Perspectives on addiction
The first set of beliefs maintains that addiction represents a refusal to abide by some ethical or moral code of conduct. Excessive drinking or drug use is considered freely chosen behavior that is at best irresponsible and at worst evil. By identifying addiction as sin, one does not necessarily ascribe the same level of “evilness” to it as one would to rape, larceny, or murder. Nevertheless, in this view it remains a transgression, a wrong.
Note that this position assumes that alcohol and drug abuse are freely chosen—in other words, that in regard to this sphere of human conduct, people are free agents. Alcoholics and addicts are not considered “out of control”; they choose to use substances in such a way that they create suffering for others (e.g., family members) and for themselves. Thus, they can be justifiably blamed for having the alcohol/drug problem
In the second view, excessive consumption of alcohol or drugs is the result of an underlying disease process. The disease process is thought to cause compulsive use; in other words, the high rate and volume of use are merely the manifest symptoms of an illness. The exact nature of the illness is not fully understood at this point, but many proponents of the disease models believe that the illness has genetic origins. For these reasons, it is hypothesized that individuals cannot drink or drug themselves into alcoholism or drug addiction.
The third position holds that addiction is a behavioral disorder; as such, it is shaped by the same laws that shape all human behavior. Essentially, then, addiction is learned. It is neither sinful (as the moral model purports) nor out of control (as the disease models purport). Instead, it is seen as a problem behavior that is clearly under the control of environmental, family, social, and/or even cognitive contingencies. As in the disease models, the person with an addiction problem is seen as a victim not a victim of a disease but a victim of destructive learning conditions.
For the most part, addictive behavior is not freely chosen, although some behavioral science theories (e.g., social learning theory) do assert that addicts retain some degree of control over their drinking or drug use. According to the USA National Institute on Drug Abuse: Addiction is a chronic, relapsing, brain disease.
This refers to when the particular activity becomes the most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually engaged in the behaviour they will be thinking about the next time they will be.
It should also be noted that some addictive behaviours such as smoking (nicotine) and drinking (alcohol) are activities that can be engaged simultaneously with other activities and therefore these behaviours do not tend to dominate an addict’s thoughts or lead to total preoccupation.
For instance, a smoker can carry around their cigarettes and still engage in other day-to-day activities. However, if that person was in a situation that they were unable to smoke for a long period (such as a 24-hour plane flight), smoking would be the single most important thing in that person’s life and would totally dominate their thoughts and behaviour. This is what Griffiths (2005) has termed “reverse salience” with the addictive activity becoming the most important thing in that person’s life when they are prevented from engaging in the behaviour.
This refers to the subjective experience (often experienced positively) that people report as a consequence of engaging in the particular activity (i.e., they experience an arousing “buzz” or a “high” or paradoxically a tranquilizing and/or de-stressing feel of “escape” or “numbing”). What is interesting is that a person’s drug or activity of choice can have the capacity to achieve different mood modifying effects at different times.
For instance, a nicotine addict may use cigarettes first thing in the morning to get the arousing ‘nicotine rush’ they need to get going for the day. By the end of the day they may not be using nicotine for its stimulant qualities, but may in fact be using nicotine as a way of de-stressing and relaxing. It could be argued that in these situations, psychology to some extent overrides physiology because of expectation effects.
In essence, many addicts use substances and behaviours as a way of producing a reliable and consistent shift in their mood state as a coping strategy to “self-medicate” and make themselves feel better in the process.
This refers to the process whereby increasing amounts of the particular activity are required to achieve the former effects. The classic example of tolerance is a heroin addict’s need to increase the size of their ‘fix’ to get the type of feeling (e.g., an intense ‘rush’) they once got from much smaller doses. In gambling, tolerance may involve the gambler gradually having to increase the size of the bet to experience a mood modifying effect that was initially obtained by a much smaller bet. It may also involve spending longer and longer periods gambling.
Tolerance is well established in psychoactive substance addictions and there is growing evidence that it can occur in gambling and Internet gaming disorders. However, it is worth noting that there is currently a tendency to argue, based on studies relying on self-reports, that various potentially excessive behaviours (e.g., dancing, shopping) are marked by tolerance symptoms.
However, it is not possible to assert any definitive conclusions regarding the existence of tolerance with regard to specific behaviours unless neurobiological evidence (e.g., alteration/sensitisation in specific cerebral circuitries) confirms it (Billieux, Maurage, Lopez-Fernandez, Kuss, and Griffiths, 2015).
These refer to the unpleasant feeling states and/or physical effects that occur when the particular activity is discontinued or suddenly reduced. Such withdrawal effects may be psychological (e.g., extreme moodiness and irritability) or more physiological (e.g., nausea, sweats, headaches, insomnia, and other stress-related reactions). Withdrawal effects are well documented in drug addictions (Orford, 2001) and there is growing evidence that behavioural addictions such as pathological gambling also feature withdrawal symptoms (Griffiths, 2004).
For instance, Rosenthal and Lesieur (1992) found that at least 65% of pathological gamblers reported at least one physical side-effect during withdrawal including insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and/or chills. Similar findings were reported by Griffiths and Smeaton (2002).
In the case of Internet Gaming Disorder (IGD), withdrawal symptoms may be experienced when the activity of gaming is taken away (American Psychiatric Association [APA], 2013). In the particular case of IGD, these symptoms are typically described as irritability, anxiety, or sadness, but there are no physical signs of pharmacological withdrawal as in substance use disorders (APA, 2013).
This refers to conflicts between the addict and those around them (interpersonal conflict) or from within the individual themselves (intrapsychic conflict) which are concerned with the particular activity. Continual choosing of short-term pleasure and relief leads to disregard of adverse consequences and long-term damage, which in turn increases the apparent need for the addictive activity as a coping strategy.
The conflict in the addict’s life means that they end up compromising their
(i) personal relationships (e.g., partner, children, relatives, friends, etc.),
(ii) working or educational lives (depending on what age they are), and
(iii) other social and recreational activities.
Intra-psychic conflict may also be experienced in the form of addicts knowing that they are engaged heavily in the behaviour and want to cut down or stop – but find they are unable to do so as they are experiencing a subjective loss of control that in turn might be facilitated due to the person’s desire to intentionally avoid or mitigate potential withdrawal symptoms resulting from the discontinuation or reduction of the behaviour.
This refers to the tendency for repeated reversions to earlier patterns of the particular activity to recur and for even the most extreme patterns typical of the height of the addiction to be quickly restored after many years of abstinence or control. The classic example of relapse behaviour is in smokers who often give up for a period of time only to return to full-time smoking after a few cigarettes. However, such relapses are common in all addictions including behavioural addictions, such as gambling (Griffiths, 2002).