AddictionDoctor.Org

By the time we learn to use words to describe things like medical interventions or public policy we’ve heard most of the words in other contexts, and we have our own idea of what they mean. Long before we heard the word Addiction in any adult setting we heard it as children. It’s meaning to us reflects our oldest understanding of the word. That is, we learned what we think Addiction is long before we learned about what it really is.

Most people I talk to about Addiction are talking about something else. They are talking about drug taking, or substance abuse or criminal behavior or just being bad. They are talking about will and decision, self-deception and lying. To be sure all of these things can be associated with Addiction, but none of them are Addiction.

I’ve written before here about separating out the core phenomena of the illness called Addiction from the surrounding epiphenomena that become associated with it. What keeps getting in the way are the definitions. Before we can actually discuss what we have learned scientifically we’re going to have to let go of our old definitions of words that we think we know the meaning to. Addiction is one of those words.

One colleague suggested that the word Addiction is so filled with false meaning to people that we need a new word to mean the illness that we treat. I came up with Subcortical Hedonic Attachment Syndrome, but there were two problems. First, it didn’t quite capture everything that is core to Addiction as an illness and second, SHAS is a stupid sounding acronym.

So here are some definitions of Addiction and related syndromes that I’ve put together for discussion and feedback. Perhaps we can get to a place of common ground starting from these:

ADDICTION: A permanent dysfunction of the midbrain reward system and resulting hypofrontality with characteristic symptoms relieved by the use of at least one rewarding substance or behavior and resulting in the compulsive use of that behavior.

 

It must be permanent – a temporary dysfunction brought about by combat or domestic violence is not addiction even if accompanied by attempts at self treatment with rewarding substances.

 

Resultant hypofrontality –  can be tested for by reward/risk test such as the Iowa Gambling Task and measures of impulsivity such as the Continuous Performance Task

 

Characteristic symptoms of midbrain reward system dysfunction include irritability, easily frustrated, relative anhedonia, poor focus, poor memory, difficulty making attachments to others, procrastination. Compulsive use of some substance without these symptoms would be a different syndrome such as a hypofunctioning GABAb input to the reward system leading over reactivity of the reward system and temporary production of these symptoms only in the case of drug use.

 

Substance or behavior must be used to control and be effective in controlling or mitigating at least some of the symptoms. Use cannot be solely for oblivion from some life situations, in response to external stressors or, in the case of anxiolytic substances, for the control of anxiety.

 

TEMPORARY REWARD SYSTEM DYSFUNCTION USE SYNDROME: The temporary production of symptoms of reward system dysfunction brought about by an environmental agent or situation leading to the compulsive use of a rewarding substance which completely resolves with the removal of the causative environmental agent or situation.

 

Clinically will look like Addiction and will be differentiated from it by history.

 

Temporary Reward System Dysfunction Use Syndrome can become Addiction with continued use and resulting damage to the midbrain reward system.

 

COMPULSIVE USE SYNDROME: The temporary compulsive use of a substance or rewarding behavior brought about only in the aftermath of a rewarding stimuli not accompanied by chronic symptoms of midbrain reward system dysfunction and hypofrontality.

 

Temporary – often seen as repeated binging episodes and not present between episodes until triggered by another reward powerful enough to cause a high and resultant crash leading to compulsive use

 

Between episodes there are no symptoms of reward system dysfunction  or hypofrontality.

 

Compulsive Use Syndrome can become Addiction with continued use and resulting damage to the midbrain reward system.

 

ANXIETY INDUCED SUBSTANCE USE: The use, compulsive or otherwise, of any anxiolytic substance, rewarding or otherwise, to quell the symptoms of anxiety, even when done in spite of adverse consequences, coupled with an absence of symptoms of midbrain reward system dysfunction.

 

Use must be solely for relief of anxiety and not for relief of symptoms of midbrain reward system dysfunction. There must be no symptoms of midbrain reward system dysfunction except in the immediate aftermath of a rewarding anxiolytic substance.

 

Anxiety induced substance use can become Addiction with continued use and resulting damage to the midbrain reward system.

 

SUBSTANCE OR REWARDING BEHAVIOR ABUSE: The recurrent, non-compulsive use of a substance, in spite of knowledge of possible adverse consequences, for purposes of experimentation, fitting in with peers, to avoid social stigma or other social reason without evidence of compulsive use, anxiety relief from use or symptoms of midbrain reward system dysfunction.

 

SUBSTANCE OR REWARDING BEHAVIOR USE: The occasional, voluntary, and non-problematic use of rewarding substances or behaviors in socially acceptable situations without compulsive use, symptoms, or symptom relief.

This entry was posted on Monday, October 5th, 2009 at 12:37 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.