What we mean when we talk about addiction – Part 1


Getting clarity about an important – and often misunderstood – issue

What is addiction? In the church, in counseling, and even in the field of recovery, this deceptively simple question gets really confusing really fast.

Susan Cheever, in her wonderful book Desire, has this to say about the challenge of getting clarity about addiction:

“For all the definitions that have been written by the hundreds of addiction specialists and doctors, addiction is still mysterious and baffling. In many cases it’s hard to tell if someone is an addict or just a passionate amateur.”

In order to overcome addiction, we need to have a clear understanding of what it is, exactly. How is a doctor supposed to treat people for illness if she doesn’t know what these illnesses look like?

We dismiss it because we don’t understand it

Related to the confusion about what addiction is — and maybe in part because of that confusion — some people are dismissive of the concept itself. I’ve heard people complain that it’s a modern invention, compared to the (idealized) past, where people seemed to just “deal with” their problems. “If someone drank too much, they just stopped” (did that ever really work?).

Today addiction is used to describe almost any kind of negative, compulsive habit. Some people feel it has become a cop-out, an excuse to shift the blame from oneself to the vague and ambiguous culprit we call “addiction.”

While it may be true that we talk more about addiction today than in previous generations, it is by no means a new word or modern concept. Historians have noted that there has been an ebb and flow of addiction across societies and time periods. Societies have existed with very little addiction among them for generations, only to be seized by widespread addiction later.

This happened, for example, with Native Americans after European colonization. Before the Europeans came, there is little evidence of substance abuse among most native peoples. But after their land was taken, the cornerstones of their society were dismantled, and they were moved into reservations, alcoholism emerged as a huge problem. (For more detailed information about this, including data sources, see “The Globalization of Addiction,” by Bruce Alexander.)

“Addiction” is not a new word

Addiction isn’t a new word in the English language. The Oxford English dictionary held an entry for the word as early as 1884: “The giving of oneself to a pursuit.” For a long time, the word was used to describe dedication and commitment, usually to something worthy and good. That changed in the late nineteenth and twentieth centuries with the Temperance Movement, when writers and speakers began using the word in relation to alcohol and other drugs.

Since then, the word has morphed into one of those confusing concepts with multiple meanings. Even psychologists can’t agree on the concept, as evidenced by the ongoing discussions about using this term in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses.

The committee writing the latest draft of the DSM (the DSM V) announced that it will include updated definitions of substance abuse and addiction, including a new category of “behavioral addictions.” For years, as addiction researcher Stanton Peele notes, the American Psychiatric Association (APA) has gone back and forth between use of the terms “addiction” and “dependence” to describe alcohol and other drug problems. Now it appears there is a growing consensus around accepting “addiction” as a diagnosable – and treatable – disorder, and expanding it usage to include behaviors, not just substances.

In a followup article, we’ll clarify the four different ways we use this term. For now, I’m curious: do you agree that the term is confusing? What do you think?


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