Of Addiction and Accountability

Article excerpt

Sitting at the airport recently, I overheard a couple behind me quarreling. I tuned in somewhere in the "Yes, she is" - "No, she isn't!" part of the argument, when the woman suddenly said, "They're both addicts; they just 'fix' on different things." With increasing interest, I listened to their discussion until the boarding call. And what was the nature of their friends' addictions? They diagnosed the woman as a "shopaholic" and her husband as an "Internet addict." The criteria for their assertions? They felt both friends acted in ways similar to another friend who was a cocaine addict.

Today, it's fairly common to hear the terms "addict" and "addiction" applied to a wide variety of behaviors by professionals as well as nonprofessionals. Adding to the confusion is the fact that although alcohol and other drug addictions have been studied for decades, mental health professionals continue to hold disparate beliefs regarding the etiology and nature of addiction.

The early definition of addiction focused narrowly on the use of alcohol and drugs and their ability to induce tolerance, physical dependence and withdrawal distress. In 1987, psychological dependence, with or without physical dependence, was included in diagnostic criteria. Today, addiction is defined by several factors: impaired control over one's behavior, compulsive (drug) seeking and use, continued use despite negative consequences and neurochemical and molecular changes in the brain.

A significant broadening of the range of activities labeled as addiction resulted from research indicating that compulsive behaviors--in addition to the more commonly acknowledged addictive substances--also result in neurochemical changes. Thus, it has been argued that all the defining features noted above can be seen in a wide variety of seemingly ordinary behaviors. In this view, whether the addiction is to food, substances, sex, gambling, other objects or activities, the characteristics of the addictive process are similar. But should accepted definitions of addiction be expanded to encompass behaviors, activities and substances other than alcohol or other drugs?

Obviously, not all addictions are alike in severity or impact on a person's life. The woman who engages in excessive shopping does not face the same life-threatening risks as a sex or drug addict. Nonetheless, if she can't pay her rent, the stability of her marriage is threatened and if she continues her self-destructive behavior despite efforts to cut back or quit, she can be seen as having an addiction. Or consider the dedicated, hard-working businesswoman, widely admired for the number of deals she closes. …

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