Addiction Today

I thought I was a bad boy who did stupid things. I got caught, charged, and convicted of possession of a CS with intent to sell. But I sweet-talked my social worker into letting me enroll in the Substance Treatment Program in jail. Seriously, though, I learned that I am not bad nor stupid. I have a mental health problem called addiction. It has something to do with my genes and brain. This helped explain some of my behavior and why I needed instant rewards like drugs, sex, or even crime to feel good. Lots of people are addicted to something. Chapter 1 looks at the many faces of addiction. It reviews the descriptive, diagnostic, and researched-based definitions of addiction; it discusses addiction severity and treatment intensity. The chapter also examines the incidence and prevalence of addiction.

The Faces of Addiction

We believe addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry, characterized by craving, loss of control, physical dependence, and tolerance Genetics, together with bio-psycho-social-spiritual factors, account for the likelihood one will develop an addiction or related disorder. Addiction jeopardizes the health and well-being of individuals, families, communities, even society itself. Addiction across the lifespan wears many faces.

• An infant born six weeks premature to a mother who is addicted to alcohol and cocaine.

• Two little girls playing dress-up and drawing red lines up their arms with lipstick to look like their mom: an IV drug user.

• Four high school seniors "high" on Adderall before taking their Scholastic Aptitude Tests (SATs).

• A 16-year old girl, "dumped" by her 25-year old boyfriend, admitted to the psychiatric unit after ingesting a quart of vodka and 50 Tylenol.

• "What do you have: gold or green OCs?" asks a teen to a street drug dealer.

• A young adult dead of cardiac arrest after a 40-hour marathon session of Diablo 3, an action role-playing game that features elements of the hack and slash, and dungeon crawl genres.

• An evening TV news anchor and sports gambler praying for a long commercial so he can check scores on his cell phone.

• A homeless soldier with four deployments to Iraq and Afghanistan admitted to a Veterans Administration (VA) Hospital with delirium tremens (DTs).

• A board-certified oncologist dismissed from his position at a prestigious University Hospital facing loss of license and incarceration for selling pain prescriptions to finance his gambling addiction.

• A hospice nurse, employee of the year, who has been suspended from work because she diverted narcotics to self-medicate her back pain.

• An executive vice president of a major insurance company admitted to a locked psychiatric ward for self-inflicted gun shots wounds, a botched suicide attempt, related to embezzlement to pay gambling debts.

• A retired electric utility worker who drinks himself into a stupor every evening to cope with his depression after the recent death of his wife.

• A 78-year old woman visiting her daughter and family who gets up during the night, falls, and breaks a hip. Her daughter discovers prescribed medications for Percocet, Xanax, and Ambien in her purse.

What is Addiction?

What do we really mean by addiction? Addiction is a broad, evolving construct that reflects a persistent, recurrent, maladaptive pattern of substance use, gambling, or other behavior that results in adverse consequences for self and others and can lead to clinically significant distress, marked impairment, or death. Substance use includes many legal products such alcohol, nicotine, prescription medications, over-the-counter (OTC) drugs, as well as a host of herbal and natural products that have brain altering properties. Marijuana, cocaine, methamphetamine, heroin, and "designer" drugs make up popular illicit drugs. Many household products like solvents, sprays, or glue have psychoactive effects, especially when inhaled.

Obsessive/compulsive/impulsive behaviors that can become addictive include gambling, eating, sex, and shopping; internet use and the cell phone; internet gaming and video games; and many more. Several terms describe gambling addiction—pathological gambling, compulsive gambling, problem gambling, or gambling disorder. Cross addiction or replacement addiction is common with substance use and other addictive behaviors.

Definitions of addiction are descriptive, diagnostic, and research-based. Many people in recovery, together with addiction professionals, consider addiction as a bio-psycho-social disorder; Howard J. Shaffer, a recognized addiction scholar, describes an addiction syndrome. The American Psychiatric Association and the World Health Organization offer diagnostic definitions respectively in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Increasingly, definitions of addiction reflect basic research, for example the work of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute of Drug Abuse (NIDA), as well as the genetic research of Kenneth Blum and colleagues and the idea of a reward deficiency syndrome (RDS). The American Society of Addiction Medicine (ASAM) defines addiction as a brain-based chronic disease.

Addiction is a Bio-psycho-social Disorder

Addiction is a bio-psycho-social disorder in etiology, expression, treatment, and recovery. A bio-psycho-social perspective includes and integrates aspects of biological, psychological, and socio-cultural theories of addiction, reflecting a holistic view of individuals. Today, assessment, diagnosis, treatment planning, intervention, evaluation, and related documentation of addiction address bio-psycho-social variables. Best addiction practice models as well as program accreditation standards and criteria reflect a bio-psycho-social model of addiction.

The Addiction Syndrome

Howard J. Shaffer, editor of American Psychological Association publication Addiction Syndrome Handbook: Volume 1 Foundations, Influences, and Expressions of Addiction; Volume 2 Recovery, Prevention, and Other Issues (2012), has long held the idea of an addiction syndrome which recognizes the similarities in etiology, expression, and treatment response among different addictive disorders. Leading addiction scholars embrace the idea of an addiction syndrome model and write extensively about addiction from this perspective in these volumes.

American Psychiatric Association (APA)

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