Addiction and Addictive Personality Syndromes

“The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them…” — Sir William Bragg (1862-1942)

The dominant philosophy of addiction presumes that particular psychoactive chemicals are inherently addictive. Conventional wisdom suggests that the use of a psychoactive substance leads directly to abuse, dependence and inevitably addiction. The only uncertainty is how long it will take to become addicted. Guided by this approach, most treatment and diagnosis of addiction has been specific to substances, and tailored to the assumption that dependence, characterized by neuroadaptation (e.g., tolerance and withdrawal), and addiction are necessarily related.

New research reveals that there are common underlying characteristics to many different manifestations of addiction, including behavioral expressions of addiction such as overeating or excessive gambling. Further, dependence and addiction are not necessarily mutually inclusive. For example, one can have an addiction without being dependent on alcohol or drugs (e.g., gambling); similarly, one can become dependent on drugs without developing an addiction, (e.g., using opioids for post-operative pain relief). Taken together, this evidence suggests that various forms of addiction arise from similar developmental and neurological causes.

According to the syndrome model, all addictive disorders generally follow a common developmental pattern.

What do different addictive substances and events (e.g. eating, gambling, shopping, sex) have in common? It’s their ability to produce a positive and pleasurable mood change.

Making a bed and gambling are both events, but for most people, making a bed produces a much smaller pleasurable mood change. Milk and alcohol are substances, but people do not become addicted to milk because it does not have the same mood-changing quality as alcohol. Thus, the ability to produce a pleasurable mood change is needed for an object or behavior to have addictive potential.

A person can switch an addictive connection from object to object and event to event. Switching from object to object helps create the illusion that the “problem has been taken care of,” when in reality one addictive relationship has replaced another. This buys more time for the addict. An addict may stop using speed and pot and “just” take up drinking. Similarly, the recovering alcoholic who hasn’t accepted his addictive relationship with alcohol may slowly develop an addictive relationship with food, putting on fifty or sixty pounds and remaining as emotionally isolated as he was when he was drinking.

Once an addictive relationship has developed, the active addict or recovering addict will always see the world in a different perspective. Like any other major illness, addiction is an experience that changes people in permanent ways. This is why it’s so important that people in recovery continue to engage regular self-help activities; the addictive logic remains deep inside of them and looks for an opportunity to reassert itself in the same or a different form.

Recovering and active addicts need new coping mechanisms and understand that at times they will want to interact with the world through their addictions, as has become their pattern. Re-wiring this pattern is an essential goal to lifelong abstinence from addictive behavior.

True recovery is the continued acceptance of addiction and the continuous monitoring of the addictive personality in whatever form it may take.