What Is Addiction?

People joke that the latest trends are addictive - the latest game, the latest toy, the latest TikTok dance - are all described as an addiction. In reality, though, addiction is not fun, it is far from enjoyable. Addiction is painful and traumatic. It turns your life upside down and has the ability to destroy your dreams and relationships. And these days there are so many more things that create such pleasure that they can become sources of addiction. There is an addiction to food, addiction to social media and addiction to video games. So it is important to understand exactly what is addiction, and with this knowledge, we are wiser to treat it.

The definition of being addicted is being

“Physically and mentally dependent on a particular substance”.[4]

But it appears from the rise of other addictions such as addiction to food, addiction to sex, addiction to social media and addiction to video games, we can now expand this definition of addiction to not only include a substance, but a thing or an activity as well.

Current Viewpoints on Addiction

What the hell is going on? I thought we were meant to be the smart species. It seems like the more things we create to provide pleasure, the more things we are creating to become addicted to. It seems like everything we create to provide enjoyment is becoming a tool of pain and suffering. More importantly, why as we get cleverer scientifically, medically and technologically, are we seeing the and increase in addiction? It surely suggests we are missing a fundamental part of the addiction picture. Let’s see the pros and cons of the three most prevalent answers to what addiction is.

Addiction as a Choice

The definition of choice is

“an act of choosing between two or more possibilities.”[5]

So technically this is correct. From an external vantage point, it would seem that a person has the ability to select to drink or not to drink. To buy the cigarettes, or not to buy the cigarettes. To pop the pill, or not to pop the pill. To pick up the device or not to walk away from the device. Certainly this was the viewpoint of Victor Frankl (psychiatrist and holocaust survivor) when he said:

“Between the stimulus and the response is a space, and in that space is your power and your freedom.”

This quote is so very powerful and incredibly inspirational but does not relate to the physical realities of addiction. As we will see when we being to discuss addiction as a brain disease, behaviours become hard-wired in the brain. At this point they become automatic and subconscious, and as a result, this space that Victor Frankl mentions either ceases to exist or becomes so marginal that it is almost invisible. It is not only the mind that desires what the substance or activity delivers, but the body and brain have become dependent upon it.

I think it is very difficult for anyone who has not experienced addiction to understand the pull, the craving, the obsession that becomes ingrained in the body and brain. But even more so the desire from the heart for relief from both mental pain and physical anguish.

The reality is that in addiction, the circuits in the brain that normally help us make good choices and exert our free will don’t function like they should. The space no longer exists to make logical decisions [7].

The only benefit to this viewpoint is the way in which it does instil a sense of personal power and responsibility. This is an incredibly important part of healing, but only when the person is physically and mentally able to take on this responsibility and able to make conscious choices and logical decisions. You wouldn’t expect someone just recovered from cancer to get out and run a marathon. So in the same way you wouldn’t expect someone who’s decision-making ability has been compromised to immediately be able to make great decisions!

Addiction as a Chronic Brain Disease

The great news for treatment of addiction is that there is overwhelming consensus that addiction

· Is a function of brain activity; and

· creates changes in the brain.

While the actual interplay of hormones and circuitry in the brain is very complex, addiction, very simply is supported physically by the ‘feel good’ hormone dopamine and becomes hard-wired into the brain by neuroplasticity.

Here is my very basic explanation of the brain science. When you do something that gives you a good feeling, the dopamine system in the brain is turned on. Humans are pleasure-seeking creatures, and so our brains will release the hormone dopamine again as a motivator to get you to do the same activity. The more you repeat the activity, the stronger the connections become in the brain. If the activity continues to be repeated then it gets hard-wired in the brain, and through an effect called automaticity, you are soon doing this activity without even thinking about it. This effect is compounded as the tolerance level for the substance increases, and the person needs more and more to achieve the same result. The fact is in addiction changes occur in the brain that reinforce and escalate the addiction. This is the reason that some people see addiction as a brain disease.

I was first introduced the disease model during one of my inpatient stays in rehab. We watched a movie called “Pleasure Unwoven” which presents a wonderful insight to the way the brain changes through addiction, and how addiction can be classified as a disease. After watching this movie I was so very relieved. It was like a huge burden had been taken off my shoulders. I was not a bad person; I had a brain disease!

This is one of the real benefits of the disease approach to addiction. It certainly does take away some of the stigma, but more importantly judgement associated with it. It also allows you to get some personal distance from the addiction — I am not addicted, my brain is. I know it sounds a bit silly, but when you are in the throws of the trauma and shame that comes with addiction, any distance and perspective is helpful.

This view also helps focus efforts and energy. OK, so what do I have to do to get my brain better?

But the disease model has its limitations. You can’t just burn off, cut out or medicate away addiction. The fact is it has become ingrained in the brain through weeks months and years of repeated behaviour. If you don’t get to the cause of the action in the first place, then there is the real risk that the behaviour will occur again, and before you know it you are back in rehab dealing with the same problems. While addiction may be a disease in itself, it is an ‘end-game’. It is caused by something else, something deeper.

Addiction as a Mental Disorder

While the brain disease view of addiction concentrates on the structural changes in the brain, the mental illness view of addiction expands to work with the thoughts, feelings and behaviours that contribute to, and result from the addiction. According to the World Health Organization, a disorder is:

“ generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others”.[9]

Substance use abuse and dependence are then listed as a mental disorder.

DSM is the standard classification of mental disorders in the United States and DSM-5 contains the criteria for what constitutes a substance use disorder. Substance use disorders are classified as mild, moderate, or severe, depending on how many of the diagnostic criteria a person meets. The 11 DSM-5 criteria for a substance use disorder are:[10]

• Hazardous use
• Social or interpersonal problems related to use
• Neglected major roles to use
• Withdrawal
• Tolerance
• Used larger amounts
• Repeated attempts to control use or quit

• Much time spent using
• Physical or psychological problems related to use
• Activities given up to use
• Craving

While the diagnostic criteria for this mental disorder are based around observable and objective behaviours of the patient, the treatment approach is a bit more holistic. As a mental illness, treatment programs also attend to the emotional instability and dysfunctions that are associated. A mental disorder approach to addiction may see a combination of:

· Psychiatry to address the physical brain changes and imbalances and treat with medication

· Psychology to help work through and correct unhelpful emotional or thought patterns that could be keeping the person stuck in addiction.

The downside of this approach though is the stigma that comes along with being seen as mentally ill. Although, slowly, as more people share their experiences, mental disorders are becoming less a source of shame, and more a celebration of resilience.

Addiction as Deep Learning

Professor Marc Lewis sees addiction as a habit that has been effective in achieving some end. Therefore, to ‘fix’ the addiction, a greater and healthier goal must be found. The drive to achieve a more meaningful and inspirational goal will help fuel the behaviours that will, over time, build new habits and new pathways in the brain. In the deep learning approach to addiction, the treatment focuses on unlearning the destructive habits and replacing them with more helpful ones that will allow them to achieve the same, or even greater goals.

I can see how the view of addiction as a learned behaviour is very helpful. It removes another layer of stigma and sees the problem more of adaptation than personal deficit. Addiction then is a function of:

· Not being focused on the right goals; and/or

· Forming dysfunctional habits to achieve these goals.

In my mind though, the deep learning view of addiction does not go far enough. Professor Lewis acknowledges that addiction is driven my deep despair and personal suffering. It is preceded by feelings of disconnection, alienation, despair and stress. My question is why are people feeling this way in the first place?

Is Addiction All of These Things?

All of these theories of what addiction is have been formed from numerous years of observation, research and in some cases personal experience. Therefore, I am really averse to disregard any of them. What about instead if they are all correct? From what I can see, they all have a place in explaining what addiction is, and in my very naïve viewpoint seem to relate together as follows:

Perhaps addiction is all of these things?

I call this my naïve view of the world, because as Professor Alison Ritter says, addiction in reality a “complex cultural, social, psychological and biological phenomenon.” [11]. And yet, while this may be the truth, it does not help anyone struggling with addiction, or their carers. A model is needed to explain what is happening for that person and to help them understand the pathway to healing.

Addiction Is A Symptom

In addition to showing how current models of addiction fit together, the above diagram also makes one critical situation clear. No matter what model you use to explain what addiction is, it all feeds back to a situation that has been reacted to through the use of substances or continued harmful activity. The definition of a symptom is:

“An indication of the existence of something, especially of an undesirable situation”.[12]

It is exactly that, an undesirable situation, that has given rise to the addiction. Therefore, by definition, addiction is not an end in itself. It may be a disease, it may be a disorder, but ultimately it is a symptom of an undesirable situation.

Your addiction to food, your addiction to social media, or your addiction to video games is only a sign that there is something else going on in your life - that there is a situation that is causing discomfort, and you are using these things to treat it - your addiction is, in fact, a kind of self-medication for a painful situation.

Unfortunately though, this insight raises even more questions. What is the undesirable situation, and why do people undertake such harmful behaviours to ‘escape’ from it? Stay tuned, because I will tackle this question next and present my theory as to what the undesirable situation is that leads to addiction.

To Think About:

· What view(s) of addiction to you tend to relate to the most? Why do you support these views?

· What view(s) of addiction to you tend to relate to the least or downright don’t believe in? Why do you reject these views?

· What do you think the undesirable situation was (or is) that has led to your use of harmful substance or activity? What situation ‘drove’ you to the substance or activity in the first place?

May you come to know and care for the great wisdom that resides within you.

[1] Global statistics on addictive behaviours: 2014 status report. Linda R. Gowing Robert L. Ali Steve Allsop John Marsden Elizabeth E. Turf Robert West John Witton. First published: Addiction 11 May 2015

[2] https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse

[3] https://www.thecabinchiangmai.com/blog/why-is-internet-addiction-growing-in-asia/

[4] https://www.lexico.com/definition/addicted

[5] https://www.google.com/search?safe=active&sxsrf=ALeKk03_xd_i0kAmWaiLPWkWTZcu_TkDBA:1603665803392&q=Dictionary&stick=H4sIAAAAAAAAAONQesSoyi3w8sc9YSmZSWtOXmMU4-LzL0jNc8lMLsnMz0ssqrRiUWJKzeNZxMqFEAMA7_QXqzcAAAA&zx=1603665808846#dobs=choice

[6] https://addictioneducationsociety.org/dr-kevin-mccauley-pleasure-unwoven/

[7] https://addictioneducationsociety.org/addiction-is-a-disease-of-free-will/

[8] https://www.lexico.com/definition/disease

[9] https://www.who.int/mental_health/management/en/

[10] https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926

[11] https://ndarc.med.unsw.edu.au/blog/why-addiction-isnt-disease-instead-result-deep-learning

[12] https://www.lexico.com/definition/symptomThe Addiction Healing Pathway



There is a path to healing and a light to guide your way.