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When are you addicted?

We are “addicted” to chocolate, smartphones and other things that we no longer want to be without. In everyday parlance, people like to talk about an addiction when we like to do something or do something often and find it difficult to keep our hands off it. But when do you actually speak of an addiction?

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There used to be no addiction. At least not as a term. Even in the Middle Ages, the daily consumption of several liters of beer to quench your thirst is not said to have been unusual. Drinking parties have also been known since the ancient Romans. There was still no talk of alcohol addiction. Frequent drunkenness was seen as a vice rather than an addiction in the sense of an illness. That was only to change in the 19th century. In 1819 the doctor Constantin von Brühl-Cramer first described the strong desire for alcoholic beverages as a mental illness.

Dependency instead of addiction

Numerous works have since been written on the nature of addiction. What characterizes an addiction and what distinguishes addictive behavior from non-addictive behavior, however, is still not a common understanding. Because addiction cannot be proven objectively, such as infection with a pathogen. Strictly speaking, there is also no medical diagnosis of addiction.

In 1964, the World Health Organization (WHO) recommended not talking about addiction or habituation, but about dependence. The term dependence enables a distinction to be made between psychological and physical dependence. However, the term addiction continues to be used by both experts and laypeople. Most of the time, addiction and dependence are probably used interchangeably.

Dependency defined by criteria

The WHO defines the ICD diagnostic system as of when a dependency is spoken of. The abbreviation stands for International Statistical Classification of Diseases and Related Health Problems. The diagnostic system is constantly being revised and is currently in its tenth version, which is why it is currently referred to as ICD-10. According to ICD-10, the diagnosis of addiction can only be made if at least three of the following criteria at the same time during the past 12 months were available:

  1. A strong wish or some kind of compulsion to consume psychotropic substances.
  2. A decreased ability to control in relation to the start, cessation or amount of consumption.
  3. A physical withdrawal syndrome upon cessation or reduction of consumption, evidenced by substance-specific withdrawal symptoms or by the consumption of the same or closely related substances, in order to reduce or avoid withdrawal symptoms.
  4. Evidence of a Tolerance to the substance, in the sense of the increased doses required to produce the original effect achieved by the lower doses.
  5. The progressive neglect of other amusements or interests in favor of substance use as well as an increased expenditure of time to consume the substance or to recover from the consequences.
  6. Persistent substance use despite evidence of clearly harmful consequences.

The diagnosis of addiction is applied to all substance classes. The ICD-10 differentiates between alcohol, opioids, cannabinoids, cocaine, stimulants, hallucinogens, volatile solvents (inhalants), tobacco, sleeping pills and sedatives as well as multiple substance use and the consumption of other psychotropic substances. However, physical withdrawal syndrome does not occur with every substance.

A decisive characteristic of addiction in the sense of the ICD-10 is “the often strong, sometimes overpowering desire” to consume psychoactive substances. This strong urge to want to consume is also known as craving.

Excessive behaviors that are occasionally classified as addictive, such as shopping addiction or sports addiction, are not listed. However, the WHO has announced that in the next revision, the ICD-11, at least video game addiction will be included in the catalog as a "gaming disorder".

Substance use disorder instead of abuse and dependence

Another important set of criteria is the DSM-5 published by the American Psychiatric Association. The criteria in Diagnostic and Statistical Manual of Mental Disorders are largely identical to those of the ICD-10. In addition, the social dimension is included in the DSM-5. This means restricting or giving up important social or professional activities due to substance use, such as neglecting school or professional activities.

Since the revision of the DSM from the fourth to the fifth edition, a distinction is no longer made between the terms “abuse” and “dependency”. Instead, both terms are grouped under the title “substance use disorder”. Substance use disorder is divided into different degrees of severity. Of the total of 11 criteria in DSM-5, at least 2 must have occurred within the last year. With 2-3 criteria the substance use disorder is considered mild, with 4-5 criteria it is moderate. Above 6 criteria, the substance use disorder is classified as severe.

The definitions in ICD-10 and DSM-5 make it clear that an addiction cannot be reduced to a single characteristic. The strong urge to consume a substance or to want to do something is an important characteristic, but not sufficient to be able to speak of an addiction. Rather, more and more criteria are required.

For example, those who are passionate about playing video games and spend hours playing them every day need not necessarily be considered a video game addict. Rather, negative consequences must have already set in. According to the future ICD-11, one can only speak of video game addiction if

  1. if the end of the game can be shown to have lost control of their gaming behavior,
  2. playing is increasingly dominating everyday life and
  3. continues to be played, although significant negative consequences have already occurred.

For example, those affected neglect learning for school or university and thus risk bad grades or fail exams. They have less and less contact with friends in real life, may have stress with their parents or other loved ones and are still unable to reduce their gambling behavior despite the obvious negative consequences.

Everyday understanding of addiction and dependence does not coincide with the official definition

The terms addiction and dependency are also used in everyday language. However, the understanding of what characterizes an addiction does not seem to necessarily coincide with the criteria mentioned, as a study on smoking shows. Three US researchers asked young people what it means for them to be addicted to cigarettes.

As it turned out, many young people had no clear idea about it. They were aware that addiction is mostly related to the compulsive behavior of having to smoke a cigarette every now and then and that it is difficult to stop smoking again. At the same time, however, many young people were of the opinion that addiction is a behavior that they can turn off at will. Many young people who smoke answered yes to the question of whether they consider themselves dependent, but at the same time believed that they could stop at any time.

However, it is in the nature of dependency that consumer behavior can no longer be fully controlled. In technical jargon, this is known as loss of control. Loss of control is particularly noticeable when you try to avoid an addictive substance such as cigarettes or video games but fail.

Conclusion

Human behavior has many facets. However, excessive excesses of certain behaviors have only been referred to as addiction since the 19th century. Today, in official parlance, people mostly speak of addiction or substance use disorder. The term addiction is still used not only in popular parlance, but also in specialist circles.

The everyday understanding of what characterizes an addiction, however, is not always congruent with official definitions. Even if, for example, a strong urge to consume or to do something is a central criterion for addictive behavior, it alone is not enough to be able to speak of an addiction in a medical sense. As a rule, several criteria must exist over a longer period of time. Loss of control over behavior and demonstrably negative consequences are just as important hallmarks of addiction.

Swell:

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