Addiction Defined

What is addiction? Addiction and alcoholism are two terms which are used interchangeably and describe a condition of powerlessness over something. Addiction is when "it" has more control over you than you have over "it". The "it" can be alcohol, marijuana, heroin, sex, gambling, food, or any other drug or mood-altering behavior.

If you are reading this and you are wondering whether or not you have an addiction of some kind, you need to understand that everything you hear or see, you hear and see through an "addiction filter." In other words, if you do have a problem with addiction, anything you perceive relating to whether or not you have a problem, you perceive through the filters that currently exist within your mind; within your thinking. These "filters" will often prevent you from seeing the truth about where you are in relationship to your drug of choice.

"Drug of Choice" is a term to describe your #1 favorite way to alter your state of consciousness. We all have drugs of choice which often shift over time. For example, in our teens, smoking marijuana may be our favorite activity; when we hit our 30’s, we become more invested in drinking beer and martinis than in smoking pot.

I consider addiction to be a disease. A disease which is Primary, Progressive and Chronic. Primary means that it must be treated as the most important aspect of someone getting better. For example, if someone is depressed and addicted to valium, that person must stop the valium use first, then deal with the depression. A lot of therapists and psychiatrist believe that if the depression improves, the need for valium will stop. This is not true. The depressed addict will continue to take the valium. Progressive means the disease gets worse over time. There may be instances where improvements occur, but these times of abstinence or "moderate" use will not last. Chronic means the disease does not go away. Ever.

And, by the way, addiction is fatal, too. It will kill you eventually. A little known fact, for example: alcohol abuse causes more heart disease every year than does cigarette smoking. But you won’t see that on beer commercials.

Another definition of addiction is: continued use of substances (or behaviors) even when confronted with the reality that negative consequences happen after using these substances or behaviors. In other words, this definition describes the person who keeps on doing the same behaviors over and over again with the same negative consequences occurring. Again, this is where denial serves the alcoholic very well.

I had a client once, a 26 year old mother of two who initially showed up in my office to deal with her older daughter’s behavior problem. It soon became obvious that the problem did not exist with the daughter but with the mother, and the therapy shifted to focus on her. After several sessions, the mother admitted she was smoking marijuana on a daily basis in addition to her sporadic abuse of other chemicals. Throughout the ongoing therapy and with much reluctance, she became fully honest with me and admitted she was in fact getting high 3 to 6 times a day. We began to look at the pattern of addiction in her life and after resistance, she agreed to try a program of abstinence. Her sobriety would last for varying time periods but she always returned back to the drugs. At one point, she said to me, "I don’t know if I’m a pot addict or what, but I do know I have a rather bizarre relationship with pot." I replied to her, "That is the best definition of addiction I have ever heard."

Can you imagine having a "bizarre relationship" with heroin? Or a "bizarre relationship" with gambling or alcohol? For the record, most normal people do not have relationships of any kind with these chemicals or with these behaviors. Once you do get into a relationship with these things…these "it’s," and the relationship becomes qualified as "bizarre," at that point, almost anyone would say that you are in fact dealing with an active addiction.

This client has recently called me from New Jersey and insists I tell everyone that she now has been clean from all drugs and alcohol for over three years now. She is proud of herself, and rightly so.


Criteria for Substance Dependence* – A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) Tolerance, as defined by either of the following:
        a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect
        b. Markedly diminished effect with continued use of the same amount of the substance
(2) Withdrawal, as manifested by either of the following:
        a. The characteristic withdrawal syndrome for the substance
        b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
(3) The substance is often taken in larger amounts or over a longer period than was intended
(4) There is a persistent desire or effort to cut down or control substance use
(5) A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances),
      use the substance (e.g., chain smoking), or recover from its effects
(6) Important social, occupational, or recreational activities are given up or reduced because of substance use
(7) The substance use is continued despite knowledge of having persistent or recurrent physical or psychological problem that is likely to
      have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or       continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

*Diagnostic And Statistical Manual Of Mental Disorders. 4th ed. Washington: American Psychiatric Association., 1994