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Understanding
Addictions
All addictions have two
aspects in common
By Dr. Tom Miller, Staff Writer
Addiction and additive disorders
have often been associated with and
understood to mean an uncontrollable habit of using alcohol or other
drugs. The Diagnostic and Statistical
Manual of the American Psychiatric
Association, Edition 5 (DSM-5)
recognizes substance-related disorders resulting from the use of close
to a dozen different classes of drugs
including alcohol, caffeine, cannabis
and hallucinogens such asphencyclidine or similarly acting arylcyclohexylamines. Other hallucinogens
include LSD, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants (including amphetamine-type
substances, cocaine and other stimulants) and tobacco. While some major
groupings of psychoactive substances
are specifically identified, use of other
or unknown substances can also form
the basis of a substance-related or
addictive disorder.
There are two groups of substancerelated disorders: substance-use
disorders and substance-induced disorders. Substance-use disorders are
patterns of symptoms resulting from
the use of a substance the individual
continues to take despite experiencing problems as a result. Substanceinduced disorders include intoxication, withdrawal and psychosis, as
well as bipolar, depressive, anxiety,
obsessive-compulsive, neurocognitive
and sleep disorders and sexual dysfunction and delirium. The DSM-5
further recognizes people are not
all automatically or equally vulnerable to developing substance-related
disorders. Some individuals have
lower levels of self-control, possibly
brain-based, which predispose them
to developing problems if they are
exposed to drugs.
Because of the physical effects of
these substances on the body, and
particularly the brain, some individuals have often thought “real” addictions only occur when habit- forming
substances are regularly used in large
amounts. This is not true. Similarly,
we have come to realize people can
also develop addictions to certain
behaviors, such as shopping, videogame playing, sex, smoking, gambling
and even quite ordinary and neces-
sary activities such as exercising and
eating.
What these various activities have
in common is that the person doing
them finds them pleasurable in some
way. There is some controversy about
which of the “behavioral” addictions
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constitute scientifically validated
“true” addictions. More research
is needed to clarify the issue. In
attempting to better understand and
answer the question “What makes
something an addiction?” we now
realize that although the precise
symptoms vary from one addiction
to another, there are two aspects all
addictions have in common.
First, the addictive behavior is
maladaptive or counterproductive
to the individual. Instead of helping the person adapt to situations or
overcome problems, an addiction
tends to undermine these abilities.
For example, a smoker might wish he
could find another way to cope with
stress, yet smoking is easily accessible
and may take less time than exercising
or going through a smoking cessation
program. Similarly, a person who is a
heavy drinker might want to relieve
the anxiety and stress of the job or
home life, yet alcohol use contributes
to the development of further unresolved anxiety and stress, resulting
then in depression. A person with
sexual addictions may crave intimacy
in what would be a healthy relationship, yet the use of porn or other
sexually related materials that focus
on abnormal sexual behaviors may
prevent real closeness with another
ADDICT Continued on Page 47