That idea that addiction has a "meaning" seems strange -- haven't they discovered "addiction" in a PET scan in a laboratory at the National Institute on Drug Abuse (NIDA)? It's either there or it's not, right?
Not actually. Here's why.
A brief world history of addiction. Addiction's meaning has changed substantially over time. And here's the funniest thing: its meaning is changing more rapidly now, when it is popularly believed that addiction has been scientifically specified in terms of the brain's neurochemistry.
For most of world history, addiction was applied as a general term, meaning people had a habit or really liked something -- as in, "He's addicted to his plum brandy." Only late into the 19th century, after the development of a modern hypodermic syringe and the synthesis of heroin from morphine, did a medical conception of addiction emerge. Oddly, in the 19th century, opiates were distributed and used indiscriminately, and it was with alcohol that the temperance movement developed the first pre-modern disease theory of addiction -- essentially the same disease theory that exists today.
This is how things stood through the 1980s. Heroin and alcohol stood alone as addictive drugs capable of creating "physical dependence." What shook the term out of its three-quarters of a century of lethargy was the large-scale misuse of cocaine, which pharmacologists had specifically decided was not addictive. They (collectively) changed their minds. And when they did, the image of addiction changed. It was no longer the stupor-inducing state associated with heroin and marked by intense withdrawal. Addiction changed shape to incorporate the experience of heightened sensations and intense energy levels of stimulant highs to which people regularly returned.
Which is where smoking comes in. The Department of Health and Human Services officially labeled nicotine addictive only in 1988. The storied 1964 Surgeon General's Report, Smoking and Health, specifically rejected the claim that smoking was addictive -- it devoted a chapter to the matter. The leading pharmacologists of the time saw things this way because smoking (a) was not intoxicating, (b) did not involve street-dealing, psychopathic -- as they were seen -- users, and (c) was not thought to create severe, life-threatening withdrawal, as narcotics were imagined to do. That these reservations were reversed shows us just how much subjective and cultural interpretation are involved in the addiction-defining process.
The recent history of addiction. Once the lid was off of that box -- the one in which they kept the official definition of addiction at Greenwich -- all barriers were broken. Next to be classified as addictive was marijuana.
But why stop with drugs? The new volume of the American Psychiatric Association's diagnostic manual, DSM-V, scheduled for release in May 2013, recognizes gambling addiction but punts on video games, eating and sex addictions.
However, the current issue of the prestigious journal Addiction takes as its theme the matter of food addiction. In 1985, I wrote for what was then called the British Journal of Addiction, "How can addiction occur with other than drug involvements?" I'm happy to see that, a quarter of a century later, the issue is being actively debated in this distinguished journal.
The lead article is titled, "Can food be addictive?", by Ashley Gearhardt et al. Unfortunately, it comes to this very muddled conclusion: "Although there exist important differences between foods and addictive drugs, ignoring analogous neural and behavioral effects of foods and drugs of abuse may result in increased food-related disease and associated social and economic burdens."
Was that a yes, or a no?
Other articles take opposing positions: One that argues "yes" states:
Preclinical studies, beginning in Bart Hoebel's laboratory at Princeton University, have shown that rats overeating a sugar solution develop many behaviors and changes in the brain that are similar to the effects of some drugs of abuse [5,6], including naloxone-precipitated withdrawal , and others have shown complementary findings that suggest reward dysfunction associated with addiction in rats that overeat highly palatable foods . These studies are supported by clinical research showing similarities in the effects of increased body weight or obesity and abused drugs on brain dopamine systems, as well as the manifestation of behaviors indicative of addiction [9-12].
Here is the countervailing viewpoint:
Over-consumption of food is one example of a more widespread acquisition of material objects well beyond any limits defined by personal need. People in industrial societies are encouraged to purchase more clothes, shoes, TVs, motor cars, refrigerators, furniture and palatable foods ... However, the acquisition of possessions beyond need extends well beyond the food repertoire. The prevailing socio-economic system encourages a philosophy of materialistic self-interest and unnecessary consumption (and purchasing) which is required in order to drive economic growth. Therefore, over-consumption takes place in a climate of abundance, aggressive advertising and easy accessibility in which food consumption is promoted strongly by the socio-economic market.
But the question is being framed poorly because of our attachment to disproved assumptions about addiction. The idea used to be that heroin is addictive, therefore people become addicted to it. It isn't true that some things are purely addictive, which is obvious in the case of alcohol. Addiction is a specific connection some people form to specific objects. As I described in The Meaning of Addiction , in 1985, which formed the basis for my piece in the journal:
People become addicted to experiences. The addictive experience is the totality of effect produced by an involvement; it stems from pharmacological and physiological sources but takes its ultimate form from cultural and individual constructions of experience. The most recognizable form of an addiction is an extreme, dysfunctional attachment to an experience that is acutely harmful to a person, but that is an essential part of the person's ecology and that the person cannot relinquish. This state is the result of a dynamic social-learning process in which the person finds an experience rewarding because it ameliorates urgently felt needs, while in the long run it damages the person's capacity to cope and ability to generate stable sources of environmental gratification.
Because addiction is finally a human phenomenon, it engages every aspect of a person's functioning, starting with the rewards (as interpreted by the individual) that an involvement provides and the individual's need for these rewards. The motivation to pursue the involvement, as compared with other involvements, is a function of an additional layer of social, situational, and personality variables. All of these elements are in flux as an individual grows up, changes environments, develops more mature coping mechanisms, loses and gains new opportunities for satisfaction, and is supported or undermined in forming new outlooks and self-conceptions.
There are indeterminate elements -- for example those activated by the person's value commitments -- affecting whether the person will continue to return to an experience that is progressively more damaging to the rest of the person's life. Even after the person has developed an addictive attachment, he or she can suddenly (as well as gradually) rearrange the values that maintain the addiction. This process is the remarkable one of maturing out, or natural remission in addiction.
To put this into common sense terms, people form addictions to intense experiences to which they regularly return to seek essential gratifications. There is nothing inherently addictive about any one thing -- people take long courses of narcotics all the time without becoming addicted. It is how the experience of that involvement -- pharmacological or otherwise -- fits into their personal ecology, and how dependent they grow on it, that determines addiction. Addiction is not a list of different objects, and eventually DSM and other respected organs will tire of asking whether this or that thing is addictive. Instead, as I wrote for Psychology Today,
The problem with the DSM-V approach is in viewing the nature of addiction as a characteristic of specific substances (now with the addition of a single activity). But think about obsessive-compulsive disorder (OCD): People are not diagnosed based on the specific habit they repeat -- be it hand-washing or checking locked doors. They are diagnosed with OCD because of how life-disruptive and compulsive the habit is. Similarly, addictive disorders are about how badly a habit harms a person's life. Whether people use OxyContin or alcohol, people aren't addicted unless they experience a range of disruptive problems -- no matter how addictive the same drug may be for others.
So, if food serves an intense emotional or other life need for people (beyond enjoyment or survival), and people grow to depend on that gratification as essential to their daily lives, whether they steadily overeat to create serious life-disturbing consequences or binge eat in ways that they regret and despise themselves for (this steady vs. binge variety of addiction occurs with alcohol as well), then they will fulfill more or less closely the criteria for addiction.
So, yes, food is addictive for some people. And to reckon that food can be addictive for some tells us how ubiquitous addiction is around us, only reaching pathological extremes in some alarming cases. At the same time this awareness informs us that addiction does not result from strange, or foreign, or chemically alien substances. Addiction attaches to experiences that are emotionally gratifying, often all-consuming, but essentially unfulfilling and negative, and ultimately dangerous. Only when we comprehend the experiential nature of the process can we define addiction and addictive objects appropriately.
But all of this is not to say that how we think about and define addiction is trivial. Such conceptions have life-affecting consequences for us as individuals and as a society, a process I detail in the next post in this series, "The Meaning of Addiction, II: Why Meaning Matters."