by Carl V Phillips
Sorry for the radio silence. Was traveling, and then exhausted and sick. During my travels, I had a few interesting debates about the concept of addiction, and promised to write the following, which I finally have completed. The funny thing about all debates about addiction that I have ever participated in is that whenever someone defending the use of that term (pretty much always in the context of nicotine, since those are the conversations I am in) is challenged to explain what it means, they cannot. Quite often – in a bit of rather patent irony – they also get mad at me for daring to suggest that it is not well defined, even as they fail to offer any useful suggestion about how to define it.
Addiction exists in the same sense that happiness or beauty exists: It is a “know it when I see it” concept we are familiar with, and most people use the common language (i.e., informal) term. But it does not have a scientific or even medical definition. If words like “beauty” are used in a scientific context, the author needs to define how he is using the word, because the common language notion is not precise enough. Those who use “addiction” in a scientific context, without explaining what they mean by it, are creating confusion (intentionally, in most cases, I would guess).
For example, in the debate about THR, it is often claimed that those who quit smoking by switching to a low-risk product are still addicted. But are they? That depends on what the word means. But even when concrete claims like that are being made – so the word is not an aside, but the crux of the discussion – no one actually explains what they mean by the word. (Aside: Note that usually the most effective quick response to the silly “but they are still addicted!!!!” rhetoric is not to attempt the actual thoughtful discourse presented in this post, but to just say something like, “So what? They are addicted to something that is almost harmless” or the snarkier, “So you would rather someone die from lung cancer than stay addicted?”)
It is definitely possible to create a valid definition of addiction. Most everyone agrees that there is such a thing, though not necessarily that it covers vaping or even smoking. Consider the following (labeling it Scenario 1 to refer back to it): A person uses meth. He knows he needs to go to work today (sober), or he will lose his job, which is his only means of support, paying not only for his food and housing, but also his meth. If he smokes meth now he will have no money in a week. Yet he fails to resist the urge to smoke now, in spite of the dire immediate consequences.
That seems to be addiction according to any typical understanding of the term. But smoking cigarettes does not produce any experience similar to that story. Indeed, using a term that evokes the image of Scenario 1 to describe tobacco use is misleading in itself, and that evocation is often intentionally used to make smoking seem worse than it is. Still “addiction” might be defined to include smoking also. Perhaps not. And if so, does it include e-cigarette use too? To address these points, we need an actual definition.
I have thought a lot about this over the years. I have a pretty good idea of what the definition must include and what it must exclude. So here is the challenge to those of you who are sure there is a defensible definition: Can you provide one that fits the following parameters, or argue that some parameters are not reasonable expectations for the definition? Note that the list is really a lot shorter than it looks, as summarized at the end.
Requirement 1: The definition has to cover a situation like Scenario 1. If anything fits this definition, it has got to be that. This probably goes without saying, but it is included for completeness.
Requirement 2: The definition cannot be so broad as to cover such behaviors as breathing and eating, or spending time with your family and trying to get your work done. If the term is to be useful, it cannot be so broad. Yet I would estimate that half of the definitions someone offers for the term include behaviors that are biologically necessary or are the most positive behaviors people engage in. Note that taking refuge in the caveat “but it not biologically necessary” does not address the second of these (and anyone who offers a definition and then realizes they need that caveat has clearly not really given their definition any serious thought).
Put another way, the definition cannot be equivalent to saying “the benefits of the activity outweigh the costs by such a huge amount that the actor will not stop doing it.” This is the definition of “highly beneficial” not “addictive”, and yet many proposed definitions of addiction do not make any distinction between those.
Requirement 3: The definition cannot be so broad as to include eating dessert, driving, travel, or mountain climbing. I am thinking of proposed definitions like “they keep engaging in a behavior even though it is bad for their health”. (Note that this is not to say that once you had a definition, it cannot be found to apply to climbing or eating for some people; it just means that if the proposed definition includes all those activities for everyone, it is clearly a fail.) Roughly half of the activities we habitually engage in are bad for our health on net, and we clearly would not call them addictive just because of that. Setting a minimum risk level (to try to include cigarettes and meth but exclude burgers) is no solution, since there are not-necessarily-addictive activities that are riskier than smoking. Also, imagine medical breakthroughs that lowered the risk of smoking to below the proposed threshold: Any proposed definition of addiction that would be changed by finding a magic cure for lung diseases, even though the behavior did not change, is a fail.
Note, however, that the harmfulness of the behavior seems to be part of the common language notion of addiction. The way the word is used, it obviously refers to something substantially bad happening to the addicted person (see Requirement 5). If so, this suggests that the use of snus cannot be addictive, whatever the behaviors and urges involved, because it is close enough to harmless that the risk is not measurable.
Requirement 4: The definition cannot just be “uses a drug” or something similar. Often in political rhetoric (some of which pretends to be science), “addiction” is just used as an inappropriate substitute for “use”. It is a political trick: Take a word with nefarious implications and use it to refer to mere existence, and thereby tar a population with it without ever actually making any substantive claim. It reminds me of my days in Berkeley at the dawn of what would come to be disparaged as “political correctness”, when the chatterers tried to declare “racist” to mean something like “gets any benefit from the fact that there are racial disparities” or merely “is white”. Obviously a word misused like this becomes so broad that it loses all real meaning – except that it does not lose innuendo because the nasty implications of the word linger, even though the new definition has no nasty implications. Cute, huh?
But regardless of whether it is intentional rhetoric or just the sloppy language of non-thinkers, it is clear that addiction does not just mean use. We already have a word for that.
Requirement 5: It must necessarily be a bad thing that someone is addicted. That is, if all you know is that a person is addicted to X and nothing more (including what X is), you know that this is a circumstance that is substantially worse than if it were not true. To be consistent with the common language usage, it must be that “addicted to X” is bad independent of whether “does X” is bad (which relates closely to Requirement 4). The way the word is typically used, it implies something bad in itself, beyond any badness of the activity. Witness the common anti-THR refrain “but they are still addicted”, meaning “something is still bad when of ex-smokers are using a low-risk alternative, even though the activity itself has no substantial downsides.”
This is a rather more complex condition than it might seem at first blush. It subsumes Requirements 2, 3, and 4. This makes those redundant, but I went ahead and included 2, 3, and 4 as separate points to emphasize their implications which might be a bit too subtle if they were just subsumed under 5.
Separating those more undeniable specifics also allows for some aspects of Requirement 5 to be relaxed if anyone wants to argue that the proposed scientific definition need not be a negative epithet like the common language usage. If that is one’s approach, it is important to keep in mind the political uses of the term (and the analogy to “racism” noted above), and to make clear when using the term that it is not necessarily a bad thing. For example, the Chicago School economic definition of addiction by Becker et al. – which is the only candidate for a real scientific definition of addiction I recall ever having read in literally decades of interest in the subject – was proposed in the context of how it can be beneficial and a rational choice to become addicted.
Requirement 6: The definition cannot appeal to untestable claims, let alone absolute claims that are clearly false. In particular, any definition that includes a phrase like “cannot stop” is a fail. First, it is probably not true: if you could credibly tell someone that, say, you would torture his mother or child to death if he smoked another puff, he would stop. No doubt there are a handful of highly dysfunctional cases where even this consequence would not stop someone, but so few that the term would be almost vacuous. Second, even without such extreme scenarios, it is impossible to know how someone would react under every possible realistic circumstance, and thus a universal such as “cannot” can never be shown to be true, and so any proposed definition that uses it actually includes nothing.
Requirement 7: The definition must be based on behavior. The phenomena that are referred to as “addiction” have to do with the actions and volitions of the actor, not the object of those actions (a drug or whatever) itself. This is not to say that the implications of the object cannot be included in the definition (e.g., “addiction means that someone does X, and X has property Y” where Y might refer to a health hazard), but the characteristics of the actor (“does X”) are primary and any “property Y” is secondary.
In particular, this requirement excludes an appeal to “brain porn”. (That term refers to the recent quasi-science of measuring people’s brain activity under particular circumstances and drawing worldly conclusions, ignoring that there is no basis whatsoever for relating the images to reality – hey, it makes cool pictures and uses fancy equipment, so it must be science, right?). It is easy to make the case that a definition of addiction cannot refer to dopamine receptors, PET scans, and the like: Recall Scenario 1. Now consider some proposed definition of addiction that is based on brain chemistry, and imagine that you measured the brain activity of the person in the Scenario and found that none of the conditions were met. Would you say “oh, I guess he was not addicted after all”? Of course not. Similarly, if someone had all the brain activity in a proposed definition, but could easily take-or-leave the behavior, we would agree that is not addiction. So while brain porn might (might!) offer a prediction about whether addiction is present, it cannot be a defining characteristic.
Additionally, this requirement excludes defining addiction in terms of merely facing withdrawal symptoms (often called “dependence”) or having an acquired tolerance. Those experiences might be part of the reason why someone is addicted, but they are clearly separate phenomena. If someone has these but can take or leave the behavior nonetheless (which is a fairly common pattern for, say, caffeine) that cannot be addiction.
Requirement 8: The definition cannot just beg the question but using other ill-defined terms. If “addiction” is partially defined by “having a compulsion”, it is necessary to define “compulsion”. (Also, if someone “has a compulsion” but does not act on it, is that still addiction? You can go either way on this, but need to be clear about it.)
So, that is a very long list, but it also can be almost completely summarized as this short version: A definition of addiction must be based on behavior and must not be so broad as to include every strongly desired behavior nor every behavior that creates health risks nor all use of drugs; meeting the definition must either be inherently bad or a case must be made that addiction is not necessarily a bad thing. And, of course, it actually has to be a definition.
As I suggested, I have some candidate ideas. But before offering those I would like to see if those who insist that there is a clear and obvious definition can tell me what they think it is. I await your replies. But based on my experience of the universal failure to actually answer the question, I will not hold my breath.
Tobacco harm reduction, anti-THR lies, and related topics 
I got one candidate response to the challenge already during the process of having this post peer reviewed before posting. The American Society of Addictive Medicine’s “short definition of addiction”:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
This “definition” fails at multiple levels. Most notably, it is not actually even an attempt at a definition; it muses about the phenomenon but does not actually tell us how to decide whether it exists or not. It also seems to be suggesting that it is primarily about what happens in “circuits”, which is unsuprisingly convenient for those who want to make money selling treatments, but fails as a definition for the reasons I noted. It also begs the question, with a crux bit using “pathologically” without defining that.
Still, even though it is not a definition, it does offer enough concreteness to apparently exclude some behaviors, notably including tobacco use. Tobacco use is definitely not characterized by “diminished recognition of significant problems with one’s behavior and interpersonal relationships, and a dysfunctional emotional response”.
Interestingly enough, my ex husband worked in addiction counseling for most of his life. When I told him I was switching to ecigs he wanted to know when I would be free of my addiction. When I told him it had been 18 months he still wanted to know when I would be free of my addiction. I reminded him that I smoked for well over 40 years and it might take me awhile to get to zero nicotine levels. But that’s why he is my ex!
How I understand LOL. I am amazed how EX’s earn there position in our lives!
Nice one Sally. I have not given this anything like the thought time the author has but a method of thinking springs to mind. If you are a smoker you are addicted in the eyes of most people regardless of how much you smoke. But let’s look at drinking. There is the now and again drinker like me, the most weekend drinker who ends up throwing up in the gutter but neither of these are accused of being addicted. Then there are the drink addicts, I have known a few. My thought was if you can define where a drinker becomes an addict you may have a definition.
The best description I have found on this (in my mind at least) was published by Addiction Science. It delves into the difference between addiction and dependence which most of society uses interchangeably without really knowing there is a difference:
“In summary, drug addiction describes the motivational strength of substance use; drug abuse describes the misuse of a substance without explicit reference to motivational strength; and drug dependence describes the necessity of using a substance to maintain normal psychological and/or somatic functioning without reference to the motivational strength of the substance use or to whether the substance use violates cultural norms. These three terms have distinctively different meanings although there are obvious and numerous cases where all three apply to the same drug-use situation (i.e., the individual may be dependent upon a drug which they abuse because they are addicted).”
http://addictionscience.net/b2evolution/blog1.php/2009/03/30/why-distinguishing-between-drug-dependen
That definite strikes me as a good start to explain the distinction of those words. (Though “abuse describes the misuse” is content-free question begging, the observation that it is independent of motivation seems good.) The claim seems to be that addiction needs to be described purely in terms of motivation rather than behavior with possible reference to motivation as I argue, but I can see that such an argument might work. Unfortunately, this does not get us even into the neighborhood of a definition: How do you assess motivational strength and how strong does it have to be to constitute addiction? Also, I suspect any travel down that road will end up with a definition that violates the requirement that it not include everything that simply has very high benefits (eating and spending time with your family).
May favorite short definition: Persistent use despite negative consequences.
I also like the American Society for Addiction Medicine’s short def: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Either way, vaping does not meet the criteria for addiction. It does meet the criteria for dependency, as does regular coffee drinking….but unless one is robbing Starbucks or the local vape store there is no addiction.
The first one is definitely too short. It covers, well, everything. E.g., I persist in eating apples in spite of the negative consequences (you have to pay money in order to get them, peel gets stuck in your teeth). Three more letters would give it some substance, though: “despite net negative consequences”. This starts to be the germ of a possible definition, though it needs a lot more fleshing out (over what period do the net consequences have to be negative, for example). However, going down that path would exclude any cases where the benefits outweigh the costs, in spite of the behavior seeming to fit the notion. In Scenario 1, I tried to make the net consequences clearly negative over a relatively short period. But is it really that limited? If so, not very many behaviors qualify.
I already addressed the ASAM’s failed attempt at definition in a previous comment.
Neither vaping nor any other tobacco use fits the ASAM’s description. Vaping and other tobacco use do fit the “despite negative consequences” definition (as do apples). They may or may not fit the “net negative” amendment to it, depending on further details. Tobacco use typically has positive consequences in the short and medium term, while smoking often has a period of high costs in the long term. However, this is not true for everyone and may cease to be true in the future (do medical breakthroughs make something no longer addictive?).
More generally, I think an emphasis on consequences is a dead end path to follow. Consider two smokers with exactly the same behavior patterns and motivations, but you are told that one is going to acquire a fatal disease next year if he keeps smoking while the other will be able to do it for his whole life with no serious consequences. Is the first addicted and not the second? It seems that the definition has to include neither or both. (You can substitute cocaine for cigarettes if you do not think that cigarettes ever fit the definition.)
One thing that might be useful to you is to note the strong similarity between the definition of “addiction” and “Habit” in the english language. If you take it deeper you will find very little difference though. The huge difference lies in politics where addictions justify intervention whereas a habit is a personal choice issue.
As an aside to the original article, I believe that I have a dependency on nicotine not an addiction. I smoked for 35 years and gave up cold turkey. I had the usual withdrawal symptoms for a couple of months but then I became moody and depressed. I had many treatments from my doctor but nothing worked well. I got to the point in life when the dangers of smoking seemed to outweigh the depression so I went back to smoking. Slowly I got my life back. Don’t tell me I did not give it long enough…. 14 years. Then I found vaping, mainly for financial reasons, and after six months my head is still in the right place. I believe the 35 years of smoking has left me with a dependency on nicotine.
This brings to mind the issue of acquired dependency vs. just dependency. Neither one is equivalent to addition, of course. But there is the interesting question of the extent to which use of a drug just digs you out of the hole created by previous use as compared to just getting some benefit from the drug for relief of an unfortunate personal characteristic that was not caused by the drug. Undoubtedly there is some of each, but how much? You might think that after decades of research on related topics we would have a good idea of how to assess that for an individual or a population, but we really do not because much of the research is such political junk.
Interestingly I’ve got into the research of Carl Hart http://youtu.be/PdsN_vYZ3w8 – A talk he did for Google
He posits that our notion of addiction is all wrong
I agree with you Carl. It dominates our western culture to an extreme. Even the Judicial system, seems to advocate for Alcohol related crimes, that AA is the only answer, and you must get a paper signed. It’s bogus and really intrusive, based on political, financial and social pressures, that this overblown and mis-applied, mistaken, mis-understood believed as if religion the concept because it can’t be proven beyond that….”Addiction”
One of the funny side notes on current accepted models as applied to smoking is that you can make a drug less addictive just by raising its price!
– MJM
Or, you have a good chance of curing your smoking “addiction” by getting married and having children. John Mallon refers to “habit”, which, decades ago in the UK, before anti tobacco, was the term used with respect to nicotine. I think this is more accurate. Something you can stop by changing your environment seems more of a habit than an addiction; although apparently many Vietnam vet opium addicts quit instantly when they returned to the USA.
Perhaps not. Of course the government’s primary reason for the taxes is to raise revenue for the government. The ANTZ like them because they punish smokers for not obeying them. Actually changing behavior is no higher than third on the list of motives, which is good for them because it does it a lot less well than it does the first two. But back to the point: Depending on the definition of addiction (if anyone ever comes up with one) it might be that smokers who are driven to quit by prices are still addicted (that might be the case if it is based on proclivities even apart from behavior). It is certainly the case that punitive taxes do not reduce the addiction of those who continue to smoke, as you allude, they just raise the costs of it. Indeed, if the definition includes some notion of how high the cost is to continue the behavior, it might be the taxes that tip it into being addictive!
An Australian doctor on radio here in Ireland said that a habit can be just as hard to quit as an addiction. In both cases there is the issue of pre-disposition also. No two human bodies are exactly alike and while most people can take and enjoy alcohol in moderation, an alcoholic cannot. Why though is alcohol not addictive for everybody? Yet it is maintained that nicotine is?
I suspect he could not have told you why addiction is different from a habit. That makes it pretty easy to conclude they are similar!
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Interesting. The term’s broadening in modern discourse to include gambling addiction, sex addiction, thrill-seeking, and many other aspects of human behavior kind of devalues the core concept of substance addiction by forcing definitions to cover a “possibly impossible” range of situations and conditions..
We might well have been better served by broadening the vocabulary and picking a term other than addiction in describing these other “disorders” – even if some of the same “circuitry mechanisms” the author discusses (rather more – but not entirely more – dismissively than I would have) may or may not be involved in some, most or nearly all of them.
Also, behavior isn’t necessarily involved in physical addiction(s) (whatever it or they might be), and certainly not volitional behavior. Born-addicted infants will certainly suffer and can die without being properly withdrawn. As can addicts in various scenarios where they’re incapacitated (and not necessarily conscious).
OTOH one can be injured or die in coming off of other RX drugs that aren’t commonly referred to or thought of as addictive by sudden discontinuaiton without “weaning” off..
So the concept of physiological addiction is still an important subject of investigation, even if definition and syntax have become muddled and in some cases mangled.
What you describe is known as drug dependence, which is definitely not a synonym for addiction though they are often confused. The former is a matter of problems a body will suffer from ending an exposure to a drug while the latter — according to both common usage and attempts at formal definitions — is about behavior, or at least motivation. Dependence can be part of the cause of addiction in some cases, but you also can have one without the other.
There is actually a better case to be made for gambling etc. being addiction than there is for smoking. Gambling sometimes can be like like Scenario 1 whereas smoking cannot. Applying the term to non-drug behaviors (again, with the usual caveat that you figure out what it means in the first place) does not devalue it. To the contrary, it indicates a recognition that the term has meaning beyond just being just a negative epithet to describe drug use.
Ice, you noted, “Born-addicted infants will certainly suffer and can die without being properly withdrawn” and yet, oddly enough, there were no reports of deaths among the tens (hundreds?) of millions of BabyBoomer and GenXr babies that were supposedly “born addicted to the most addictive drug on the planet”!
– MJM
Michael J. Mcfadden, wow a great debating point, I’ll remember this as I comment to the arguments that cast a shadow over nicotine use as being an addiction!
That is an excellent way of disproving this Stan Glantz rederic, he calls e-cigarette users “Addicts”, the question where are all the billions of babies born addicted to nicotine. BULLSEYE!
Fascinating article.
Here’s my attempt:
1. To say that an “addiction” exists arises from a particular interpretation
of particular bad decisions made by people.
2. “Addiction” is a way of explaining bad decisions in terms of a pattern of previous, similar decisions in a person’s life, rather than giving
prominence to the particular circumstances involved in the particular
decision that was a bad one – or simply writing off the bad decision as a one-off accident.
The “similar” decisions are similar in that they result in similar behaviour to the bad decisions: they don’t have to also result in bad consequences to count as “similar”.
3. For a decision to be “bad”, it doesn’t have to be a decision to behave in a way that’s immediately harmful, or even necessarily ever harmful in
itself. The decision only needs to be “inappropriate”, meaning that it has bad consequences because of factors to do with the particular situation in which it was made.
3. To attribute the bad decision to “addiction” is to draw a causal link
between the instances of “similar” decisions (that is, those that result in
similar behaviour), and to examine the decisions in terms of their differing prevailing circumstances.
4. The assertion involved in calling a behaviour “addictive” is the
assertion that previous instances of the behaviour (which might all result
from “good” decisions, in that they don’t result in bad consequences) will
tend to over-rule consideration of changing circumstances, so that the
behaviour is repeated, even though it may now result in bad consequences.
An “addictive” behaviour is one that tends to skew future decisions about it. This meets Requirement 1 by covering Scenario 1.
The “tendency” for the behaviour to skew subsequent decisions about it must be established by observation (and perhaps interrogation) of many people who engage in the behaviour. This of course makes it impossible for the label “addicted” to stick, definitely and absolutely, to a particular person at a particular time, since it’s only a statistical generalisation. It becomes impossible to definitively ascribe bad consequences happening to any particular John/Jane Doe as being “caused by their addiction”: the ascription has to remain a causal hypothesis, which might provide a more useful explanation than the other hypotheses available.
The advantage is that the definition can meet Requirement 6 by not making untestable or absolute claims.
5. To be described as “addicted”, the person must have experienced actual negative consequences from repeating the behaviour. Otherwise there is no harm done, and we should say instead that the person is engaging in potentially addictive behaviour. I think this is an important distinction to make, because people are often mistakenly described as “addicted” in terms of the behaviour they habitually engage in, merely because other people have suffered negative consequences from this behaviour. (“Many people who smoke cigarettes are addicted to them; you smoke cigarettes -> therefore you too are addicted to them”).
(Without this stipulation, the definition would fail on Requirement 5).
Let’s go through your requirements:
Requirement 1:
I think it meets this one.
Requirement 2:
I think it does meet this requirement, because of the stipulation that the
behaviour must be “inappropriate”. Breathing is not an addiction. But
breathing when underwater is not appropriate. Continuing to breathe when underwater captures something essential about addiction, which is that it can’t be defined merely in terms of a regular behaviour; in addition, there must be a mismatch between the behaviour and the circumstances (I attempt to capture this mismatch using the admittedly undefined term “inappropriate”). More precisely, continuing/repeating the behaviour gets undue weight in the decision, at the expense of considering the surrounding circumstances.
Requirement 3:
Trickier. I think this is the hardest requirement. I also think it’s impossible for any definition to meet it without resorting to a value-judgment about the level of harm done. I suspect you of being slightly sneaky in setting this requirement: because following it up seems to me to reveal that no definition is possible without a value-judgment.
I think my definition has the advantage of isolating the scope for value-judgments in one place: in the term “inappropriate”.
But I disagree with what you say here:
“Any proposed definition of addiction that would be changed by finding a
magic cure for lung diseases, even though the behavior did not change, is a fail.”
because my definition is in terms of negative consequences. I think you’re setting an impassable obstacle to a definition here, by implying that something that _IS_ an addiction under the definition must remain an addiction irrespective of the absence of negative consequences. This also contradicts Requirement 5: how can it be possible to define something that is necessarily a bad thing, but which also remains a bad thing even if it causes no harm?
The really tricky thing revealed here is that everyday talk about addiction involves a sleight of hand whereby the judgment “bad” is lifted off cases where the behaviour actually does cause harm, and applied (for the purpose of exhortation) to all cases where the behaviour takes place at all, even where no harm is done. This is a second-order phenomenon: it still remains the case that the behaviour leads to no harm in a particular case, even if the evidence shows that it _TENDS_ or _MIGHT_ lead to harm. (In the worst kind of definition, which would fail your Requirement 6, the absolute claim is made that the behaviour _WILL INEVITABLY_ lead to harm).
Requirement 4:
Meets this. The behaviour itself doesn’t have be inherently bad or harmful. Its “badness” arises only from its tendency to repeat itself in circumstances where harm arises because of other circumstances.
Requirement 5:
Meets this, because behaviours without negative consequences are excluded. Admittedly, this is at the expense of decanting a large group of people – those who engage in behaviour similar to that which tends to cause negative consequences – into a new group called “engaging in potentially addictive behaviour” rather than “addicted”.
Requirement 6:
My definition bypasses the tricky ground of untestable claims by appealing instead to “tends to lead to bad decisions with negative consequences”, on a statistical level generalised across people. This brings along its own weaknesses, of course.
Requirement 7:
Meets this. It’s entirely behaviour-based, and doesn’t even postulate a
mechanism that somehow allows repeated behaviours to influence subsequent decisions about them. The assertion that is does influence decisions is backed up statistically, rather than in terms of an “addictive phlogiston” contained in the object of the behaviour.
(Q: do we need a mechanism, even a postulated one, to legitimately call a behaviour “addictive”? Or is a correlation enough?)
Requirement 8:
“Inappropriateness” is the foundation of this definition. Is it well-
defined? I think not. To try to meet the other requirements, I’ve had to bring in an undefined term. My intuition is that this is inevitable (though I could try to come up with some definition of “inappropriate”, given time).
At least “inappropriate” isolates the contentious, value-laden judgment in one place in the definition.
Would be interested in your thoughts on this.
Ok, let me try to walk through this… You are saying that a sine qua non of addiction is a repetition of previous behavior. That seems to comport with typical usage (and all by itself calls into question some really dubious uses of it; see for example this really excellent analysis of the claims about youth becoming addicted to smoking after taking just one puff http://www.harmreductionjournal.com/content/7/1/28 ). You further argue that the past use is causing the ongoing use. This is the neighborhood of the Becker et al. definition, and also seems to comport with general usage. You correctly warn that since causation is part of the proposed definition, there is no way that the existence of a case of addiction can ever be proven, since causation can never be observed but only inferred; a nice point, though it probably does not contrast substantially with most real-world categorizations, most all of which call for inference and can never really be proven.
I am a little unclear on the role of “bad” in your conceptualization. You declare it to be necessary that the decisions resulting from addiction are bad, which makes it fit the common usage and the related requirement that I suggested (however, this might be too strong — one could argue that someone can be addicted without ever acting on the resulting urges to make a bad decision). But what is “bad”? The question is critical because tobacco control and other drug war types try to suggest that if there is any downside whatsoever, the decision is bad (because they pretend that there are no benefits), which brings up my “eating an apple” observation from a previous comment. Are you saying “doing it even though it is bad for oneself, on net”? If so, that is a (reasonable) strong condition for defining a behavior that is better avoided. You have some temporal issues in there (about changing circumstances and such) that I am unclear on.
One specific point that is more clear to me is that the there must be actual negative consequences. I am not sure you want to claim this quite the way you do. See my point about two apparently identical smokers, one of which will get a disease from in next year and other who never will — I find it impossible to justify calling the first addicted but not the second. If such harm is part of the definition, it really needs to exist on an expected value basis: a behavior creates some particular health risk as an average across the population and that average needs to be the basis for evaluating the harmfulness of current behavior. Your approach does mean that a behavior that has no substantial health risks on average (smokeless tobacco, coffee) cannot be addictive. That is definitely a reasonable exclusion.
As for my requirements, the core of your proposal, like the core of Becker’s, has some trouble with the “badness” Requirements (2, 3, and 5). This is actually a fairly natural result of trying to think this through, as you have done. You quickly run into difficulty trying to find a fundamental distinction between smoking and enjoying classical music — both are relatively unappealing to the uninitiated but become more attractive as you do them more. Becker’s original approach was to call them both addiction and then caveat as negative and positive versions of addiction (with this based on the effect on welfare of past consumption — does it dig you into a hole or does it make you happier for having done it in the past). In later versions he make the negative part of the requirement and just forgot about the positive side, which seems similar to your approach of adding a separate set of conditions for badness. This is needed to fit my stated requirements, which are based on meeting common usage. But it does point out a core awkwardness of the whole concept (which you have discovered — unlike most people who use the word — because you tried to think it through): Unless you kludge on some requirement that the outcome is bad, the description of the pattern of past behavior, changing preferences, causation of future behavior, and such refers to positive learning and enthusiasm-building experiences.
(And on that note, no, Requirement 3 is not a trick. It is to force you to come up with a definition that does not include behaviors that are generally accepted as beneficial on net, including those that happen to pose some health risk. Well, force you to either do that or to argue that the word cannot be made meaningful without including those too, and so the response needs to be to push back against the notion that addiction is necessarily bad.)
You challenge my condition that the addictiveness of a behavior cannot by changed by finding a cure for the diseases caused by it. You are right that if some form of “is bad for you” (recalling that I am not sure exactly what your concept if this is) is part of the definition, then curing the harm eliminates the addiction. However, note some implications of this in terms of differential susceptibility to the harms: A billionaire cannot be addicted to casino gambling, even if his behavior is identical to that of normal people who might be called addicted, because he cannot lose enough money to cause himself any material harm. An author or artist who uses a (not highly physically harmful) mind-altering substance is not addicted if it helps his process, whereas an office worker who has the same urges to use and use pattern is because it interferes with his work and is going to get him fired. If a cure for lung diseases is found but is expensive (pretend for the moment that it is the only disease caused by smoking), then smoking is no longer addictive for Americans but is still addictive for Kenyans because they cannot afford the cure.
To then clarify, how can I contend that addiction needs to be a bad thing but needs to still be addiction even if a cure for the diseases is found? What I was trying to get at there was that the label “addicted” means something bad, even if we do not know what someone is addicted to (and thus its specific implications). But you make a good point that if the definition explicitly includes harms caused by the particular behavior, then finding a cure would render the behavior non-addictive. Not everyone would agree with that specific inclusion in the definition, of course. For example, the Becker approach to separating negative addiction from positive is whether the accumulated past use makes you worse or better off, rather than basing it on impact of future use. But I concede that if actively doing harm is just part of the definition then finding a cure for the cancer cures the addiction too. However, I am not sure this proposed approach sits right with me — I am not convinced that a non-gerrymandered definition is possible that discriminates between otherwise identical behaviors and motives based on whether they pose a risk to a particular individual.
As for your point about sleight of hand, I totally agree. I think that this is a revelation that is inevitable for anyone who actually thinks this through. I am glad you came to that conclusion too.
Continuing, you are again definitely right about any definition about causation requiring appeal to statistics or inference rather than being able to observe the causation. That is fine. Indeed, I think it is not just possible to define something in unobservable terms and then apply it with observations, but necessary to do so. Any worldly definition (i.e., not purely mathematical or semantic) is going to have such properties. A definition needs to have clear properties, and then the assessment of meeting that definition needs to be based on observable properties. This is true for most anything I can think of (e.g., “I have the stomach bug that is going around” is defined based on having an active infection of this virus that is causing particular disease states; the inference about it comes from observing the disease state matching the known symptoms and inferring the virus is causing it; indeed, even if the biological measure of the existence of the virus in my body was done and positive, this would still not prove the causation). Note that the “phlogiston” of addiction can be pushed further down in terms of economics — welfare functions and such — but does not have to be; even if it is, the economics can help clarify what you are assessing but it is still no more directly testable than any other causal claim.
When discussion Requirement 8, I think you recognize that there is something still a bit fuzzy about your definition. This is not a criticism, but a suggestion for further thought and clarification. But I think it is actually possible to meet this condition fairly well (as Becker did) though perhaps not perfectly (again, as Becker failed to do).
Thank you for giving this serious thought and for providing a useful test of my framework. Your analysis suggests that most of what I started with is solid, though points out that if bad health effects are sine qua non then some of what I proposed does not work.
Hi Carl,
I have the feeling that you will not be surprised that I react to this extremely interesting challenge. I also would much appreciate your comments. Before stating my way of circumventing the problem I want to relate to your requirements. Requirements guide definitions and may or may not be relevant.
Requirement 1 (The definition has to cover a situation like Scenario 1), for example, would not be accepted for all “addicts” by Gene Heyman in his book “Addiction – a disorder of choice”, Harvard University Press, 2009, who claims that those who cannot stop habitual drug use is a small minority that came to represent the “typical” user in the public eye. You will judge by yourself whether my (tentative) position fulfills this requirement.
Requirement 2 is tricky. If you want to relate the term addiction to drugs only (“drug addiction”) I agree. On the other hand, if you support the position of some of my colleagues who talk about “workaholics”, sex addicts, carrot addicts, etc., you make any definition problematic. My position is that scientific terms should delineate fields that can be defined separately. Using the same word for different behaviors (like addiction over the past 100 years or more of the use of this term) causes exactly the confusion existing today. I would prefer to redefine this requirement as being restricted to “drug addiction”. Furthermore, if we talk about the mechanisms that cause drug addiction “highly beneficial” cannot be lightly discarded. The high percentage of Vietnam vets who were “addicted” to heroin upon return to the USA but kicked the habit and did not return to the drug may be an argument.
Requirement 3. There can be addictions that are beneficial. The negative connotation with the word “addiction” (in my opinion) has no place in science and invalidates the term a priori to be a scientific term.
I agree with requirement 4. I have yet to meet a person who does not use psychoactive chemicals like caffeine (in chocolate, coca cola, or coffee), theophylline (like in tea), alcohol (if even for religious practice) but it does not mean all drug users are addicted.
I do not agree with Requirement 5 for the same reason as requirement 3. I believe that the behavioral (and brain) mechanisms allowing addiction are at its origin beneficial for human behavior. That the word “addiction” has a negative connotation invalidates it as a scientific term and I myself would gladly replace it with another.
Requirement 6. Referring again to Heyman, there are many drug users who seemingly are addicts (use drugs regularly for years) and stop without intervention when the practice becomes unsuitable with their life style. I take it that you do not want to talk about those. Still, I would like to refer to Harry Levine (the invention of addiction), Peter Cohen, and John Booth Davis who basically deny that addiction as such exists.
Requirements 7 and 8 are OK.
To the point: I do not believe that a satisfactory definition of the term “addiction” (with its negative connotation and according to all of your requirements) is possible. However, most existing definitions are on a continuum which allows a choice (moral, scientific, and political).
The crucial underlying term is “habit”. There are various definitions of what a habit is (for the most recent one see Anthony Dickinson – older ones available on request). Let us accept for the moment that a habit is a behavioral routine “that is established with reinforcements other than those which perpetuate it, becomes largely independent from direct cognitive control, and hence largely automatic”. To give 2 examples: When my daughter was about 6 months of age, she had a problem falling asleep. The pacifier was a great solution. The use of the pacifier generalized to other situations (when she was hurt, insulted, etc.) until she finally faced life with a pacifier in her mouth and two more in each hand (reserves for the one she had in her mouth). When deprived of her pacifiers she had a withdrawal syndrome very similar to that of an abstinent smoker: aggression, depression, problems falling asleep, irritability, etc.
Example 2: When crossing the street I look first to the left, then to the right, again to the left and then I cross. Of course that habit would kill you in London, where the traffic is coming from the wrong direction. You are also clearly warned on Heathrow, in London (by marks on the side-walk) and elsewhere. For somebody used to driving a car in Europe (where the habit shows up by sometimes arriving at your destination without basically any memories of how you got there) it is a nightmare driving in Australia or Ireland. Every habitual move has to be brought back under cognitive control which is not easy. Habits are hard to break.
My point of the first example is to show that the pacifier in a habit can acquire affective value (and hence serve as a positive reinforcement and its absence a negative reinforcement as evidenced by a withdrawal syndrome). The point of the second example is to show that the reinforcement creating the habit (presumably not by being hit by Mack trucks or buses, but rather parental praise) is not the same as maintaining it: The stress evoked by not being able to practice the habit in the way learned. No drugs are involved – let us call those habits category I. Note, however, that habits are biologically and behaviorally an efficient way of performing tasks without having them under complete cognitive control. We can drive our car and talk to the passengers, listen to the radio, and talk on the phone (via Bluetooth, of course). Habits, in principle, are “good”, meaning that they help us to cope with life efficiently.
Drug users have a drug related habit. That means that, like all other habits, these are sustained by positive reinforcement of practicing a habit, and negative reinforcement by being prevented from practicing it, just like habits of category I. There are 3 different interactions of drugs with habits. The first is that there is none. People eat chocolate (with exceptions) just for the taste of it and not for the caffeine. Some people like the taste of coffee without the effects of caffeine – hence decaf. Decaffeinated Coca Cola is a commercial success, indicating the same. We shall call those habits category II.
Habits of Category III are normal habits – however, the drug involved adds positive reinforcement to those of the habit. Drugs like LSD, cannabis, cocaine, etc. do precisely that. Note, that consuming caffeine (to those who like the perking effects of coffee) would be a category III habit to these people.
Finally, category IV habits are distinguished by the observation that withholding the drug after long time use results in a withdrawal syndrome that is different from the one created by cessation of the habit (a drug specific withdrawal syndrome).
What is my evidence for and what are the benefits of the model?
The evidence is abundant. If, for example, we give a heroin antagonist (say, naloxone) to a habitual heroin user he will have a precipitated aversive withdrawal syndrome identical to the one he has when not taking heroin. This shows that naloxone blocks positive reinforcement of the drug and causes negative reinforcement. Both are reasons to continue taking the drug. The injection of saline to heroin users gives them a “high” (less that real heroin) and diminishes the severity of withdrawal (several articles by O’Brien in the 1980ies). In other words, additional positive reinforcement from the habit as such can be shown. Clearly, this is a habit of category IV.
Interestingly, when talking about nicotine, mecamylamine – the antagonist) does NOT cause precipitated withdrawal. Nicotine does not (in the absence of cigarettes or tobacco) provide positive reinforcement (it is not self-administered by humans). It does add to the taste of the cigarette so I would classify it as a category II (if you press me, maybe III but not because of its psychoactive effects). Denicotinized cigarettes, on the other hand, suppress (observed in many papers) the smoking withdrawal syndrome just like regular cigarettes, suggesting that these are by the cessation of a habit, not of nicotine intake.
The benefits of this model are that you do not have to define addiction on the basis of any stringent criteria. If you believe in “workaholics” habits of category I are an addiction, fine with me. If you are a psychopharmacologist of the 1970ties, only habits of category IV are an addiction. Bravo.
Of course we both know that this is all very nice, but not sufficient. Relapse occurs months after “detoxification” for all drugs I know of. After Gulf war 1 nearly 90% of detoxed heroin addicts came back for a second round and the general success rates of the first round are well-known and low. We all have a memory of stress reducing and pleasurable effects of habits and can renew them at any time when we want to.
So what is an “addiction”? In this I am very close to Peter Cohen. It is a cultural invention aimed at taking the responsibility from the “addict” and dumping it on the substance or whatever agent “causing” addiction. Call it the devil.
Thanks for that. I am very busy for a few days but will respond to this with the details it deserves as soon as I can.
Thanks again for the comment. I am finally getting back to this.
>Requirement 1 (The definition has to cover a situation like Scenario 1), for example, would not be accepted for all “addicts” by Gene Heyman in his book “Addiction – a disorder of choice”, Harvard University Press, 2009, who claims that those who cannot stop habitual drug use is a small minority
I totally agree that this is a minority of users. I was just trying to say that everyone would agree that this story is *sufficient* for “addiction”, not necessary. So I don’t think there is any disagreement here.
>Requirement 2 … My position is that scientific terms should delineate fields that can be defined separately. Using the same word for different behaviors (like addiction over the past 100 years or more of the use of this term) causes exactly the confusion existing today. I would prefer to redefine this requirement as being restricted to “drug addiction”.
This brings up a good point. I did not drill down into “what I would argue should be the case” and tried to stick to “what we all surely agree is the case”. So, if you narrow to “it must involve drug use” then the examples I gave of what it should not include are obviously excluded. However, I would argue that the word “addiction” in the phrase “drug addiction” should still mean something and if you substitute “gambling” for “drug” it should still mean close to the same thing applied to the other behavior. Then it re-extends to my point, it should not just include everything that is very desirable.
But we can also specify that within the realm of *drug* addiction itself. It should not be sufficient for “addiction” if someone is dedicated to using a drug because his natural state is “in great pain” or “dysfunctionally unable to focus” (or perhaps even “suffering from HIV and will die without ongoing treatment” if the proposed definition gets too sloppy). It might be that someone is using the drug to relieve great pain *and* he is “addicted” also (if we would figure out what “addicted” means, of course). But it cannot be that “using it constantly to relieve a completely horrible alternative” cannot possibly be sufficient for addiction or the word simply means “likes a lot”.
>Requirement 3. There can be addictions that are beneficial. The negative connotation with the word “addiction” (in my opinion) has no place in science and invalidates the term a priori to be a scientific term.
Fair enough. I agree with what you say. So when someone is using the word in an ostensibly scientific contexts as a judgmental term, they are failing twice (using an mal-defined word without explaining what they mean, and misusing it with its political connotations), and thus are clearly not really doing science. (Indeed, that is a good litmus test for whether a writing about tobacco or other drugs is real science.)
Unfortunately, it still leaves open the question of how to deal with the use of the word in non-scientific contexts. The perfectly valid way of dealing with it based on your suggestion is to add “so what? addiction is not necessarily bad” to “what do you mean when you use that word”. But you are forced into that. If you push back against the dominant view of the word (that it is negative) and thus broaden the space in which it can be defined, you then run into the rhetorical trick of someone using a word that does not technically have a particular meaning, but using it to imply that meaning because of the popular conception.
>That the word “addiction” has a negative connotation invalidates it as a scientific term and I myself would gladly replace it with another.
That is probably the optimal way to do it. It is nearly impossible to salvage a term once it has started to wander in popular interpretation.
>Requirement 6. Referring again to Heyman, there are many drug users who seemingly are addicts (use drugs regularly for years) and stop without intervention when the practice becomes unsuitable with their life style. I take it that you do not want to talk about those. Still, I would like to refer to Harry Levine (the invention of addiction), Peter Cohen, and John Booth Davis who basically deny that addiction as such exists.
It is not a matter of not talking about them, but they do provide an example of the point. If the definition were based on their behavior while “seemingly” addicts, they might qualify (in spite of being able to quit later). But if the definition were based on some “cannot quit” notion, we would have no way of knowing they do not qualify until they suddenly stop (and we would have no way to know someone did qualify because that sudden stop could always happen tomorrow). It is true that there are useful definitions that cannot be tested in philosophy and theoretical physics and such, but I think it is pretty clear that in this context no definition that can *never* be shown to apply in any case is appropriate.
>To the point: I do not believe that a satisfactory definition of the term “addiction” (with its negative connotation and according to all of your requirements) is possible.
I think you are right. I realize that I should have flagged that “must be negative” requirement as something of a “trick question”. I think I can offer a defensible definition (and will get around to doing so before too long, I hope), but it pretty clearly does not pass the “definitely is a bad thing” test. In other words, I guess what I did above was create a hopeless challenge, perhaps semi-intentionally, for those who use the term as if it were both scientific and a negative epithet.
>Let us accept for the moment that a habit is a behavioral routine “that is established with reinforcements other than those which perpetuate it, becomes largely independent from direct cognitive control, and hence largely automatic”.
I agree that this is one good candidate anchor point for offering a definition. I lean more toward Becker’s notion of increasing marginal returns (which is a failure as originally stated, but starts in a promising direction). They overlap substantially, of course.
>…
I like your approach of dividing up the factors that make using the drug etc. attractive (the word I would use as someone focusing on consumer economics). That is definitely a necessary start for unpacking the concepts under discussion here. It may not lead clear to a definition (as you seem to agree) but at least it points out the nonsense of treating casual use of the term as if it were useful communication.
>Interestingly, when talking about nicotine, mecamylamine – the antagonist) does NOT cause precipitated withdrawal. Nicotine does not (in the absence of cigarettes or tobacco) provide positive reinforcement (it is not self-administered by humans). It does add to the taste of the cigarette so I would classify it as a category II (if you press me, maybe III but not because of its psychoactive effects). Denicotinized cigarettes, on the other hand, suppress (observed in many papers) the smoking withdrawal syndrome just like regular cigarettes, suggesting that these are by the cessation of a habit, not of nicotine intake.
I have to part with you here. I agree that denicotinized cigarettes are satisfying for some people, to varying degrees, so there is something about that behavior other than drug delivery (although this conclusion is complicated by the fact that cigarettes deliver psychoactives other than nicotine). But it is clearly the case that many people self-administer nicotine ex-tobacco leaf. E-cigarettes are the obvious example, but people have been self-administering NRT since it became widely available. The manufacturers (let alone the tobacco control industry) do not like to admit it, but most of their sales are to people using it this way and not for weaning to abstinence as they are officially supposed to be used.
>Of course we both know that this is all very nice, but not sufficient. Relapse occurs months after “detoxification” for all drugs I know of. After Gulf war 1 nearly 90% of detoxed heroin addicts came back for a second round and the general success rates of the first round are well-known and low. We all have a memory of stress reducing and pleasurable effects of habits and can renew them at any time when we want to.
I usually cite the equivalent observation as part of why the usual notion of “addiction to tobacco” is glaringly wrong (as is the belief that NRT weaning and similar methods have any chance of being very useful). However, I would take it out of the loaded language and just say “people like doing it; they remember that they liked doing it even after they are no longer hooked or withdrawing, and so they want to do it again”. This is why THR is clearly superior to abstinence in most cases – it lets people do what they enjoy and they do not have to constantly resist their preference for using rather than not using.
>So what is an “addiction”? In this I am very close to Peter Cohen. It is a cultural invention aimed at taking the responsibility from the “addict” and dumping it on the substance or whatever agent “causing” addiction. Call it the devil.
Indeed. I don’t know if you have seen what I have been writing about modeling THR uptake this year, but I make the observation that the tobacco control industry’s underlying “model” of why people use these products is that it is demonic possession. Their business model is predicated in pretending that people do not like to smoke etc., so this means that they are assuming that people are acting against their own will. (My focus there is on the fact that they cannot hope to figure out how people will respond to new options or other changes if they have no idea why anyone is acting in the first place.) In order to keep up that demonic possession (or devil) view they need enough of an explanation for the behavior that they can trick people who do not think very hard, and thus do what you say: assign the demon role to the product and make preposterous claims about what it is capable of.
So it seems like we might have a good collaboration available here to pursue this more. Interested?
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I am certainly interested in reading more, This is sufficiently well written that I can actually understand what you are saying. please continue!
Here’s my somewhat “simplified” version.
If you are addicted to something, no matter how long it has been, you will always be fighting the “urge” or cravings to partake in whatever it is. Your addiction never truly leaves you.You have no control over it.
If it’s simply a “habit” then you can take it or leave pretty much.
There are two different preference concepts in there, which are commonly part of the not-actually-definition soup, but neither of them really works. One is nothing more than “having experienced it, you do not forget you like it”. Of course, there might be something more there, but most of those “urge”-based attempts at a definition do not exclude mere appreciation of a high-quality experience.
The “lack of control” concept seems like a place to start, but obviously it is not an absolute, so you need to draw some lines. Is any “urge” (which is to say, desire) at all sufficient. In that case, everything pleasant is “addictive”. No control at all? Only rare very extreme experiences would fit that description (including things like rabies, but definitely not smoking). As Prof Frenk, who commented above, has pointed out in great (and amusing) detail, the tobacco control industry’s notion of “loss of autonomy” includes such situations as “tried one cigarette and has not touched another, but after trying the one she discovered that it is more enjoyable than she originally thought.” This points out that a vague “no control” concept invites the liars to debase the concept down to being so broad that it is obviously absurd.
IMO the WHO needs addiction. If there is no addiction then their work is illegal. They need addiction otherwise they are not allowed to “care” for grownup people. Their business model depends on addiction. They are addicted to addiction. That is why they call reward or self-reward addiction. There is no demon.
They need to call every smoker an addict despite the fact that only some smokers show signs of “addiction” according to their own standards (DSM-IV, ICD-10, Fagerstroem cigarette dependence test). They will never stop to tell the story about “one cigarette is enough to get hooked”. They know that chippers exist, people using drugs from time to time and never getting “hooked”. They know that nicotine is not addictive. They (WHO/FDA) have approved nicotine NRTs for longtime and dual use and are more than convinced that nobody will become addicted. They use double-think and tell everybody that nicotine is addictive. They had to fabricate the kinetics story about the speed of nicotine reaching the brain in order to explain their double-think. Every nicotine user titrates nicotine to his pleasure level. This level is high enough to create the reward. Some spikes in the nicotine concentration curve explain nothing. Inhalers, nasal sprays and good e-cigs filled with high nicotine liquids show the same kinetics as cigarettes.
This is tough. These are some thoughts. Nothing is definitive although some questions and answers may appear that way.
Starting point: The term “Addiction” is an abstract noun, it is a snapshot of a process. It is a nominalisation of the verb ‘addict’, an on-going process ‘to addict’.
An issue immediately arises with the use of ‘addict’ as it can relate to the process, the name of the result of the process or even just a way of describing an obsessive. This maybe where we run into the problems associated with activities not normally thought of as addiction. e.g shopping addict. Both ‘addict’ and ‘addiction’ are vague enough to allow people to supply their own interpretations.
How does someone addict? What has to be done to addict someone to something? What are the required elements? For example, a substance maybe used. What are the properties of that substance that enable its use to addict someone to it? This is not like requirement#9, in this case some property is an actor in the process. The process can be applied to a person or can be applied by the person themselves.
Thinking about requirement #2, can you use something biologically required to addict? Can you become addicted to chocolate? On the one hand, Chocolate is something you eat, eating is a biological requirement, so no. On the other hand, eating specifically chocolate is not a biological requirement, so yes. Since a process implies a change, some change must occur after the ‘addict’ process. If you want to include chocolate as something that can addict, then what of chocolate does the ‘addict’ process?
What is the ‘addict’ process? If someone is in state A before the process and state B after the process, applying the ‘addict’ process would make the changes from State A to B. It seems we have many descriptions of State B, compulsion etc. and some ideas about the process e.g reward or chemical change. To maintain state B, process ‘addict’ needs to be on-going. The nature of State B can be described in physical and/or psychological terms. There is a problem with the descriptions, many people acquire them without the application of the ‘addict’ process.
States A and B are a series of states. Stopping the ‘addict’ process does not necessarily return the person to state A but one of the subset states of non-addictive states. Is the withdrawal state a subset of A or B? If the process needs to be on-going then it is a subset of A, therefore subsets of State A include states that manifest themselves in ways similar to State B.
Summary: To summarize this ramble, ‘Addiction’ is the (abstract) name given to the application of an on-going process, ‘to addict’, that produces, for want of a better descriptor, an ‘addictive state’.
Non-addictive state –> process ‘addict’ –> Addictive state
Potential feedback loop…………^————————?
Both the process and the addictive state are requirements. The presence of an ‘addictive state’ in the absence of the ‘addictive’ process is not addiction. Note also that the ‘addictive state’ may become an input to the process, essentially creating a feedback loop.
More questions than answers. What are the defining characteristics of a) process ‘addict’ and b) the set of ‘addictive states’?
I hope this makes some sense. More thought is needed
Some of those who cannot stop habitual drug use strongly believe to be addicted. They could stop but as long as they believe to be addicted, no way. Before 1990 most smokers thought of smoking as a habit. Then the Surgeon General in 1988 told them that smoking is as addictive as heroine and cocaine and since then some stick to it. Decades of WHO-propaganda made fools out of intelligent people.
And Pharma knows that the wish to stop smoking is a conditio sine qua non for the “efficency” of their patches, lozenges and inhalers (comparable to placebo and useless without counseling).
For some people addiction is mere belief, a self-fulfilling prophecy.
Forked tongue Pharma. They are PIMP DADDY of all Healthcare! It’s not easy to remove their rigamortis hands from the purses of SMOKERS!
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From the point of view of a simple consumer who likes to keep things simple (and who likes to contemplate before contributing – obviously), there are only two points of any interest here:
– A term such as addiction has a cultural measure built in; it is era and location and culture-relevant only; and therefore philosophy not science. Person A’s addiction or abuse is Person B’s normal, in another time and place. It isn’t scientific as it can’t be measured. Measurement can be attempted but is speculative at best, as clearly there is no agreement. A Fagerstrom test for example doesn’t even have an inalienable subject to test for, never mind agreement on its outcome. You can measure the earth-moon distance and few will argue; addiction is another matter.
– If a range of terms are available, then one could be used for action with risk of harm, and another for action with little risk of harm (since we are talking about philosophy not science here). So you could, for example, use ‘addiction’ for a compulsion that has a significant risk of some kind of negative effect, physical or social, and ‘dependence’ for a compulsion that generally has little risk. How to pull any small harms out from the background of modern urban life is a mystery, given that it is an extremely unhealthy mode of living. Addiction and dependence are concepts not specifics.
I agree that usage, including most faux-scientific usage, is about judgment and not a worldly phenomenon. It is more like “devient” than it is “depressed” — neither is well-defined, but at least those using the latter are striving to capture a concept that is about the world and not about their own preferences. Still, some people using the word clearly seem to think they are conveying information and not merely expressing disgust, so I still will push them for what that is.
I recently started musing about (and put into a recent post as an aside) how the antis talk about “abuse potential” one moment and “cigarettes kill when used as intended” the next. So which is it? Are they being abused or used as intended? Of course, “abuse” is also used by them as a judgment that means “using something, in whatever way, that I don’t approve of”.
The risk of a negative effect is very sketchy to introduce into the definition. It probably does have to end up in there to match the common language use of the term. But it is possible to reconstruct any scenario so that the harm goes away. That ought not change the existence of addiction. E.g.: An average person can be addicted to heroin. Someone who is hopelessly destitute (but somehow has a supply of heroin) or soon to die cannot be because he has nothing to lose. A rich heir who does not need to be productive and can use with a well-equipped medic standing by is also not addicted. But they might all have the same relationship with the drug. That fails the test for a valid definition.
And, of course, the simplistic non-definition that you hear sometimes, “continuing to do something despite serious health risk” or some such, is absurd. Is a soldier who continues to go on patrol in a combat zone addicted?
Some soldiers are addicted to it. It might even be hard to do it unless addicted. It is the most important thing in their lives, they keep going back and doing it even though the outlook isn’t great, in reality they care little for their families or anything else (no matter what they say) except going back into action and getting another fix. The rush, the fear, the danger, the intense excitement that no one except a combatant will ever know, the terror, the relief, the survival. All fighters know this compulsion. They grow out of it but it never leaves entirely, the draw is always there. And you can see clearly, in old boxers past their prime, how a person is the worst possible judge of themselves.
But I know what you mean. Continuing to do highly risky things is not necessarily addiction. Sorry to pick on a small point, of little significance compared to the rest of your comment; it was a juicy bit of bait though.
Methinks you need to read some Wilfred Owen and Sigfried Sassoon, my British friend, instead of the Hollywood Jarhead view. Or Tolstoi and Saint Exupery if you want to go continental, or O’Brien if you want to come back to the land of Hollywood, and even Marlantes if you don’t like old books. ;-)
Anyway, you got my point.
I’m talking about personal experience and acquaintance not books.
Ah. Then please remind me not to argue with you when we are in the same room.
Well I’m just an old softie, but it’s worth pointing out that the hardest of the hard have an indomitable sense of humour and couldn’t care less about insults or arguments in a bar; people who think they are tough are another matter.
I just came across the best definition of addiction I’ve seen yet, especially good because of its brevity: “Compulsion to continue a habit despite negative consequences”.
You have to add “net” to that. Otherwise it applies to everyone you desire to do and is a complete fail. I have a compulsion to eat every day even though it has negative consequences (e.g., it costs money).
If you make it about “net negative consequences” then it is a meaningful claim. It says that something is causing someone to behave in a blatantly economically irrational way. But it gets tricky then. You have to be able to show that someone it getting more costs than benefits, which can be argued, but is more effort than the addictionistas are willing to ever do. And the costs and benefits are subjective, both in the sense that the biggest benefits typically cannot be externally observed, and in the sense that if someone is mistaken about them, such that they think they are getting net benefits, that should not count — it is a different kind of irrationality.
Indeed, standard economic simplifications would declare that the benefits have to be bigger than the costs and use that to measure the benefits (or put a floor on them). That would negate the entire construct, and while it is a simplification, it is not a bad one.
Moreover, the exact same experience would change its addiction status based on someone’s circumstances. That is true even without the “net”. A 1%-er heir who can afford clean drugs and rigs, and to have an aide standing by, and does not need to work, can use drugs with minimal cost. Whereas a normal person who has the exact same relationship with the drug would be addicted.
In short, I don’t think this works, and if it does, it can exist only as a theoretical, not operationalizable, construct.
-sob-
Even if the only “consequences” are that of being attacked for enjoying an activity due to other people’s opinions laced with agendas for their own personal gain, you could say Mitch Zeller and Thomas Frieden are the real consequences for several million who are currently vaping. As they wield their lies to media who faithfully spread disinformation to the ignorant public like rogue plagues and fuel the creation of more consequences for the millions of ex-smokers who are now using Electronic Cigarettes, i.e., usage bans, with punitive damages. Both of them are out to condemn vaping on non-science and have this life saving behavior classified as an addiction worse than that, a crime.
That is a good point. For any definition the relies on costs, the government imposing punishment for doing it can change something from not addictive to addictive. That definitely does not seem to fit what is intended by the word.
Fully agreed. Although I believe I’ve seen the Antismokers play the word game from the opposite end of the court as well: claiming that cigarettes are more addictive because they are cheap and easy to get. As usual, the Antis want to have their cake and eat it too: they have their “answer,” i.e., cigarettes/nicotine = most addictive thing/drug in the world, and they’ll take almost ANYTHING they’re presented with and say, “See, this proves we’re right.”
Antismokers see the addiction argument as EXTREMELY important, and you can see why if you look at the statements on The Wall Of Hate:
http://tinyURL.com/WallOfHate
As pointed out in TobakkoNacht, fully a quarter of those statements reference drugs/addicts/addiction. The addiction argument is usually taken to be a vital springboard for using the “Save The Children!” propaganda tool. And when you want a ban to apply to teens or twenty-somethings, you just need to redefine the word “children” — perhaps changing the terminology to “young people” for the more delicate statements in your presentation while making sure the actual word children or explicit true-children imagery is used nearby. “Young adults” is also a good propaganda trick term because it’s technically correct for people well up into their twenties and yet traditionally it is used to tell 12 year olds that they are “now young adults and must behave responsibly.” (Not sure how universal that is, even in American society though. Might be a Catholic thing having to do with getting the sacrament of Confirmation at about that age? I think it extends a lot further though — thinking about “young warriors” being sent off to survive in the woods etc.) In any event, addiction has been a VERY powerful weapon in the hands of the Antis and it was one that was pretty nonexistent for them before the 1990s, Waxman’s grilling of the tobacco execs, and the Henningfield/Benowitz opportunistic change of definition.
– MJM
The problem for those CEOs was that they were smart enough to know that the right answer to “is tobacco addictive”, whatever it is, is not “yes”, but were so used to being in a 1%-er echo chamber that they had no idea how to handle being put on the spot. You can see me responding to congressman “what do you mean by addiction? etc.”, can’t you :-).
The ease of access and the relatively low health cost (compared to what is often the impact of drugs that actually fit the common notion of addiction) are, of course, what make smokers less inclined to quit. The statement “more addictive than heroin” really just means “much less harmful than heroin”.
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