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Summary: Addiction

The concept of addiction involves volun­tarily repeated behaviors. Depen­dence occurs when a person strongly resists stopping an addiction. When a harmful addiction is suddenly terminated, a person may go through an unpleasant withdrawal syndrome.

Modern psychologists sometimes speak of positive addictions. These are habit­ual, pleasurable behaviors that have a positive or constructive effect on a person's life but do not cause physical harm or painful withdrawal syndromes.

Solomon's opponent process theory was originally proposed in 1974 and is still referenced in research on acquired motives and addiction. Solomon pointed out a quick-acting (A) process which was the immediate response to a stimulus (positive or negative) followed by a (B) process, opposite in sign, slower to develop and slower to fade.

In Solomon's theory, the A process grows smaller with time (the process of habituation) but the B process grows larger. This leads to peculiar and distinctive phenomena of addiction and learned preferences.

For example, a stimulus that is initially shocking (like monster movies) can become pleasurable with time. Conse­quently, people can become addicted in the behavioral sense to activities such as parachute jumping, giving blood, fighting fires, or other activities that are initially painful or difficult.

Alcohol addiction is a widespread and damaging addiction in many countries. Simple checklists can diagnose alcohol­ism, which is now called AUD (Alcohol Use Disorder) in DSM-5. There is good evidence for genetic contri­butions to alcoholism, and one of the best predic­tors of alcoholism is the number of alcoholic relatives.

Cocaine and methamphetamine are highly addictive, in part because they act directly upon the dopaminergic circuits in the brain that normally reward and encourage constructive behaviors. These addictions can be very persistent, as shown by professional athletes who were given multiple chances to quit but proved unable to do so, destroying their careers.

Tobacco is the most widespread addic­tion in the world and a foremost cause of preventable deaths in many societies. Rates of smoking have declined in the U.S. and many other countries as aware­ness of health consequences increases.

Non-drug addictions can also do harm to individuals, families, or society. Gambling is a prime example because it requires no drugs, yet it fits the pattern of drug addictions almost exactly. It is cate­gorized as an addiction in DSM-5, the diagnostic manual used by psychiatrists.

Other non-drug addictions have been proposed, such as television addiction and internet addiction and sexual addic­tion. Any learned preference repeated to the point of causing damage could be regarded as a harmful addiction.

However, experts in the field of addiction have doubts about whether internet and videogame addictions deserve the label. They prefer to limit the concept of addic­tion to compulsive behaviors known to cause family and personal destruction.

Sexual addiction may or may not qualify, based on that criterion. Definitely cate­gorized as addiction is compulsive consumption of tobacco, alcohol, heroin, meth, opioid, and cocaine, as well as pathological gambling.

Therapies for addiction have a low success rate, and recidivism (back­sliding) is common. About 75% of people fail at the first attempt to quit an addiction, whether it is heroin addic­tion or tobacco addiction.

12-step programs modeled after Alcoholics Anonymous dominate addiction treatment. Over a thousand different 12-step programs have been proposed, covering all forms of addiction, tweaked for different countries and cultures. Most use a list of 12 principles or statements very similar to the original AA program.

Criticisms of 12-step programs are com­mon, and some researchers claim that AA and similar programs have poor success rates, in the single digits if suc­cess is defined as lasting abstinence. Nevertheless, most people suffering from AUD in the U.S. are urged to join 12-step programs.

12-step programs commonly advocate total abstinence. Outside the U.S. it is more common to find therapies aimed at controlled drinking. Drugs such as naltrexone, an opiate antagonist, were developed to help stop cravings in heroin addicts, but they also reduce the desire for drinking in alcoholics.

At least three different drugs and four different behavioral treatments have met with some success at reducing problem drinking. None of the treatments for addiction is significantly more successful than its competitors.

Self-cure of addiction is possible, espe­cially when an addiction is not extreme, and when an individual is willing to persist despite initial failures. Research confirms that an addict's readiness to change, reported before treatment, is a strong predictor of success in quitting or reducing harm from an addiction.

Write to Dr. Dewey at

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