Brief Extract/Summary (an overview)

Synopsis: In this post I will cover three definitions regarding how Addiction is defined. There are more associations, institutions and so on that may have even more varied definitions. I decided to stick with these three since they seem most directly related to the concept of Addiction. The proper take-home-message that should be specifically noted is that these three major associations do not have identical conceptualizations/definitions of an “addiction”. This is needed and required for consistency of communication, research and treatment. Without an ideal standard definition(s)– is a severe problem because as I have stated before you get to proverbially ‘shift-the-goal-posts’ when you want to use the term addiction to meet your needs.

American Society of Addiction Medicine (ASAM) 

According to the American society of Addiction Medicine they define Addiction as follows:

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

The quote was from this webpage:

www.asam.org/quality-care/definition-of-addiction

If you notice they have such a vague definition it is almost laughable except it is such a serious issue. Every sentence or combination of certain words together can be reinterpreted to fit the situation. Complex interactions allow for anything. An “individual’s life experiences”, what does this mean? As examples a job loss, break-up, death in the family and so on.

Also, they say it is a “medical disease”. My question as a psychologist is a psychological problem, say, “subsumed under a medical disease”? However, I’d rather not go down that proverbial rabbit-hole right now (at this point). 

Also note, I am surprised they use the term “behaviors that become compulsive.” I say this because in the Diagnostics and Statistical Manual of Mental Disorders-5-TR (hence forth DSM-5-TR) there is an entire section on “Obsessive-Compulsive and Related Disorders (OCD)”. What is a Gambling Disorder? Is it in the OCD section or the particular ‘Substance-Use-Disorder’ section? Then, say, “where do other notable behaviors fall? (such as exercising, gaming, internet usage, and ‘globalized’ pornography etc.)”.

Then when you read on to the background section the opening sentence is “Clear language and terminology in medicine is critically important” How is the above definition clear at all?

American Psychological Association (APA) 

Now, we move to the American Psychological Association. Their page points out this conceptualization/definition:

Substance use disorder is a cluster of physiological, behavioral, and cognitive symptoms associated with the continued use of substances despite substance-related problems, distress, and/or impairment, such as impaired control and risky use.

Addiction is a state of psychological and/or physical dependence on the use of drugs or other substances, such as alcohol, or on activities or behaviors, such as sex, exercise, and gambling.

Adapted from the APA Dictionary of Psychology.

The quote was from this webpage:

www.apa.org/topics/substance-use-abuse-addiction

Again, as noted why include activities and/or behaviors. Gambling is in the section “Obsessive-Compulsive and Related Disorders”. Sex, exercise, pornography etc. in my professional opinion should have their own unique criteria sets just like gambling does.

This above APA definition at least instead of “harmful consequences” has some more specificity, of “problems, distress, and/or impairment, such as impaired control and risky use.” At least this last sentence is in line with the Diagnostics and Statistical Manual of Mental Disorders-5-TR. “Harmful consequences” is a catchall term. Yet, still this is lacking since can be essentially applied to any type of behavior. My friend did point out that there has to be some ‘purposeful’ omissions and ‘some’ wiggle room; and he is right yet how far do we take it? What are the ‘suitable’ parameters as he says?

Then we move onto the American Psychiatric Association (APA). Here out of the three definitions the following I do like the best since it is specific to substances and does not include “activities or behaviors” yet see my commentary after the quote.

American Psychiatric Association (APA)

Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence. People with SUD have an intense focus–sometimes called an addiction–on using a certain substance(s) such as alcohol, tobacco, or other psychoactive substances, to the point where their ability to function in day to day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems.

The quote was from this webpage:

www.psychiatry.org/patients-families/addiction-substance-use-disorders

Statements and Opinions (points of view or viewpoints)

Do keep in mind we do not have in the DSM-5-TR “Substance Use Disorder (SUD)” that is technically an old term from the DSM-IV-TR period (i.e. the fourth official American DSM publication), which was published back in 2000. The only utility that term is useful for is that we have a very general idea of “addiction” which them become circular. We now have specific criteria sets for each substance in the DSM-5-TR. Out of the three the ideal in my professional opinion is somewhere of a cross between the American Psychological Association and the American Psychiatric Association ‘interrelated’ definitions. I do love that the American Psychiatric Association stated, “sometimes called an addiction” since it indicates is common every usage, and to be belittles the term “addiction” which I read it as and like. 

I do believe based on my professional opinion that there is a problem speaking of addiction being both substances and activities/behaviors. The reason for my issue with this is what is the actual underlying mechanism that is common to both of these domains? “Substances” are actual chemicals you put into your body which is one domain. Then “activities and behaviors” being a separate domain. You are not putting something into your body. I understand exercise, sex, pornography etc. can change someone’s or a person’s neurochemistry. Yet firstly a person can put chemicals into his or her body (e.g. related substances). Secondly, a person does not do so (does not engage in activities and/or said behaviors). Both types of these two activities do have an effect on neurochemistry (e.g. neurobiological aspects or given outcomes).

It is inescapable and I have posted on this before, that you get to “shift the goal posts” when using a generic term like alcoholic/alcoholism or addiction/addict. Notably the reader can change the related definitions; and within this post I have clearly pointed out the three different ‘major associations’ in the United States that define the concept of “addiction” differently. At least the American Psychiatric Association (APA) proverbially sticks-to-its guns and ‘markedly’ restricts it to substances.

Consistency is the issue at hand! Use of a seemingly agreed upon term “addiction” can be misleading. I do concede the fact that the definitions overlap probably about 80% to 90% plus, yet again the leeway afforded people is a lot when people consider putting a substance into their bodies versus an activity or a behavior.

I do believe there is a need to have differing definitions and conceptual frameworks between activities/behaviors and substances that actually go into your body. I am agreeing that there will have to have a common feature of something to the effect in my own words “causes distress and or impairment or interference with or in social, academic, interpersonal functioning, self-care, daily routines, work etc”.

A final note is that there is no consensus for a very serious situation “addiction” (notably which is a very ‘catch-all’ phrase or term) that does effect millions of people worldwide.