time. People who might be described as “happy people” all experience episodes of other emotions. There are no such people who are always happy.

Many people drink or use drugs to celebrate, at some point, sometimes the very first time, they go to extremes and develop a substance use disorder. Someone who drinks only one time a year, say for New Years, but over the last three years received two DUI’s and was arrested once for a bar fight clearly has an alcohol use disorder.

  1. Alcoholics or addicts do not look different than the non-addicted person. About 70% of drug addicts, those who report to treatment with a substance use disorder, have full-time jobs. About 95% of alcoholics work full-time but still find themselves unable to control their drinking when they try.
  2. Most teens who begin to use substances report the reasons they first tried substances was because it sounded like “fun.” Later in the process of developing a substance use disorder, they will report that they do it “socially” and eventually that it has stopped being “fun” and now they continue with the drug or behavior because it is difficult and painful to stop.
    While there are many factors involved there is increasing evidence that there are not two kinds of people “normal happy” ones and “addicts” but that for reasons we do not yet fully understand at some point a behavior or a substance can alter brain functioning and result in an addiction. Describing people who take prescribed medications and develop tolerance, withdrawals, and a physical addiction as not being addicts is, in my opinion, a distinction without a genuine difference.

Thanks for the comment anyway, it inspired this further explanation.

Staying connected with David Joel Miller

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