What is Addiction?

Addiction is a defect in some people so that the first use of mood-altering substance or process in any day tends to trigger a craving for future use.

This definition makes some very important points:

Addiction goes with the person not simply with the substance or process. For example, alcohol is a mood-altering drug that some people can use safely and in moderation and they do not appear to get craving for more. Others find that once they have the first drink they may lose the capacity to control further drinking. They can go dry altogether for weeks, months or even years. In that state they may have rotten tempers or they may simply cross-addict into sugar or nicotine or mood-altering prescription drugs or other addictive substances and processes. However, as soon as they go back to alcohol they will sooner or later be drinking alcoholically again, with the inability to predict further drinking or abstinence once they take one drink in any day.

The same general principle applies to any form of addiction and any mood-altering substance or process. Thus, an addict is not necessarily someone who uses a particular substance. A great many people use alcohol or cannabis or even cocaine and other illegal drugs but this does not necessarily make them addicts. They may be stupid and they may cause damage both to themselves and to other people but they are not necessarily addicts. They do have the capacity to put the substance down in any day in which they once use it. This is obviously true to alcohol: vast numbers of people drink perfectly sensibly and no one would ever consider that they might be alcoholic. Vast numbers of young people (and some not so young) use cannabis but are not necessarily addicted to it. Cannabis is a dangerous drug causing damage to memory and to motivation. It is also addictive in the same way that alcohol and nicotine are addictive and some people are heavily addicted to it. It is not the innocent substance that it is sometimes made out to be and the fact that alcohol and nicotine are legal whereas cannabis is illegal is irrelevant when considering whether the drug is addictive or otherwise. The first is a political concept and the second is medical.

People often imagine that real addiction only applies to heroin and cocaine and perhaps to LSD and ecstasy. In fact all these substances are potentially addictive whereas other substances such as potatoes and rhubarb are not. Thus, one cannot become addicted to something that does not have a mood-altering potential.

Ultimately, three separate processes are required for someone to become addicted:

The first is the genetic potential towards having an addictive nature, the second is an emotional stimulus that sets up a craving for mood-alteration, and the third is the exposure to a substance or process that has a mood-altering effect. If any one of these three factors is missing then addiction does not become manifest. For example, many families have some individuals who have obvious addiction problems whereas others do not. They may share the identical environment and upbringing yet be like chalk and cheese in their use of mood-altering substances and processes: one may be able to handle them perfectly safely while another, not at all. (Unfortunately the people who cannot manage them safely very often believe that they can).

Some people seem to go through life perfectly happily for many years and then are suddenly laid low be a stressful event such as when the children leave home or when unemployment or bereavement strikes. At that time the craving for mood-alteration may occur and an underlying addictive nature suddenly becomes manifest and alcoholism or prescription drug addiction to tranquillisers, sleeping tablets or anti-depressants, may occur.

Obviously one cannot become addicted to a substance one has never taken. If one grew up in an environment where there was no cocaine, then it would be impossible to become a cocaine addict. Many people who might otherwise be alcoholic may have been brought up in an abstinent culture for religious or other reasons and therefore may never have been exposed to it. However, they might not be equally abstinent from nicotine or from sugar and refined (white) flour and therefore they might develop a nicotine addiction or an eating disorder. Thus, if one has an addictive nature the probability is that it will come out one way or another in adult life at some time.

Not all addicts have the same intensity of addictive nature any more than all people with short sight or diabetes have exactly the same intensity of their conditions. Thus, addiction has a different course in some people when compared to others. Some may have a relatively small addictive potential and gradually deteriorate relatively slowly while others have an intense addictive nature and go down very fast.

It has been estimated that approximately 10% of the population will tend to have an addictive nature. In some races, such as Eskimos or American Native Indians the estimates are higher, but all races and cultures are affected to some extent and the figure of 10% generally holds true for the number of people who will have an addictive nature.

People often refer to an addictive "personality" but this is misconceived. An addictive nature is probably genetically inherited rather than a product of upbringing or environment. Long-term adoption studies in Scandinavia showed that alcoholism when with the genetic inheritance rather than with the environment of upbringing. The Vietnam War veterans study showed that 90% of drug using servicemen and women were able to get off the addictive substances that they had been using while 10% had long-term problems.

There is no evidence that the addictive population is short of willpower or intelligence or deficient in understanding of the damage that is being done to themselves and to other people (although they commonly deny the direct connection between cause and effect). Indeed, addictive people may be highly intelligent and be extremely determined but nonetheless be unable to control their addictive nature once it is stimulated in any day by the use of a mood-altering substance or process.

If addicts become abstinent through sheer willpower they will often become absolutely abominable to live with. They may become critical and argumentative and be thoroughly unpleasant. This condition is known as the "dry drunk" and that term applies to any form of addiction, not simply to alcoholism. The dry drunk state is addictive disease in its pure form. This illustrates the underlying mood defect before the use of a mood-altering substance or process. Thus, addictive substances or processes are in fact what the suffering individual uses to treat the underlying mood defect. Depression is "untreated" addiction. (Sadness, the reaction to unhappy events, is something else altogether).

A great deal of confusion comes from the word "alcoholism". This names the illness after one of its "treatments". One would not call a sore throat "Penicillinism" and alcohol is only one of the various substances that can be used to treat the underlying mood defect of addictive disease.

An addictive nature is probably a defect in neurotransmission in the mood centres of the brain. Neurotransmitters are small chemicals that transmit nerve impulses from one nerve to another. If this chemical switch does not work effectively (either the chemicals are not produced correctly or they don’t jump across the gap between the nerves effectively or they are not picked up properly on the far side) then the suffering individual will feel depressed "for no reason". In other words, the depression of an addictive nature does with the person rather than with any particular event. This person then discovers mood-altering substances and processes that "work" for him or her. They make him or her feel better. Under those circumstances these people would consider it crazy not to use substances and processes that they find make life tolerable. Obviously they would also tend to use those substances and processes when they want to feel particularly happy for some reason or another. As time goes on the neurotransmission defects become worse, partly through age and partly through bombardment through chronic use of mood-altering substances or processes, and the end result is that more stimulus is required to produce the same end result. Thus, addiction is progressive. It is also destructive because progressively greater risks are run and progressively more social, economic, educational and other forms of damage accumulate.

The pharmaceutical industry focuses on four neurotransmitters in particular: serotonin, dopamine, noradrenaline and gamma amino butyric acid. Anti-depressant drugs commonly focus upon the action of one or other of these neurotransmitters. At first sight this appears to be sensible; if the defect is a chemical fault in neurotransmission then the treatment should also be chemical. However, this overlooks several extremely important considerations. How does one take exactly the right amount of a drug without at the same time becoming a zombie? Should one take a constant dose regardless of variations in day-to-day stresses? What happens if one tries to discontinue treatment with one of these drugs? What is the effect on the other 59 neurotransmitters that have already been identified and the 2,000 or so that are estimated to exist altogether? Are these anti-depressant drugs (selective serotonin re-uptake inhibitors: SSRIs) only effective because they are addictive in their own right? Are these drugs actually effective at all in healing depression or would placebo (inert substances that nonetheless have a psychological effect simply because one takes them) be equally effective?

Our understanding of brain biochemistry is in its absolute infancy and questions like these simply have not been answered. It is therefore quite appalling that doctors prescribe tranquillisers, anti-depressants and sleeping tablets to one third of the adult population without a real appreciation of just how ignorant they are of the true effects of these medications. Indeed, prescription drug addiction is exceedingly difficult to treat not only because these drugs have been targeted to act directly upon the neurotransmission systems but because the patients have implicit faith in their doctors’ prescriptions. The drugs may indeed have an effect, in the same way as heroin might cure toothache, but that does not imply by any means that it is an appropriate treatment.

Alternative treatments, such as the Twelve Step programme of Narcotics Anonymous, Alcoholics Anonymous, Overeaters Anonymous, Gamblers Anonymous or various other Anonymous Fellowships, work totally effectively in substituting mood-altering process (reaching out to help someone else anonymously) in place of the destructive mood-altering substance or process that was previously used. The importance of a Twelve Step programme, in comparison with prescription medications, is that there are no damaging side effects or long-term catastrophes. There is the obvious requirement that one should continue to work The Twelve Step Programme if one wants to stay abstinent and to have peace of mind (avoiding the "dry drunk" state) and there is the equally obvious drawback that people have to want to undertake this treatment if they are to benefit from it. This reveals another basic characteristic of addictive disease: that people who have it very often believe that they do not. This "denial" is the basic psychopathology of addictive disease.

The sad consequence of this is that people will often resist seeking help until they are in so much pain that they don’t really have a choice. Some die before they make the choice. This is a tragedy when the condition is so readily and effectively treatable.