DEFINITIONS, TYPES AND CHARACTERISTICS OF ADDICTIONS
Numerous definitions of “addiction” have been put forward but, as is the case with the term “abnormality”, this is another term that is too complex to be simply labelled.
Mark Griffiths (2005):
Griffin defined addiction as “any behaviour that features all the core components of addiction”.
The six core components of addiction, also given by Griffiths, are: salience, mood modification, tolerance, withdrawal, conflict and relapse.
- Salience –
A particular activity becomes the most important activity in a person’s life. It dominates their thoughts, feelings and behaviour. Even when the person is not actually engaging in the activity, they would still be thinking about it.
- Mood modification –
The subjective experience that occurs in an individual after engaging in the particular activity is a modification in the mood. It may be a “buzz” or a “high” (check me out trying to sound all gangsta) or a “numbing” haze.
- Tolerance –
This refers to the process in which the particular activity needs to be consistently increased for the individual to feel the strength of the former effects. Basically, one dose of something has to be doubled or tripled for the individual to be affected by it again.
- Withdrawal –
The unpleasant feelings, state or physical effects which occur when the particular activity is suddenly reduced or discontinued are called withdrawal symptoms. They may be psychological (e.g. moodiness) or physiological (e.g. insomnia).
- Conflict –
The addicted person may suffer from interpersonal or intrapersonal conflicts. Someone who always chooses short-term satisfaction and disregards the consequences usually compromises their personal relationships, work, education, society and recreational activities. The intrapersonal conflicts usually involve feelings of guilt or helplessness which stem from the addict wanting to get better but feeling like they are simply unable to do it.
- Relapse –
There will be a tendency for repeated returns to the earlier patterns of the particular activity. The most extreme patterns may be restored quickly even after years of abstinence or control.
There are various types of addictions. Some of the most common are discussed below.
Alcoholism is the addiction to alcohol. This condition involves the continued consumption of alcohol despite negative consequences in the individual’s personal, social and professional life. Some factors have been suggested as contributors to alcoholism, namely: physical dependence, neuro-chemical conditions, and the false perception of alcohol being beneficial. There are also different symptoms of this addiction, and the main ones are: cravings, loss of control, physical dependence and tolerance.
Impulse control disorders are those disorders which are characterised by a failure to resist a temptation, an urge or an impulse that may be harmful to oneself or to others. The DSM-IV includes a category named “impulse control disorders not elsewhere classified”. This group includes conditions such as kleptomania, pyromania, trichotillomania and pathological gambling.
Impulsivity has five distinct stages of behaviour:
- An impulse
- A growing tension
- Pleasure when impulse is satisfied
- Relief from satisfaction
- Guilt or lack of guilt
Some impulse disorders are explained as follows.
First described in 1816, kleptomania is the inability to resist the urge to steal items for any reason other than financial gain. Basically, kleptomania is when you steal things but you’re not doing it to profit financially. According to the DSM-IV, it has these features:
- Repeated inability to resist the urge to steal items for non-financial/personal reasons.
- Escalating sense of pressure just before the theft.
- Satisfaction when the theft is carried out.
- The theft is not done to display bitterness or revenge, or because of a delusion or fantasy.
- Thieving is not due to a behavioural disorder, manic episode or an antisocial personality.
Pyromania is the inability to resist the urge to deliberately start fires for the purpose of internal relief or gratification. Pyromaniacs start fires on multiple occasions. The DSM-IV gives the following diagnostic criteria for this condition:
- Deliberate and purposeful starting of fires on more than one occasion.
- Tension or affective arousal before starting the fire.
- A fascination with, interest in, attraction to or curiosity of fire and its situational context.
- Pleasure, gratification or relief when starting fires.
- Starting fires is not done to display bitterness or revenge, or because of a delusion or fantasy.
- It is not due to a behavioural disorder, manic episode or an antisocial personality.
Compulsive gambling, also called pathological gambling, is the failure to resist gambling urges. The DSM-IV gives the following diagnostic criteria for this condition:
- Persistent and maladaptive gambling, shown by five or more of the following:
- Preoccupation with gambling
- Amount during gambling consistently increases to achieve pleasure.
- Repeatedly unsuccessful attempts to cut down, control or stop the gambling.
- Restlessness or irritability when attempting to change gambling habits.
- Gambling as a means of escapism.
- When amounts are lost in gambling, they return to make up for the loss.
- Deceptive towards family, therapist and others about the extent of gambling.
- Acts of fraud, forgery or theft to finance the gambling.
- Jeopardised or loss of a significant relationship, job, education or career opportunity because of the gambling.
- Reliance on others to provide money during desperate financial situations caused by the gambling.
- Gambling is not due to a manic episode.
Physical and psychological dependence
Physical and psychological dependence refer to different consequences, but they overlap greatly.
Physical dependence is defined by the appearance of withdrawal symptoms, such as sweating or tremors, when the chronic use of a substance is stopped. The speed with which a person becomes addicted varies according to the substance itself, the frequency of use, the method of use, and the individual’s genetic and psychological vulnerability.
Psychological dependence is related to the mind and leads to more psychological withdrawal symptoms. Some examples are cravings, irritability, insomnia and depression. Psychological dependence is not limited to substance abuse; activities, habits and behavioural patterns can also become addictions. This includes things like compulsive gambling, internet addictions, pornography addictions and self-harming addictions.
CAUSES OF ADDICTION AND IMPULSE CONTROL DISORDERS
The importance of genes in alcoholism is supported by the family-based nature of this disorder, the significantly higher concordance rate in identical twins, and the fourfold risk for children of alcoholics who may or may not be adopted.
It has been observed that female twins actually have lower concordance rates than male twins, which is the opposite to what we saw in depression concordance rates.
Marc Shuckit (1965):
Schuckit, an American addiction psychologist, conducted research on the role of genes and biology in the development of alcoholism. His study on the sons of alcoholics involves 400 college men, half of which had alcoholic fathers. Alcoholic mothers were excluded so that any pregnancy-related effects could be avoided. None of the men were alcoholics themselves.
Schuckit gave the volunteers an alcoholic or non-alcoholic beverage without their knowledge. Every drink had the odour and taste of alcohol to help in deception. The men were given four or five drinks and then their blood alcohol levels were tracked.
The sons of alcoholics said that they felt less drunk than the sons of non-alcoholics, and they even performed better in tests of hand-eye coordination. This all happened even though both groups of men had the same blood alcohol level. Schuckit reported that the sons of alcoholics swayed much less when walking and had less obvious changes in their hormones.
40% of the sons of alcoholics showed a decreased sensitivity to alcohol in terms of drunkenness, performance and hormone levels. This was seen in less than 10% of the sons of non-alcoholics. Schuckit concluded that there are very real differences between men with alcoholic fathers and men with non-alcoholic fathers, suggesting that the role of genes in this addiction is very strong.
The biochemical explanation of addiction discusses the neurotransmitter dopamine. The theory is that the “high” or “buzz” (here I go again) caused by taking a drug is the result of a build-up of dopamine in the brain. The dopamine cells are largely concentrated in the brain’s limbic system (the part that is mainly responsible for our emotions).
When GABA is released, nearby dopamine cells take it up in GABA receptors. The enzyme GABA-transaminase destroys GABA. Dopamine cells receive the signal for GABA and stop releasing more dopamine. Meanwhile, existing dopamine gets on top of neighbouring cells and re-enters its home cell through a “gate”. When this happens, a “pleasure signal” is sent. When the dopamine leaves, the pleasurable feelings also reduce. The point of this paragraph is basically that dopamine is the cause of the pleasure felt when an addict takes their drug.
When nicotine is consumed, it travels to the brain and goes to special receptors present on dopamine cells. It sends a signal that drowns out the GABA signal. Nicotine’s signal tells the dopamine cells to release more dopamine. All this extra dopamine causes a large increase in the available stock of dopamine. The extra dopamine sends repeated pleasure signals. This feeling, and the craving to feel it again and again, creates the basis of addiction.
Drugs basically cause an overload of dopamine in the brain, resulting in pleasurable feelings for the addict. Cocaine, for example, stimulates nerve endings into producing large amounts of natural neurotransmitters that have a stimulating effect on our brain.
The behavioural model explains addiction as the result of positive reinforcement (rewarding). “Reinforcement” basically refers to how behaviour will increase or decrease, depending on whether people associate it with a positive reward or a negative punishment.
For example: when someone is suffering from uncomfortable periods of depression or chronic pain, they will experience relief after taking painkillers. For them, this experience is rewarding (because pain is numbed) and they will probably take the drug again to repeatedly feel that same relief. This would eventually end in addiction and dependence.
Similarly, someone who believes that winning equals succeeding would feel rewarded if they won money when gambling. Even when they lose, they would probably have distorted cognitions about “nearly winning” and consequently feel anticipation to again win money and be “rewarded”. The person would become addicted to gambling as well as the feelings of success that tag along.
Cognitive psychologists explain addiction as a result of distorted cognitions. One theory discusses a “self-fulfilling prophecy”. This means that whatever one expects will happen, will actually happen.
For example: someone attends a party believing that “nobody will like me or want to talk to me”. As a result of this illogical thought, the person behaves awkwardly and unpleasantly, thus distancing other people and making them avoid the person. From the first faulty thought, the expectations really did come to life. The self-fulfilling prophecy, therefore, can play a part in maintaining addiction.
For example: an addict keeps telling herself that recovery is impossible, saying things like, “I’m just incapable of recovering and I’m going to be stuck as an addict forever.” Her distorted cognitions and imbalanced thought processes are aiding in the formation and maintenance of her addiction.
COPING WITH AND REDUCING ADDICTION AND IMPULSE CONTROL DISORDERS
Token economy is a system of behaviour modification (or “conditioning”) which is based on the systematic positive reinforcement (rewarding) of target behaviour. It is based on the principles of operant conditioning. It uses secondary and primary tokens that are the “reinforcers” of good behaviour. The tokens are collected and later exchanged for a meaningful privilege or reward.
The token economy technique has proved to be quite effective when treating addicts. A study conducted in 2006 used a reward of being entered into a prize draw when treating alcoholics and gave positive results. Another study from 2007 found similarly positive results with 120 cocaine addicts involved in a 12-week programme. The higher the amount of the prize ($80 turning into $240), the higher the success rate of recovering addicts. Former addicts stayed clean longer and were more likely to complete the whole rehabilitation programme.
Aversion therapy (for alcoholism):
Aversion therapy is a controversial form of behavioural treatment based on the principles of classical conditioning. Classical conditioning, introduced by Ivan Pavlov, is when a neutral stimulus is made to be associated with an automatic response. Pavlov himself conditioned dogs to start drooling and anticipating food every time they heard a bell noise that represented the arrival of food. Before the dogs even saw or smelled the food, they would be ready for it simply by hearing the bell.
Since behaviourists believe that all behaviour is learned, they believe that it can also be unlearned. Aversion therapy for alcoholism aims to unlearn the thought of alcohol being supposedly equal to pleasure by breaking the positive association it holds for alcoholics.
In this treatment, the patient would consume alcohol while suffering from a negative stimulus. This stimulus could be a vomit-inducing (also called “emetic”) drug or even an electric shock. Since the patient is being “punished” for undesirable behaviour – in this case, alcoholism – a successful outcome would be the elimination of this undesirable behaviour.
In 2001, Matthew Howard treated 82 alcoholics with an emetic drug for 10 days. After being treated, the subjects stated that they felt like they would be able to resist drinking alcohol after having aversion therapy. However, this is not a very preferable form of treatment and some people consider it to be like “programming” people like computers.
Cognitive-behavioural therapy for kleptomania
CBT has been used successfully in the treatment of kleptomania, an impulse control disorder. CBT can include covert or imagined or systematic desensitisation, aversion therapy, relaxation training, and other alternative sources of satisfaction. CBT has largely replaced the psychoanalytic and psychodynamic therapies used in the treatment of kleptomania. Recent studies do suggest that this treatment is more effective when used alongside medication, rather than a patient being treated with medicine alone.
Kohn conducted a case study on a man with kleptomania who also had depression, suicidal ideations and potential legal complications. Strategies included covert sensitisation, behavioural chaining, problem solving, cognitive restructuring and homework. After treatment had been administered, Kohn noted that symptoms of depression and kleptomania decreased significantly. A four-month follow-up showed positive results in the client, who also reported that no episodes of kleptomania occurred.