What is the Medical Disease Model Definition of Addiction?

Addiction is a primary, progressive, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over use of the substance, preoccupation with the substance, use of the substance despite adverse consequences, and distortions in thinking. Morse & Flavin’s (1992)

Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and World Health Organization (ICD-10) an addiction must meet at least 3 of the following criteria. The DSM-V, which will be released in May 2013, is revising these definitions. I’ll keep you posted on relevant changes.

1. Tolerance. Do you use more alcohol or drugs over time?  A year ago you could achieve your intoxication goal with a few shots and today it takes a fifth . . . needing more of your drug of choice to achieve intoxication or satisfaction is progression of the disease.

2. Withdrawal. Have you experienced physical or emotional withdrawal when you have stopped using? Have you experienced anxiety, irritability, shakes, sweats, nausea, or vomiting? Emotional withdrawal is just as significant as physical withdrawal.  Alcohol and opiates are very physically addictive with distinct withdrawal symptoms.  While cocaine may not have strong physical withdrawal symptoms, there can be powerful psychological and/or emotional withdrawal symptoms associated with its use.

3. Limited control. Do you sometimes drink or use drugs more than you would like? Do you sometimes drink to get drunk? Does one drink lead to more drinks sometimes? The lowering of inhibitions resulting from drinking alcohol leads to using other drug use you would not normally try . . . finding yourself in risky situations that put your safety in jeopardy.

4. Negative consequences. Have you continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family?  Losing your temper, becoming verbally or physically aggressive, engaging in risky sexual behaviors, drinking and driving, stealing, lying . . . negative consequences related to addiction that affect all areas of your life.

5. Neglected or postponed activities. Have you ever put off or reduced social, recreational, work, or household activities because of your use?  Missing family events because you are drunk or hung over, getting to work late because you were up all night using, being an “absent parent” because you are intoxicated and unable to engage with your children . . . often the guilt associated with this behavior perpetuates more isolation.

6. Significant time or energy spent. Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? Have you spend a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?  All of these behaviors involve lying and being deceitful to those that care about you which lead to guilt and defensiveness.

7. Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?  I will only have one drink tonight, I will stop using for a week and show everyone that I don’t have a problem . . .

What is a Behavioral Addiction?

We typically think of addictions that include alcohol or drugs but addictions can also include behaviors that create problems in our lives.  Some examples of behavioral addictions include gambling, sex/pornography, exercise, shopping, love, food, video/internet gaming, and even social media . . . really, Facebook can be an addiction?  All of the above criteria can be applied to a behavioral addiction.

As with addiction to substances like alcohol, behavioral addictions are visible through several symptoms and signs. Typically behavioral addiction treatment may be necessary if you experience one or more of the following signs of behavioral addiction:

  • Increasing the frequency in which you engage in the behavior or engaging for a longer period of time than you initially intended.
  • Constant need to engage in the behavior.
  • One or more failed efforts to stop, reduce or control the behavior.
  • Majority of your time is spent engaging in the behavior, arranging to engage in the behavior, or recovering from the effects.
  • Preoccupation with the behavior itself or with the actions required to prepare for it.
  • Neglecting other obligations such as work, school or family so that you can engage in the behavior more often.
  • Isolating yourself so that it is easier to engage in the behavior without friends or family knowing about it.
  • Continuing to engage in the behavior despite negative consequences.
  • Increasing the intensity or frequency of the behavior to achieve the same effect. Restlessness, irritability, hostility or anxiety if you are unable to engage in the

Signs of Addiction

Symptoms can only be experienced by the person with the addiction, whereas signs can be observed by other people. You can never know what someone else is experiencing unless they tell you, so if you are concerned that someone else may have an addiction, look for signs as well as for symptoms.

You might see some signs in an addicted person but not others. These are signs which occur across many addictions including behavioral addictions:

  • Extreme mood changes – happy, sad, excited, anxious, etc
  • Sleeping a lot more or less than usual, or at different times of day or night
  • Changes in energy – unexpectedly and extremely tired or energetic
  • Weight loss or weight gain
  • Unexpected and persistent coughs or sniffles
  • Seeming unwell at certain times, and better at other times
  • Pupils of the eyes seeming smaller or larger than usual
  • Secretiveness
  • Lying
  • Stealing
  • Financially unpredictable, perhaps having large amounts of cash at times but no money at all at other times
  • Changes in social groups, new and unusual friends, odd cell-phone conversations
  • Repeated unexplained outings, often with a sense of urgency
  • Drug paraphernalia such as unusual pipes, cigarette papers, small weighing scales, etc
  • “Stashes” of drugs, often in small plastic, paper or foil packages

If I described these symptoms to someone, they would most likely assume that the person was abusing drugs or alcohol.  But what about the gambler whose financial situation fluctuates, has unexpected outings or stays out all night, is caught in lies, seems preoccupied and forgetful, begins to have trouble at work because he is going in late or leaving early?  Does he sound like a alcohol or drug addict?  Possibly having an affair?  A person who is addicted to a behavior or activity builds a psychological dependence on the behavior in a similar way that an alcoholic becomes dependent on alcohol.

If you are concerned that you or someone you can about is struggling with an addiction, contact me for a consultation.  I can help.