Why is the word “addiction” so controversial?

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At the time of writing, there are now numerous studies including several reviews of internet pornography use, which indicate that compulsive use of internet pornography, like drugs or alcohol, is addictive. Yet there are some researchers, scientists and even clinicians who refuse to accept that sex or internet pornography can become addictive. They are a relatively small group but, as the saying goes, small does not mean quiet. In-fact, they are very vocal with their assertions and are often cited in the general media as “experts” in the field. One of the more prominent ones even offered therapy advice via an internet pornography cam site. In-fact a casual search on the internet will net you many articles claiming to ‘debunk’ the ‘myth’ of sex and/or porn addiction, citing a select few researchers and studies which support their “porn is harmless” stance or to explain the reported negative effects as the “belief” that you are addicted to porn that is a problem, not your viewing habits themselves. There also seems to be a current and ongoing Twitter battle for the hearts and minds of anyone who cares to listen on what can and cannot be called an “addiction”.

Why is this so? Anyone who cares to do their own actual research into the matter will find many studies and a growing number of systematic reviews of the research (a systematic review is when you do a search of a topic, collate all the studies you find, and attempt to come to some consensus of what the studies are reporting). However, Gary Wilson of the website Your Brain on Porn has a very thorough job of collating a long list of reviews and studies on the effects of porn which you can access here – if you have a free week or so to wade through them all! One thing I can tell you at a glance is that these studies are all primarily peer reviewed research articles and some are reviews of the research. It is hard to argue against the sheer volume of literature out there now on the topic, yet the T’war (Twitter War) rages on. There are even legal proceedings underway indicating that what started out as an academic debate is now getting real-world serious, with a number of individuals filing defamation suits against one particular researcher who seems to have taken things very personal indeed.

My own thorough review of the literature, which my own study supports, is that the research on problematic pornography use is leaning towards the classification of this phenomenon as a ‘behavioural’ addiction. Meaning, the person is “addicted” to an activity or behaviour, rather than a substance. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has already included one behavioural addiction in its category called “Substance Use & Addictive Disorders” (APA, 2013). However, interestingly, the terminology of the DSM-5 does not use the word “addiction” to describe any of the diagnoses in this category, despite the use of the term “addictive” in the category heading. In fact, as Richard et al. (2019) point out, they specifically state that the use of the word “addiction” has been removed because of its “uncertain definition and its potentially negative connotation’ (APA, 2013, p. 485). Despite its seemingly awkward welcome/not welcome guest status, the word “addiction” refuses to leave the party graciously. It continues to hang around in common usage and in both academic and social media circles, lurking about like the friend that no-one wants to admit knowing.

So why is the word “addiction” so controversial?

At the centre of this academic and social media tempest seems to be the word “addiction” itself. In order to make some sense of the passionate debate that is still raging as we speak, I thought it might be time to take a closer look at this currently unfashionable, problematic yet persistently sticky word “addiction”. Firstly, I shall look at some definitions, then I will attempt to look at the history of the word and finally I will add my own, humble, opinion at the end.

The American Society of Addiction Medicine (ASAM) defines addiction broadly, as “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours. Addiction is characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response.”

The Centre on Addiction’s definition of addiction is similarly broad, “Addiction is a complex disease, often chronic in nature, which affects the functioning of the brain and body. It also causes serious damage to families, relationships, schools, workplaces and neighbourhoods. The most common symptoms of addiction are severe loss of control, continued use despite serious consequences, preoccupation with using, failed attempts to quit, tolerance and withdrawal.”

Popular psychology website, Psychology Today states that a “person with an addiction uses a substance, or engages in a behaviour, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcoholinhalants, opioids, cocaine, and nicotine, or behaviours such as gambling.”

The APS defines addiction in terms of criteria for diagnosis relating to substance use disorders, and only mentions gambling and internet gaming as examples of behavioural addictions in line with the DSM it publishes.

Of course, there are others but I’m sure you get the idea. The common theme seems to be this: Addiction affects the reward centre of the brain, which causes the addicted person to want to engage in the activity or use the substance repeatedly, which in time causes the person to be unable to stop or reduce using the substance despite wanting to, and in the face of increasing problems caused by the addiction. But what does the actual word “addiction” mean and where does it come from?

Etymology of Addiction

According to Richard et al., (2019) the word addiction has a long and interesting history. It originally appears in the early Roman republic. The latin root addicere, was used as a legal term meaning “to speak to”. In the later Roman period, it was also used to describe indebtedness, usually in relation to gambling debts. In Roman times the person (addictus) who owned a gambling debt was in a sense, attached or enslaved to his debtor until the debt was paid. By Elizabethan times it was used to describe an intense attachment to some person, cause or object. Mostly the word “addict” was used as a verb, as in to attach or devote oneself to something. Attachments could be either positive or negative, so the use of the verb was in itself neutral. Richard et al. (2019) argue that it is the flexibility of the word addiction and its ability to be used to denote either an extremely negative or positive attachment which has led to its longevity and popularity in common usage, as well as causing diagnostic ambivalence.

The connecting of the words addiction and attachment makes a lot of sense to me clinically. While running a substance-use recovery group for offenders, I would often start the group with an activity which involved various definitions of the word “addiction” in order to facilitate discussion. There were various definitions, including some medical, some from official sources such as the DSM and some quotes from famous ex-users. I would then ask the group members to choose which quote they felt mostly described their own experience. Most often the users chose a quote by Dr Patrick Carnes, (who specializes in treating sex-addiction and has written several books on the topic including, Out of the Shadows ) in which he describes addiction as a “pathological relationship”.  That this quote, written by a sex addiction specialist, was the one that these men would choose most often is interesting to me. They would then go on to describe their relationship to drugs as the most intimate, reliable and consistent relationship they had experienced. Their attachment to their drug of choice was very real and often, it had been the only thing they could turn to for comfort. Most of these men had histories of dysfunctional, abusive family lives, and most often they were let down by the very people you and I expect to be able to trust, again and again. No wonder their attachment, their addiction to their substance was so hard to give up. Carnes goes on to say that the pathological relationship with sex is a replacement for a healthy relationship with people. The same can be said for excessive substance users, problem gambling and those who consume pornography compulsively, which is what my own research documented:

“I don’t really have relationships. That’s why I view internet porn. But a couple of times I’ve come out of short-term relationships and felt a sense of relief that came from knowing I was free to go back to internet porn, and I know that that can’t be a good thing”

If we take the word “addiction” to mean simply an attachment, devotion, or enslavement to something, whether it be a substance, like alcohol or drugs, or an activity, like gambling, gaming or internet pornography, then the term addiction does seem to fit, at least as a descriptive term if not a diagnostic one. Any negative connotation to the word may well be attached to the substance or the behaviour which becomes problematic in that case, not the word “addiction” itself. Furthermore, those headlines claiming that porn addiction “does not exist” or is a “myth” because it is not listed as a diagnosis in the DSM are technically correct, because, in the current DSM there is no disorder with the actual term “addiction” listed at all. They are all disorders attached to the substance or behaviour, as in Alcohol Use Disorder or Opioid Use Disorder etc. – even though all these disorders fall under the umbrella of Substance Use & Addictive Behaviours.

Goodman (2001) made a, still, convincing case for the term “sexual addiction” to describe the phenomena of sexually related behavioural problems. He noted the similarities between substance use disorder and sex addiction and found them to be almost identical. In the proceeding 20 years, advances in neuroscientific imaging have shown these similarities are observable in the brain. So, if the term “addiction” where to be removed from the debate what would we be left debating? That excessive and compulsive use of sex or pornography does no harm? That people who describe themselves as addicted to internet pornography are delusional or wrong? I don’t think that’s helpful at all. The fact is, problematic use of internet pornography and sex exists, and is a real problem for many. Those that are experiencing this phenomenon firsthand no doubt care less for what you want to call their affliction, but more about getting help, recovery and healing from this issue, whatever it is called. As a counsellor, it is not my job to debate with clients about whether or not their issue is a “real addiction” or not. My job is to listen, to help facilitate change and to support my client create a better life for themselves and loved ones.

 

 

 

 

 

 

 

 

 

 

American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Author.

 

Goodman, A. (2001) What’s in a name? Terminology for designating a syndrome of sexually driven behavior. Sexual Addiction & Compulsivity. 8:191–213, 2001. DOI: 10.1080/107201601753459919

Richard J. Rosenthal & Suzanne B. Faris. (2019) The etymology and early history of ‘addiction’, Addiction Research & Theory, 27:5, 437-449, DOI: 10.1080/16066359.2018.1543412

 

 

 

 

 

 

 

 

 

 

 

 

 

4 thoughts on “Why is the word “addiction” so controversial?

  1. I used the word addiction the other day and a Christian man took issue with it. I think it is because some see it as a cop out. If we say this is an addiction some think that means a sickness and then we no longer take responsibility for our actions. Personally I have no trouble whatsoever saying that I was addicted to porn. I kept going back to it, over and over again, even after I said I would never do it again. Yet, while I was stuck in the compulsive cycle of porn for decades, when I finally sought help I was able to get off of the hamster wheel of addiction. I was at fault. I worked to find a new life. With God’s help and the help of many friends, books, etc. I broke free from my addiciton.

  2. Yes, the disease model of addiction itself is an ongoing debate which some see as problematic and for the very reason you describe. My own opinion, is that addiction functions like a disease in that it is progressive, as in gets worse over time, and in that there is no ‘cure’ as such and if left to run its course can lead to extinction of the host organism, that is they body it inhabits. Not to mention the spiritual, relational, and social disintegration that occurs along the way. That is not to say it is a disease in the way that cancer is, but more so that it is similar to a disease in the way it operates, if that makes sense.

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