Addiction psychology
About 1 in 7 Americans reportedly suffered from active addiction to a particular substance. Addiction can cause physical, emotional and psychological harm to those affected by it.
Background
Definition
Addiction, in its most fundamental sense, has long been defined by psychologists as a loss of self-control. It stems from a powerful, rewarding effect that is incredibly difficult to overcome. Those struggling with addiction often find their desire to quit is constantly challenged by an overwhelming urge to give in to temptation. This can lead to an intense "internal battle," where the drive to continue the addictive behavior clashes with the longing to regain control over their action.The American Society of Addiction Medicine defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences."
Common models
In the fields of psychology and medicine, there are two models commonly used for understanding the psychology behind addiction itself. One of such models is referred to as the disease model of addiction. This model classifies addiction as a diagnosable disease just as cancer or diabetes. It attributes addiction to a chemical imbalance in an individual's brain associated with genetics or environmental factors.The other model is the choice model of addiction, which contends that addiction is a result of voluntary actions rather than brain dysfunction. Through this model, addiction is viewed as a choice and is studied through components of the brain such as reward, stress, and memory. Substance addictions may be related to drugs, alcohol and smoking, process addictions are related to non-substance-related behavior, such as gambling, spending money, sexual activity, gaming, spending time on the internet and eating.
History
The word addiction is dated to the 17th century. The consumption of addictive substances, such as alcohol, opioids and cocaine, is reportedly traceable to ancient Syria, China and South America. Some of those abusing narcotics were called opium and morphine "eaters", while the term drunkard referred to alcohol abusers. Particularly, medical textbooks categorized such "bad habits" as dipsomania or alcoholism.However, it wasn't until the 19th century when addiction diagnoses were first printed in medical literature. In the 1880s, Sigmund Freud and William Halsted began conducting experiments on cocaine users. Freud was convinced that cocaine could be the answer to many mental and physical problems. He published the paper On Coca concerning its benefits.
Being unaware of the drug's powerful addictive qualities, Freud began to recommend it as a means to overcome morphine addictions. Over time, Freud and Halsted inadvertently became guinea pigs in their own research. As a result, their contributions to psychology and medicine changed the world. Freud publicly endorsed cocaine and its uses, theorizing that cocaine could be used as an anesthetic. This idea was later tested and found to be true. However, most of his other claims about cocaine turned out to be false and his advocacy for cocaine severely hurt his career.
Cocaine took possession over Freud's life while he was working in Austria's Vienna General Hospital and found that the drug relieved his migraine. When the effect of cocaine decreased, the amount of cocaine Freud consumed increased. With information about the pain suppressing properties of cocaine, physicians began prescribing cocaine to their patients who required pain relief.
Unaware of Freud and Halsted's experiments with cocaine, American Physician W.H. Bentley was conducting his own similar experiments. The Index Medicus published his article describing how he successfully treated patients with cocaine who were addicted to opium and alcohol. In the late 1800s, the use of cocaine as a recreational drug spread like a worldwide epidemic. It wasn't long until it was realized that cocaine was far more addictive than previously realized and how many deaths were being caused because of cocaine overdose.
As cocaine continued to spread, physicians began looking for ways to treat patients with opium, cocaine, and alcohol addictions. Physicians debated the existence of the label "addictive personality," but believed the qualities Freud possessed were of those that fostered the "addictive personality".
Important contributors
Sigmund Freud
Physician Sigmund Freud, born on May 6, 1856, in Freiberg, Austrian Empire, was instrumental in the field of psychology. Dream interpretation and psychoanalysis, also known as talk therapy, are two of his well-known contributions. Psychoanalysis is used to treat a multitude of conditions including addictions.As one of the most influential thinkers in the 20th century, he altered the way we perceive ourselves and communicate about our perceptions; as a number of his theories have been popularized and terms he created have entered into general language.
Theories on mental health, personality development, and illness that Freud developed, are considered highly controversial. According to Freud, people are endowed with three levels of awareness: conscious, preconscious, and unconscious. The conscious level refers to what we are fully appreciative of; the preconscious, to what people could be aware of if they became more attentive; and the unconscious level includes facts that humans cannot be aware of. The aim of the therapy is to turn unconscious into conscious.
William Halsted
, born on September 23, 1852, in New York City, received his degree in medicine in 1877. Throughout his medical career as a surgeon, he contributed surgical techniques that ultimately led to improvement of the patient's outcome following surgery. During Halsted's professional career, he and Freud conducted experiments with the drug cocaine. While their research was in process, they became guinea pigs for their own experiments when they became addicted to cocaine.In 1884, he became the first to describe how cocaine could be utilized as a localized anesthetic when injecting into the trunk of a sensory nerve, and how the localized ischemia prolonged the anesthetic properties of the drug.
G. Alan Marlatt
was a pioneer in the field of addiction psychology. Born in Vancouver, British Columbia, in 1941, he spent his professional career as an addiction psychologist, researcher, and director of the University of Washington's Addictive Behaviors Research Center and professor in the Department of Psychology.Marlatt adopted the theory of harm reduction, and developed and scientifically tested ways to prevent an addict's slip from becoming a relapse. He understood that expecting immediate and complete abstinence from addicts often deterred addicts from seeking the help they needed and deserved.
A. Thomas McLellan
was born in 1949 in Staten Island, New York. He is a professor at the University of Pennsylvania School of Medicine at the Center for Studies of Addiction. McLellan serves or has served on editorial boards as a reviewer of medical and scientific journals, and as an advisor to government and non-profit organizations including: the National Practice Laboratory of the American Psychiatric Association, and the World Health Organization. He is co-founder and chief executive officer of the Treatment Research Institute located in Philadelphia, Pennsylvania.McLellan has conducted decades of research for the efficacy of treatment for substance abuse patients, and is recognized both at the national and international level as an addiction psychologist. He is also known for the development of the Addiction Severity Index or ASI and serves as editor-in-chief of the Journal of Substance Abuse Treatment, and the deputy officer of National Drug Control Policy, Research and Evaluation.
Arnold M. Washton
has specialized in addiction since 1975 and is an addiction psychologist known for his work in the development of therapeutic approaches to the treatment of drug and alcohol abuse. He is the author of many books and professional journal articles on treatment and addiction. He is a lecturer, clinician, researcher, and has served on the advisory committee for the US Food and Drug Administration. Washton is the founder and executive director of Recovery Options: a private addiction treatment practice located in New York City and Princeton, New Jersey.William L. White
William L. White is a Senior Research Consultant at Chestnut Health Systems, an addiction counselor, researcher, and writer in the field of addiction for over 45 years. He wrote over 400 papers and 18 books. He received awards from the National Association of Addiction Treatment Providers, the National Council on Alcoholism and Drug Dependence,, the Association of Addiction Professionals, and the American Society of Addiction Medicine.Addiction
Addiction is a progressive psychiatric disorder that is defined by the American Society of Addiction Medicine as "a primary, chronic disease of brain reward, motivation, memory and related circuitry." It is characterized by the inability to control behavior, it creates a dysfunctional emotional response, and it affects the users ability to abstain from the substance or behavior consistently." Psychology Today defines addiction as "a state that can occur when a person either consumes a substance such as nicotine, cocaine, or, alcohol or engages in an activity such as gambling or shopping/spending."Many functions of the brain work to prevent addictive behaviors. Such obstacles include anxiousness about trying a drug or behavior or nervousness of the possibility of getting caught, etc. Not all use of addictive substances or behavior results in addiction. However, a non-addict may choose to engage in a behavior or ingest a substance because of the pleasure the non-addict receives. A non-addict can become an addict through frequency, when an addictive behavior becomes a compulsive action. The change from non-addict to addict occurs largely from the effects of prolonged substance use and the result of behavior activities on brain functioning. Addiction affects the brain circuits of reward and motivation, learning and memory, and the inhibitory control over behavior.
There are different schools of thought regarding the terms dependence and addiction when referring to drugs and behaviors. One adopted belief is that "drug dependence" equals "addiction." The second belief is that the two terms do not equal each other. According to the DSM, the clinical criteria for "drug dependence", include compulsive drug use despite harmful consequences, inability to stop using a drug, failure to meet work, social, or family obligations, and sometimes, tolerance and withdrawal.
The latter reflects physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased. Physical dependence can happen with the chronic use of many drugs—including even appropriate, medically instructed use. Thus, physical dependence in and of itself does not constitute addiction, but often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, where the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.
There are some characteristics of addiction, that regardless of the type, share commonalities. The behavior provides a rapid and potent means of altering mood, thoughts, and sensations of a person, which occur because of physiology and learned expectations. The immediate precipitating factors of the relapse, the timing of the relapse and the rate of relapse following treatment is high. Preventing relapse, across addiction types, is difficult. In a quote attributed to Mark Twain: "It's easy to stop smoking—I've done it hundreds of times."