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Definition of Addiction

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

The term "addiction" can mean many things to many people. For our purposes we define addiction as follows:

Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

addiction word collageThe reader should not confuse this definition of addiction with other related terms.  Although similar, this definition of addiction should not be confused with the diagnostic criteria for a category of disorders known as Substance-Related and Addictive Disorders (APA, 2013).  We will compare and contrast other terms later in this chapter.

There are four key parts to this definition of addiction:

1. Addiction includes both substances and activities (such as sex and gambling).
2. Addiction leads to substantial harm.
3. Addiction is repeated involvement despite substantial harm.
4. Addiction continues because it was, or is, pleasurable and/or valuable.

Now let's examine each part of this definition of addiction in greater detail.

1. Definition of Addiction includes both substances and activities

Definition of addiction: Addiction is repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

The definition of addiction includes four key parts. In this section, we discuss the first part of the definition: people may become addicted to both substances and activities. Substance addiction includes any substances that are taken into the body. This may include street drugs, nicotine; and some prescription medications when used improperly. An activity addiction includes activities such as gambling, sex, the internet, pornography, and shopping. Sometimes people call these "process addictions." Notice that it is quite possible to live a full and satisfying life without using any of these substances, or activities. However, there are also substances and activities that are essential to our very survival and even these things can become addictions. For instance, obese people often describe food as a type of addictive substance but clearly no one can live without food. Other people describe romantic relationships with a dependency so deep and damaging that their relationship could represent an addictive activity.

Obviously many people engage with these substances and activities at various times in their lives. Most do not develop any significant problems or difficulties. This leads to the question, "At what point does an activity or substance use become an addiction? These rest of our definition helps to answer, "Where's the line between 'behaving badly' and addiction?"

2. Definition of Addiction includes substantial harm.

Definition of addiction: Addiction is repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

The definition of addiction includes four key parts. In this section, we discuss the second part of the definition: substantial harm. The most commonly agreed upon part of any definition of addiction is that it leads to substantial harm. Addiction harms not only the person with the addiction but also everyone around them. When distinguishing between "bad behavior" and addiction, the primary consideration is: Has the behavior caused substantial harm? In other words, what are the negative consequences of that behavior? If I buy two beers at a bar every week, even expensive beer, it won't create a financial disaster. I might not be able to afford going out to lunch with my co-workers. It's just a choice I'm willing to make. I haven't sacrificed too much. On the other hand, if I buy 20 beers a night, every night, that creates a substantial financial burden. I might not even be able to afford my groceries, much less lunch with my co-workers. The odds are good that I might not be able to keep my job either! Similarly, depending upon your own personal values, occasionally looking at porn probably doesn't cause substantial harm to most people. But if someone begins to prefer porn over human contact or cannot enjoy sex without porn, and starts to spend half their income on purchasing porn, they start to meet the criteria for substantial harm.

One way to understand "substantial harm" is to consider the harmful consequences of the activity or substance use. Let's call these consequences costs. Some costs are obvious. They arise directly from the substance or activity itself. There are also other, less-obvious costs. These occur because of the preoccupation with the addiction. Direct costs may be unique to the specific substance or activity itself. If you snort enough cocaine you will damage your nose. If you drink enough alcohol you will damage your digestive system. If you watch porn all day, you will lose interest in real sexual partners. If you shoot up enough heroin you will damage your veins. If you gamble a lot, you will lose a great deal of money. Some direct costs universally apply to most addictions: declining health, damage to interpersonal relationships, and diminishing financial resources. The less-obvious, indirect costs arise solely from the preoccupation with addiction. Eventually an addiction becomes so central in a person's life that it consumes all their time, energy, and preoccupies their thoughts.

Sometimes individuals affected by addiction do not readily see that their involvement with a substance or activity has resulted in substantial harm. Therefore, they may "deny" they have addiction. Of course, this "denial" makes perfect sense because substantial harm is a defining characteristic of addiction. Without it, there is no addiction. However, to other people these individuals seem indifferent to the harm their addiction causes. In response to this apparent lack of concern, these individuals are often told they are "in denial." This statement implies a form of dishonesty. We have never found accusations of this sort to be helpful. A more useful approach is to recognize many individuals are simply unaware of the total costs associated with their addiction. This recognition leads to a non-judgmental approach that encourages an honest and accurate appraisal of these costs. This helps people recognize the substantial harm caused by remaining involved with an addictive substance or activity.

You can review the harmful costs of addiction in the section called, How do I know if I have an addiction?