The Meaning of Addiction Has Changed — Addiction is Not a Characteristic of Things
Writing as editor of MedPage Today, the redoubtable George Lundberg* confidently (and briefly) declared: “All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction.”
George, are you behind times! The new definition of addiction in the American Psychiatric Association’s forthcoming manual doesn’t discriminate — any substance may be addictive. Moreover, the manual (DSM-5), soon to be released, will for the first time include a non-substance addiction (gambling), and may include a catch-all “behavioral addiction — not otherwise specified” category. That last bit is meant to indicate, well, that people may become addicted to anything. This is noted psychiatrically when a person seeks out an experience, ritual, or reward to the exclusion — and detriment — of all other goals and activities. The measure of addictiveness is how absorbing, compelling, and harmful to the person an involvement is. Nothing else matters.
While this may catch in Dr. Lundberg’s throat, as it does for many — “Why, then, anything can be addictive — email, my morning coffee, or my spouse/lover!” — others are jumping rapidly onto this bandwagon. One way to do so is to note that any captivating activity or experience shows up in the brain, to wit:
A team of scientists led by Nora Volkow at the National Institute on Drug Abuse have used positron emission tomography (PET) scans to show that even when cocaine addicts merely watch videos of people using cocaine, dopamine levels increase in the part of their brains associated with habit and learning. Dr. Volkow’s group and other scientists have used PET scans and functional magnetic resonance imaging to demonstrate similar dopamine receptor derangements in the brains of drug addicts, compulsive gamblers and overeaters who are markedly obese.
There are a few things wrong with this formulation:
1) Do the addicts whose brains glow on seeing something actually pursue that object? Always? When do they or don’t they? Why or why not?
2) Do others who use cocaine or who enjoy eating and gambling (or — let’s get down to it — sex) within normal constraints also show dopamine activity in the brain when presented with images of these things? Then why aren’t they addicts? Or are they, but controlled addicts?
3) Can virtually anything be powerful enough for some people to show powerful neuroresponsiveness? Then why are we typecasting only a subset of things as addictive? Lundberg makes this mistake by telling us only some drugs are addictive, but not which ones (reminds you of the Republicans’ budget cuts, doesn’t it?). He implies that pharmaceuticals aren’t addictive (“Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh-Day Adventists, and the like”), but then maybe he hasn’t read I’m Dancing as Fast as I Can (tranquilizer addiction) or hasn’t been paying attention as prescribed painkillers rise to the top of the addictiveness list. (Dr. Lundberg, are marijuana and caffeine addictive?)
To quote Joseph Conrad in Victory, “There are more magic potions than your commonplace magician can imagine.” Virtually anything can be addictive for the “right” person at the “right” time — one of stress or disorientation, when that experience holds out significant and powerful associations for the person, when the person is not inclined or able to be restrained, when all consequences are damned. Addiction, you see, is not a label to be applied to specific things, but to an involvement a person creates in time and space.
*Lundberg is the former editor of JAMA. He was unceremoniously fired, a move for which he successfully sued — but that’s a totally different story.
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