Drug use/abuse is among the most commonly discussed mental health issues. And for good reason. It is highly prevalent.According to the National Center for Drug Abuse Statistics, in 2018, 140 million Americans drank alcohol, 59 million utilized tobacco, and 32 million used illegal drugs. During the same time period, nearly 20% of the population had used a harmful illegal drug or misused a prescription drug. Not surprisingly, the government spends a lot of money on drug control. In 2020, for instance, the federal budget for drug control was close to 35 billion dollars.
You may have noticed the above data do not refer to addiction but drug use and misuse. So what is addiction?
Substance use disorder
Before discussing the meaning of addiction, let me inform you that some clinicians and organizations do not like to use the term addiction. Why? Perhaps the following quote, on page 485 of the DSM-5, the diagnostic manual of the American Psychiatric Association, sheds some light on this question:
Note that the word addiction is not applied as a diagnostic term in this classification, although it is in common usage in many countries to describe severe problems related to compulsive and habitual use of substances. The more neutral term substance use disorder is used to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive drug taking….[The term addiction] is omitted from the official DSM-5 substance use disorder diagnostic terminology because of its uncertain definition and its potentially negative connotation.
The term replacing addiction is substance use disorder, which, like addiction, is associated with a number of behavioral, cognitive, and physiological symptoms. Individuals with this condition continue “using the substance despite significant substance-related problems.” The DSM-5 suggests a substance use disorder may be considered mild, moderate, or severe, depending on the number of symptoms present.
Okay, so what is addiction? Some uses of the term suggest addiction is simply a more severe form of substance use disorder. For instance, according to the data from the National Center for Drug Abuse Statistics, “30% of those who use marijuana may have some degree of marijuana use disorder,” but only “1 in 6 users who start using it before age 18 become addicted.”
The official definition of addiction is provided by the American Society of Addiction Medicine (ASAM):
Addiction is 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. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.
As can be seen from the definition, ASAM suggests addiction concerns not only substances but also behaviors.
In a 2012 article in the Journal of Psychoactive Drugs, commenting on the new definition of addiction and changes in the DSM-5, David Smith notes a variety of substances and behaviors (e.g., food, shopping) might be considered addictions because “both psychoactive drugs and certain behaviors that produce a surge of dopamine in the midbrain are the biological substrate for addictive behavior.”
Many factors could potentially influence whether the use of a particular substance results in addiction. Some of these include the substance’s addictive properties (e.g., heroin vs. caffeine) and ease of access to it, peer pressure, genetics, stress, pain, and mental health issues. Mental health problems might play a role both initially and later in maintaining chronic usage.
Concluding thoughts on defining addiction
Because of stigma and negative associations, the word addiction is used by fewer clinicians and organizations than before. Simultaneously, addiction now seems to refer to a broader list of substances and behaviors not previously associated with addiction.
This leaves us with many questions about substances and behaviors that could be considered addictive. For example:
Is sugar addictive? Is shopping addictive? And what would it mean for them to be addictive, or for a person who uses them or engages in those behaviors to be considered an addict?