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.

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)

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)

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

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)

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.

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)

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)

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.

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)

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’.

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.

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)

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)

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.

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.