Preserving the Name ‘Addictions’

Is the concept and name of “addiction” worth preserving even though the American Psychiatric Association will not use it?  If so, or if not, then why?

 

This essay will look at whether or not it is important to preserve the concept and name of “addiction”.  In order to do this, the factors which might lead someone to becoming addicted will be examined, as will the common features associated with addictions.  Examples of two non-substances-related addictions will be briefly discussed, as will the notion of positive behaviours, to determine if “addictions” are, in fact, normal aspects of human behaviour and necessary for some people to live a happy and fulfilled life.  I aim to show that the term “addiction” is helpful when describing negative behaviour, which someone wishes to overcome.

Kilpatrick (1997) sets out the various characteristics of addiction.  They are: a tolerance for the addiction, so that the addict requires more to gain the same effect; salience, that is, there is an increasing importance of the addiction in the person’s life; conflict, where there becomes an increasing awareness of the negative consequences; withdrawal, due to the distress, the person experiences a period of non-engagement; craving, where there is a desire, but also distress, to re-engage in the behaviour; and relapse and reinstatement, where the behaviour starts again after a decision to stop or reduce.  These are quite specific factors in the diagnosis of addiction, and they do differ from obsessions and compulsions.

According to the DSM-IV, obsessionsare persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate, causing anxiety as the person feels the obsession is outwith their control and not the kind of thought that he or she would expect to have.  Nevertheless, they are able to recognise it as a thought from their own mind.

Compulsions are described as being repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress, rather than to provide pleasure or gratification.  Usually, the person feel they must perform the compulsion to reduce the accompanying distress, or to prevent some dreaded event occurring.

Furthermore, we not only can we identify the characteristics of addiction; we can also identify some factors which may lead to addiction.  This is a more complex matter, but nevertheless, it is possible to see patterns.  Many things can contribute to someone becoming addicted.  The ‘buzz’ or ‘high’ given by carrying out the behaviour; peer pressure; boredom leading to sensation seeking; legality (or lack of) and availability; a need for excitement; separation or disassociation with family/friends/relationship causing depression; lack of support; in (for example) prison, an exposure to ideas.  Because these ideas and possible causes are so varied and complex, and not necessarily able to be applied to every addict, qualitative research is necessary to establish the similarities in addiction.

A sample group of joy-riders were studied.  They came from various backgrounds. Seven of the group came from families where both parents were together; four came from one-parent families; four were living with other relatives because of abusive parents.  Some of their parents worked; some did not; and the joy riders were of varying ages between fourteen and seventeen years old.

The feedback gave a clearer picture of why the teenagers became hooked on joy-riding.  They reported feeling a thrill of driving with their peers (Kilpatrick 174), and of crowds watching them joy-ride; they felt a sense of freedom; they felt the need to, and enjoyed, showing off to their peers and bystanders; it gave them a feeling of “superiority” (175).

Peele (1985) believes that this possibly shows that what they were feeling emotionally was a sense of control, power and self-esteem that their current life was not offering them.  These positive consequences and feelings might very well lead to the desire to re-experience the sensation again and again (174).

The social context also became clear during this test.  There was certainly an element of both peer pressure and competitiveness; and also a desire to be part of a group.  Joy-riders rarely steal alone.  However, this is not a characteristic of all addictive behaviours, depending on the individual.  For example, some alcoholics drink alone, some do not.

All the joy-riders engaged in certain fundamental behaviours: the need for drink and drugs, which reduced inhibitions; usually a feeling of guilt when their parents found out; peers were regarded as being more credible than parents; an availability (of cars); anti-social behaviours (delinquency, problem drinking, drug-taking) (177).

Arguably, many other non-substance addictions are entirely possible to develop, as Witman, Fuller and Taber (1987) point out.  They manage to come up with 40 possible activities, only twenty two of which are substance-related.  Furthermore, on looking at the list, it is easy to come up with several more possibilities to add.  One could argue that it is entirely possible to become addicted to absolutely anything.

The addiction model would also seem to apply to a minority of cases of killers who were studied by Gresswell and Hollin (1997).  Their research illustrated the behavioural features of addiction that were present in two different case studies (140).

Brittain (1967) put forward the possibility that fantasy had a role to play in sadistic acts, which seems to be confirmed by Prentky et al (1983) who found that 86% of serial sexual killers admitted a history of violent fantasy, which lead to fantasy ‘try-outs’ (141).

Some murderers, it would seem, have things in common with some addicts, especially gamblers.  Pathological gamblers can become addicted “to their own arousal and its physical and psychological effects” (141).  In the same way, a killer may become addicted to the reward of sexual pleasure, power and control (142), as well as the pleasure derived from the adrenaline rush, which is understandably addictive.

Gresswell and Hollin (1997 145-148) indicate how some serial killers may fit the addiction model perfectly.

Salience:

Many hours are spent in fantasy, ‘try-outs’, acquiring weapons, selecting victims and locations, ‘environmental grooming’, offending and following their case in the media.

Conflict:

Some offenders do appear to feel conflict and some describe feelings of revulsion and guilt after they have killed.

Tolerance:

There appears to be evidence of tolerance…MacCulloch et (1983) found clear evidence of a progression in the fantasies of 9 out of 16 sadistic offenders…  This increase in the power of fantasies was accomplished by increasing the sadistic content…

Withdrawal:

Revitch (1965) cites Krafft-Ebbing (1934) who described the case of a man who did succeed in “mastering his morbid cravings, but this produced feelings of anxiety and perspiration would break out on his entire body”.

Relief:

For some serial killers there may be a sense of relief of frustrating sexual feelings prior to killing; or the killing may relieve feelings of powerlessness, anger or other (non-sexual) frustration.

Relapses:

Due to abnormal socialisation “fantasies are used both to escape the aversive realities of everyday life…and to enhance sexual pleasure.”  He may act out parts of the fantasy and develop beliefs that legitimise and normalise his violence and sadism.

As well as these factors, Gresswell and Hollin believe that triggers for the first killing sequence should be evident; and these triggers would be likely to bring to light aggression if the activity was on an extinction schedule (148).

William Glasser has also put forward an argument for positive addictions in his book of the same name.  Here he has developed six criteria:  It is something non-competitive that you choose to do and you can spend an hour (plus) doing each day; you can do it easily and without a great deal of mental effort to do it well; you can do it alone or (rarely) with others, but it does not depend upon others if you do it; you believe that it has some value (physical, mental, or spiritual); you believe that if you persist at it you will improve, but this is completely subjective—you need to be the only one who measures that improvement; the activity must have the quality that you can do it without criticizing yourself. If you can’t accept yourself during this time the activity will not be addicting. This, Glasser explains, is why it is so important that the activity can be done alone. If you introduce other people you chance introducing competition or criticism, often both.  The most common of these addictions are running, yoga and meditation (122-133).

One addict of positive addiction stated that when he doesn’t sing “I feel lousy inside, lazy, like I haven’t completed something.  I am…also a more confident person.”   Glasser tells us that:

Person after person describes the discomfort as feeling grumpy, hard to get along with, upset with himself or herself. Some say their day doesn’t go right, and in most cases they say they feel guilt because they have missed something important that they didn’t have to miss. In fact, many people just write the word “guilty” and that sums it up. Some people say they feel more tension, more nervousness, more self-doubt; others that they are more impatient, less communicative with others, and irritable. Several people describe fatigue, a feeling of tiredness or deadness, if they don’t do their addicting thing.

It would seem, too, that the benefits of maintaining the positive addiction are endless: weight-loss/control; the cessation of negative addictions like smoking or drinking; mental alertness; self-awareness; a physical sensation of well-being; a greater sense of confidence; more tolerance; less anger; more energy; sleep less.

Glasser sums up positive addiction, thus:

While all positive addicts must do something they want to do, what is most important, I believe, is to figure out how to do whatever it is that you choose in such a way that you can accept yourself completely and non-critically as you do it. If you can’t do this, then you have little chance to become addicted.

Kilpatrick (1997) adds, however, that there is hope on the horizon for those suffering from negative addictions.  She explains that the interventions which appear most useful are those based on cognitive-behavioural techniques.  This would suggest that the idea of an “addictive personality” is mythical, and anyone can form an addiction.  Just as it is part of human nature to become positively addicted to an activity, it is possible to form a negative addiction.  Cognitive-behavioural techniques teach the addict how to think and behave differently in order to feel better about the world around them.  It has often been described as “changing the way you think”.  People’s feelings of loss of power, low self-esteem and lack of control are not “truths”, they are only beliefs which can be challenged and put to the test.  In doing so, they can be changed, improved and the person can be shown a much more positive outlook on life.

In conclusion, control, power and self-esteem seem to be a desire in all aspects of addiction, both positive and negative.  Both are achievable and give us a deeper understanding of what it means to be an “addict”.  Positive behaviours can perhaps be taught to the addict who feels they are missing something in his or her life.  Overall, it seems that “addictions” are normal human behaviours and reactions to things which we all desire and which, once we possess, make us happier.

With the addictions check-list in place it is, of course, much easier to distinguish whether something is an addiction, compulsion, obsession or habit; and that is, I believe, preferable to referring to the condition of being addicted as an “illness”, which can take away someone’s sense of empowerment and ability to help themselves get over a negative addiction.   Using the term appropriately means negative behaviours can be treated with appropriate evidence-based techniques.  Changing a negative addiction to a positive one is equal to using an avoidance strategy.  In the long-term, this is unlikely to be helpful to someone with a negative addiction.  The evidence would seem to suggest that positive addictions and negative addictions occur for different reasons, hence why they have different check-lists associated with them.

 

References:

Glasser, W (1976) Positive Addiction Harper Collins: USA

Gresswell, D M & Hollin, C R “Addictions and Multiple Murder: A Behavioural Perspective” in Hodge, J E et al (1997) Addicted to Crime John Wiley & Sons Ltd.

Kilpatrick, R “Joy-Riding: An Addictive Behaviour” in Hodge, J E et al (1997) Addicted to Crime John Wiley & Sons Ltd.

Witman, G W, Fuller, N P, Taber, J I (1987) Patterns of Polyaddictions in Alcoholism Patients and High School Students.   Eadington, W R (ed) Research in Gambling: Proceedings of the Seventh International Conference on Gambling and Risk Taking University of Nevada, Reno