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identifying addiction, diagnosing addiction, what is addiction, defining addiction, dependence

WHAT IS ADDICTION OR DEPENDENCE?

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added, e.g. ‘I want to maintain [my current level of consumption]’. Ellipses within square brackets […] show where text has been removed, e.g. ‘Counselling was good but […] I would have liked more information about other treatment options’.

Ideas about addiction vary across time and place, and experts and others disagree on what addiction is and what causes it. In medical and public health circles in Australia and some other countries, the term ‘dependence’ is preferred as it is considered to be less stigmatising than ‘addiction’. In everyday conversation terms such as ‘habit’, ‘drug problem’ or ‘compulsion’ are also used. The personal accounts presented here reflect this range of ideas and terms. People describe their alcohol and other drug use in many different ways. Some use the word ‘addiction’, while others prefer the term ‘dependence’. A number of people opt for the word ‘habit’. Several resist all these terms and describe their consumption in other ways, for example as part of their lifestyle, or as a regular activity that they organise around other activities and commitments.

Beyond the terms used, our participants also hold a range of views about addiction and why it happens. Many share the view that it usually refers to a pattern of regular long-term consumption that is connected to other social, psychological and physical issues. According to some of our participants, the term ‘addiction’ doesn’t just apply to patterns of alcohol and other drug use but can describe any activity that is experienced as compulsive, such as gambling, computer gaming and overeating. In some cases, alcohol and other drug addiction is described as different from other kinds of addiction because it involves physical symptoms. Many explain what addiction or dependence means to them by using terms common in popular culture such as ‘craving’, ‘habit’ and being ‘out of control’. These terms have a long history but correspond broadly with the measures used in official screening and diagnostic tools. Used to screen for and diagnose alcohol and other drug problems, the tools list symptoms such as ‘tolerance’ (the need for higher doses after repeated consumption), ‘withdrawal’ (physical symptoms when stopping or cutting down), and ‘craving’ (a strong desire for the drug). Many of those interviewed for this website draw on these terms in their own accounts of addiction or dependence.

Some people describe addiction using the language of abstinence-based, self-help programs as a chronic, progressive disease that can’t be cured. According to this understanding, the main sign of alcohol and other drug addiction is being unable to control consumption. Those who describe addiction in these terms say getting better requires stopping altogether. Several point out the challenge of doing so and talk about cycles of ‘relapse’ and ‘recovery’. In other cases, neuroscientific language is used to refer to addiction as a brain disease affecting the structure or ‘wiring’ of the brain and its chemistry.

Although the terms ‘dependence’ and ‘addiction’ are widely used in healthcare settings, some of the people interviewed for this website question their usefulness and note their potentially stigmatising effects. They point out that the idea of addiction implies that a person is sick or otherwise has a problem that needs to be addressed. They say that even though their alcohol or other drug use is regular and holds a key place in their lives, they don’t see it in these terms. Instead they present it as an important part of their lives with benefits as well as disadvantages.

When asked what causes dependence or addiction, many people say they are not sure. Some suggest trauma, pain and suffering. Others say it’s a form of learnt behaviour, shaped by everyday circumstances and situations such as growing up in a household where heavy consumption is the norm. A few say dependence or addiction is influenced by genetics. They say that a person can inherit genetic tendencies that make them more prone to addiction. Several mention the idea of an ‘addictive personality’ to refer to certain personality traits that are thought to make a person more likely to develop addiction or dependence.

Read on to find out more about these different views on addiction and what causes it. We begin with the most common accounts, highlighting the key ideas and terms people use to describe what addiction means to them.

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Official screening & diagnostic measures

Many of the people interviewed for this website share the view that addiction usually refers to a pattern of regular long-term alcohol and other drug use that is connected to other social, psychological and physical issues. They say a sign of addiction is when consumption disrupts other parts of everyday life, such as work and relationships with family and friends. As Jason (M, 34, studying, ice) puts it, ‘Addiction [is…] when it impacts on other areas of your life in a negative way. So stopping you from going to work or having decent relationships or doing what you are supposed to be doing […] I mean, I’m addicted to coffee and to cigarettes or to nicotine, and yet they’re not destructive. For me, addiction is destruction’. Related to this view, many describe addiction or dependence using ideas that appear in popular culture, such as compulsion, craving and loss of control. These concepts have a long history and many shape policy, legal and public health responses to alcohol and other drug use. They also tend to correspond broadly with the measures used in official screening and diagnostic tools. Used to screen for, measure and diagnose alcohol and other drug problems, the tools list symptoms such as ‘tolerance’ (the need for higher doses after repeated consumption), ‘withdrawal’ (physical symptoms experienced when stopping or cutting down), difficulty stopping, and a strong desire or ‘craving’ for the drug.

Devoting too much time

Several people say that a sign of addiction or dependence is devoting too much time to finding and taking the drug. They suggest this can disrupt everyday activities, such as going to work, doing household tasks, or spending time with friends and family (also see Work, study & making ends meet; Relationships, confidentiality & telling others; Consumption in everyday life). Others express the view that continuing to take a particular drug even though it seems to lead to psychological, physical and social problems is a sign of addiction.

Lala (F, 35, works in health services, cannabis) considers her regular cannabis use a ‘dependency’ because she spends a lot of time trying to access cannabis and gets stressed when her supply runs low. (Played by an actor)

I’ve been smoking every day for the past two years, and I smoke after work and on my days off. I know it’s a dependence [because] when I’m about to run out, I start to get stressed about how I’m going to get some more, and […] the idea of being without cannabis is a stress to me. Like, it’s something that I seek, so when they talk about drug dependence [involving things like] spending a lot of time thinking about, and [trying to] access a drug, that’s my relationship with cannabis.

[…And I mean] I don’t really want to go chasing it, I don’t like the chasing thing. Like, it’s such an obvious drug […] dependent behaviour that it just makes me cringe at myself.

According to Artemis (M, 28, works in education, cannabis and party drugs), addiction is a pattern of consumption that disrupts other parts of everyday life. (Played by an actor)

There’s a lot of stigma associated with drug use and with the concept of addiction […] which is kind of a misused and misunderstood term, but I don’t know, what is [it] to me? [It’s, like, when your drug use…] is impeding other aspects of [your life]. It’s encroaching on getting to work on time, accomplishing the things you want to accomplish, seeing your friends, going for brunch with your family. Like, the [kinds] of basic social markers that […] I ascribe to a successful and meaningful life.

Jacob (M, 33, works in hospitality, cannabis) links addiction to health issues and a pattern of consumption that disrupts work and other everyday activities.

I think it [is] more than the people struggling. [It’s] where it hurts you day to day. Where you don’t have a job […] It’s not like I’m all about, everybody’s just got to work. Like, I wish I could not work. I would be the happiest person to not have a job and just do my thing, but I think the minute you can’t really be a part of society, that’s where it becomes a problem […] Or you see this vicious sort of circle happening. I don’t know, that’s the stuff that scares me. That’s where I see addiction. That’s where you can’t go and have a job, where you can’t have a normal life.

Compulsion

A common theme in participants’ accounts of addiction is that the desire for the drug is hard to control, implying that addiction involves compulsion. As Fozz (M, 59, works in employment services, alcohol) puts it, ‘My addiction […] is part of my compulsive behaviour’.

According to Jim (M, 21, studying, cannabis), addiction involves a feeling of ‘need’ and can apply to any activity that is experienced as compulsive. (Played by an actor)

[Addiction] is feeling that you need [the drug] or that you want it. And it’s on your mind a lot of the time. It’s always on your mind. It’s always present […] I don’t think it’s a good term, because it’s implying that you need something. But people are addicted to a lot of things […] Like, I know an old teacher [who] used to say she was addicted to exercise, and she was.

Developing ‘tolerance’

Another sign of addiction that some of our participants identified is a need for higher doses after repeated consumption (‘tolerance’).

Matthew (M, 49, not working due to illness, cannabis) describes his cannabis use as an ‘addiction’ because he thinks about smoking cannabis when he wakes up and needs a higher dose to get the desired effect.

[Addiction] means that you need that drug to survive […] Addiction is where, like, you wake up and the first thing you think of is your smoke. How much have I got? Where am I going to get the next lot from? Got to make sure I’ve got it. Then you go and get it. And then if it’s really bad stuff, then you’re really angry with yourself because you’ve wasted all your money on this stuff that you don’t even feel. I don’t know whether I’m getting immune to it because they say it’s twenty times stronger [than] what it was when I was a kid [but] I reckon it’s twenty times weaker. It used to hit me a lot more back then, than [it does] now. I can smoke it and I’m just numb […] so I don’t know whether you can become immune to marijuana. I don’t know but it just doesn’t affect me any more. Probably one of the reasons I wanted to then try and get off it [is] because it wasn’t doing its job anymore. That’s when I sought help.

Craving & withdrawal

In a few cases, alcohol and other drug addiction was described as different from other activities experienced as compulsive because it involves physical symptoms, such as withdrawal and cravings.

Helen (F, 53, not working due to injury, heroin) says that drug addiction involves physical withdrawal symptoms and cravings. (Played by an actor)

With something like heroin you do have very acute withdrawals […] If you’ve had it in your system for long enough to become habituated to it. And you’re going to feel absolutely terrible if you don’t have it. To me, that’s addiction. People can say they’re addicted to TV or gambling or food, or whatever, but to me, like my experience of addiction has been that kind of fear of feeling awful, as well as the attraction of the good feeling [and] not wanting to feel sick […] When it comes to heroin […] you do get cravings and you do experience withdrawals.

Addiction: physical or mental?

Some people distinguish between physical dependence and psychological or mental dependence. They say that a physical dependence or addiction involves tolerance and withdrawal. As Zadie (F, 33, works in the health sector, heroin) explains, ‘For me, [opiate dependence] is very physical. It’s when you start to get flu-like symptoms and cramps if you don’t have a shot. It’s purely that, like, you know, at the point when physically, you feel sick’. Helen’s comments above also refer to physical symptoms as signs of dependence or addiction. By contrast, several people link dependence with the mind. They describe emotions such as being preoccupied with finding and taking the drug, feeling ‘reliant’ on it and feeling uneasy when stopping or cutting down. Some say the kind of drug determines whether the addiction is physical or mental as some are much more physically addictive than others.

Lucy (F, 34, works in retail, cannabis) describes her daily cannabis consumption as a ‘mental dependency’ as she relies on it for ‘comfort’. (Played by an actor)

If you’re having [marijuana] every day, but then you’ve just got to go without it for a night or two, you’re all right […] because that’s the thing, there is no physical dependency […] It’s not like other drugs, like, even cigarettes, where you’re just […] going mental. Marijuana is the one thing that I think is more a mental dependency […] I wouldn’t really consider myself like an addict, smoking [marijuana]. I’m just dependent on it, mentally dependent because, like I said, it’s my comfort […] It’s not like I’m actually full on tearing my hair out without it. So I guess, yeah, dependency is just more of a reliance, whereas an addiction is, if you don’t have it […] you are, like, suffering, or there’s terrible pain. I guess that’s the difference I have in my mind about it.

Nick (M, 50, not working due to illness, heroin) finds the ‘mental part’ of heroin addiction harder to deal with than the physical symptoms he experiences.

I find [it’s] not the physical pain or the physical attributes of the heroin addiction [that are] hard. I find the mental part of it the hardest. It’s trying to stay away from thinking about it, which is the hardest for me.

[…]

I have been withdrawing from heroin that much that I’m sort of used to it. But the physical part is easy, it’s the mental part that is hard, to maintain that clean life. Don’t think about heroin. Also triggers, things like seeing a discarded syringe on the foot path, or a discarded syringe top on the footpath would do [it] for me sometimes. [It] would trigger my thought process straight to heroin, and therefore trigger another thought process of how to obtain it. That’s my problem, is how to not think about it.

A chronic, incurable disease

Some people draw on abstinence-based treatment or self-help programs to describe addiction as a chronic, lifelong disease that can’t be cured. Here ‘disease’ means a physical illness and/or a spiritual condition involving a separation from God or a higher power. According to this view, a key sign of addiction is being unable to control alcohol and other drug use. People who describe addiction in these terms say it’s incurable so getting better involves stopping altogether and remaining abstinent. Several highlight the challenge of being abstinent, and talk about cycles of ‘relapse’ and ‘recovery’ (see also What is recovery & how important is it?). As Anika (F, 19, studying, cannabis) explains, ‘You can either fall back into addiction or you can fall back into recovery, but […] I think, throughout my life, it’ll be a constant battle between the two’.

For Zoe (F, 30, studying, ice), addiction is an incurable condition and getting better means giving up drugs permanently. (Played by an actor)

Everybody has a pre-drug history and then addicts have a drug history. And it’s re-learning how to function and live daily life, and balance everything, without using drugs and without having to feel empowered by an artificial substance […] I do know how easy it is to relapse and, even now, I do have some days where I just think, ‘I just want to numb everything. It would be so easy. I know where this person lives, I could go just see them [and get drugs]’. And to me, that’s almost a relapse in itself, just thinking about it. It’s the recovery side of it that stops you from actually going and following through with that. So relapse and recovery, I guess you’re walking a tightrope with them, day in and day out. And I don’t think you can actually put a timeline on being in recovery, like, [on when you will have] recovered. That’s why I said at the start of this, I’m always going to consider myself an addict, because I was addicted to [ice]. I know that I could very easily go and get addicted to it again. So to me […] I’m always going to be an addict, whether I’m using or not.

A ‘brain disease’

A few people draw on neuroscience to refer to addiction as a brain disease. They say that addiction happens when regular consumption affects brain chemistry and reshapes or damages pathways in the brain.

According to Opal (M, 45, primary carer for his children, alcohol and prescription painkillers), addiction occurs when regular consumption affects ‘receptors in the brain’.

Part 1

[By learning about the brain] I really understood the nature of the addiction and everything [and] it really helped me to be able to get over it. Once I really knew what was going on with me, and the means of what addiction was doing, you know, with the receptors in your brain and everything. And how you really had this desire and need to take the stuff […] You were lost without it. [Realising this helped me get over my addiction].

Part 2

As it’s been explained to me now, once you’ve had like an addiction to something like that, the pathways are already there. They are already set there already […] Like, what do they call those things in your brain? Like, the receptors in your brain, they’re already accustomed to accept that opioid, so then you’ve already got a tolerance already before you’ve even actually started to take it.

Questioning addiction or dependence

Some participants criticise the ideas and language of addiction and dependence. They point out that the idea of addiction implies that a person has a problem that needs to be addressed. They say that even though their alcohol or other drug use is regular, they don’t see it in these terms. Instead they present their consumption as an important part of their lives with benefits as well as drawbacks (see also Consumption in everyday life; Looking after health & well-being; Living with illness or a health condition). For some their regular consumption is a routine practice or habit that develops over time. As Ted (M, 26, works in the arts, party drugs) puts it, ‘Habit is something that you do frequently, regularly and [my own consumption] certainly is a habit. A habit is something that you do because it feels comfortable, because it’s a bit of a routine, and my use of drugs certainly falls into those categories’. Like any habit or routine, a habit of regular alcohol or other drug use can be broken, sometimes without any particular plan or effort. As Callum (M, 36, studying, cannabis] explains, ‘I would call my cannabis use a habit, [because] habits can be stopped and started. I don’t have any issue [with cannabis. I can] stop and start, it doesn’t affect me’ (see also Changing patterns of consumption).

According to Brad (M, 50, unemployed, speed), addiction refers to ‘repeated choices’ or habits that can be varied when they’re no longer enjoyable.

Anything that you like doing and want [to] do again, is probably what most people think of as an addiction. You know, it’s just a habit to my mind. It’s anything. Everything’s, you know, [a habit]. We are all creatures of habit and you choose your habits and that’s the one I chose amongst many others. […Addiction] is a word for habit, right. And in my experience […] it’s always a choice, even when it’s not. There have been times where if I haven’t had [speed] wow, what do you know, you wake up the next morning and you’re still going, in some form or another. So, you know, it’s just a habit and […] like I’ve said before, habits are just repeated choices […] You just forget that you are making a choice, but it’s always there. And I chose to [take speed] in the beginning, so, you know, I’ve got friends who have stopped for the same reasons. You know, you just get tired of it.

Kate (F, 36, works in the health sector, prescription sedatives and ice) says that while others might say she has an ‘addiction’, her consumption doesn’t affect others parts of her life so she doesn’t see it as an issue. (Played by an actor)

If you can afford [to take drugs] and it’s not affecting your lifestyle, and you’re still working, and undertaking your duties, and paying your bills and saving, and buying things that you want, and going out and doing stuff, then how is it problematic? And if it’s not affecting the other things that I was doing before […then again how is it problematic?] So yeah, I’m sort of still reconciling this in my head, and leaning towards the fact that, yes, I may be dependent. But as long as I have a regular supply, then it shouldn’t be an issue, because it’s my choice, and it’s not affecting any other aspects of my life.

Sources or causes

When asked about why addiction or dependence happens, many people say they’re not sure. Several point out that it’s very complex and is linked to a number of different causes, including trauma and other stressful life circumstances, genetics, family history, and changes to the brain after repeated consumption. The next sections present these different accounts of why addiction happens.

Trauma, pain and suffering

Some people say that addiction or dependence is caused by trauma, pain and suffering. For example, domestic violence, homelessness, child abuse, chronic illness and injury are identified as possible sources or causes. Several describe alcohol and other drug use as a way of ‘self-medicating’ or coping with physical and emotional pain (see also Living with illness or a health condition; Living with a mental health condition). Social isolation and relationship difficulties are common themes, with some people saying addiction can happen because of loneliness and relationship problems (see also Relationships, confidentiality & telling others). As Phoenix (M, 48, works in the media, alcohol and prescription painkillers) puts it, ‘People become addicted, I think, because they lack connection to other people’. George (M, 58, not working due to ill health, alcohol) makes a similar point in describing his own experience: ‘[My alcohol habit is] a daily ritual, mostly created by my isolation’.

Ethan (M, 39, works in hospitality, ice) describes his ‘addiction’ to ice as a ‘survival mechanism’ for coping with social isolation. (Played by an actor)

The drug was my best friend and it stopped me feeling. When I had my drug, I didn’t feel lonely. I discovered [this] later through […] rehab […And] so addiction was survival, yeah, I think it was a survival mechanism.

[…Like, taking meth] made me feel like I was a part of something […so, for me it] filled the holes. It gave me what I was missing, and I used that as much as I could. But then […] I wasn’t learning any coping mechanisms, I wasn’t learning how to function in the world, I wasn’t learning how to deal with my emotions. I was using the drug to mask or to change all of those feelings that I couldn’t deal with.

Learnt behaviour

A fairly common understanding of addiction or dependence that our participants gave is that it is a form of learnt behaviour, shaped by everyday circumstances and situations such as spending time in contexts where heavy consumption is the norm or growing up in a household where family members drink or smoke heavily.

Phoenix (M, 48, works in media, alcohol and prescription painkillers) says his experience of addiction was shaped by the social context in which he grew up.

Part 1

I grew up in a violent home. Both my parents were alcoholics, both very violent people.

Part 2

I started drinking, I was about twelve, I think, and I stole alcohol from my parents. The original intent of the theft was so that they wouldn’t be so drunk, so they wouldn’t punch each other and punch me and carry on. I ended up drinking of course. What else was I going to do with it? So I began thieving and drinking. And of course they had no idea that they were not drinking as much as they thought they were, no idea at all.

Part 3

What was driving it? A lack of knowledge of anything else. I just didn’t know any other way to live, I had no clue that this was not normal. That this was all I’d seen. Most of my friends from school had alcoholic parents. If I was at a sleepover, [it was] almost the same [as being at home with my parents], except they were drinking something different. It was a horrendous thing, plus there was no information, there was never any information back then about what happens or how to do things. It was all just very naïve.

Genetics

A few people say addiction is shaped by genetic tendencies in the sense that it’s possible to inherit certain genetic tendencies that make a person more likely to experience addiction.

Emma (F, 42, works in retail, alcohol) says that she may have inherited an ‘addiction’ to alcohol from her father.

My mum’s the same. We can go all day without a cigarette. If we can’t, we’re not one of those people that will find somewhere to smoke. If it’s not appropriate to smoke, then I won’t. But so then I thought, ‘Well, I’m not addicted [to cigarettes]’. But yeah, I am addicted. The same thing with alcohol, I didn’t realise the addiction. I didn’t understand the physical addiction. People saying like, ‘It’s genetic and everything’. I could never work that out. Like, how does that work? You can inherit it and my father’s an alcoholic and I always thought that maybe I’d follow his path.

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