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.
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)