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Will Winter, MD, FAAP

The Latin root of the word Addiction, Ducere, means "to lead" or "draw out from". (This is also the root of the term aqueduct- a structure that draws water (aqua) from a source, using the force of gravity).
What has the power to lead us- to force us? Don't we have free will choice?

The seeking of pleasure
The avoidance of pain

Pleasure Construct
Anything that yields an instant pleasure is potentially addictive. Because we can only focus on one thing at a time, when engaging in momentary pleasure, perception of pain is also avoided. Wants very quickly escalate to needs. Once this happens, interference with basic functioning is unavoidable.

Circular Mechanism
Temporary pleasure leaves us empty
Attempt to return to the initial state of pleasure
The result is a state of habitual inclination or desire.

Pain avoidance Construct
The need for escape from day to day worries or basic responsibilities compels us to find something, albeit temporary, to engage in. Pleasure, although usually an integral aspect of the process needs not be as significant. The compulsive aspect is more important than the pleasure obtained.

Vignette- Alcohol
John went to a party last night and got drunk. He blacked out (doesn't remember what happened) and woke up with an enormous headache. He couldn't get out of bed because when he lifted his head he was dizzy and nauseous. Because of this he missed his classes and missed work that day.

Although alcohol gives pleasure, in this case John didn't remember any of it. But he certainly remembered the hangover- and was forced to miss the following day. This is an argument for escapism being a stronger motivator than the pursuit of pleasure.

The DSM IV diagnoses dysfunction- impairment or inability to function in day-to-day life. Diagnoses, such as Alcohol Abuse, describe the object (substance) of choice and the severity of the dysfunction.

Substances that can be abused:
Illicit Drugs

Returning to the Latin root, addiction describes a behavioral relationship. The idea is not about what it is but how you do/use it.

Potentially Addictive Activities:
Drug usage
Video games
Internet usage

Addiction is about one's relationship with oneself. There is no focus on others when dedicating the moment to satisfying one's own needs. Addiction is about taking, not giving. That's why it destroys relationships with others or blocks them from being created in the first place.

What is a so-called "Addictive Personality"?
This refers to a set of personality traits that predispose an individual to addictions. It is used colloquially but is not a diagnosable personality disorder in the DSM IV.

-Talk therapy is important. Addiction carries with it other psychological issues. It is a symptom of an underlying problem. It also causes psychological problems.
-Medication. It has been theorized that some people "Self-medicate" with substances that they abuse. If they were to be prescribed appropriate medication which was salutary, the substance abuse would stop.
- Detox/ structured program. If the abuse or dependence on a substance is marked, outpatient treatment may not be enough. "Detox" or "Rehab" may be necessary.