Addiction and the
by Liane J. Leedom, M.D.
The American Psychiatric Association’s DSM IV does not recognize the term addiction. Instead, the term substance dependence is used. Many psychiatrists (myself included) use the term addiction because addiction is different from dependence. A cancer patient who takes strong painkillers to relieve pain will likely become physically dependent on these substances. This physical dependence that occurs in everyone exposed for long duration to these drugs is not the same as addiction. Addiction involves much more than physical or even psychological dependence.
Addiction entails the pursuit of intoxication with a substance irrespective of the negative consequences to self and family. Putting a discussion of cause and effect relationships aside for the moment, addiction is also associated with impairment in all three sides of the Inner Triangle. Ability to love, impulse control and moral reasoning ability are all reduced in addiction (and perhaps also by addiction).
Adolescents and adults addicted to substances have impaired ability to love. With addiction comes blunted feelings and lack of empathy. Callous exploitation of others becomes a way of life for addicts. They behave as if nothing and no one matters as much as intoxication. Mothers even abandon their children to use drugs.
Impairment of impulse control occurs with addiction.
One of the criteria for substance dependence is the inability to fight an impulse to use a substance even when the substance dependent person wants to stop. Young people who have not developed impulse control are at great risk to become addicts if they happen to try an addicting substance.
Treatment of addiction involves improving impulse control.
Moral reasoning ability declines with addiction, as addicts stop believing in moral values they once held dear. Many, addicted individuals engage in criminal behavior in order to obtain their substance of choice. This behavior puts them in a position of having to justify their actions. Addicts use a multitude of rationalizations to support their lifestyle of gaining substances at the expense of everything and everyone else.
I trained in psychiatry at a large teaching hospital in Los Angeles County where I evaluated and treated many patients with addiction. Like many of my colleagues, I was astounded by what appeared to be the high prevalence of antisocial personality traits in addicted persons. Could it be that the antisocial personality traits preceded addiction in ALL these people? The family members of addicts and alcoholics answered my question. Many maintained that addiction had changed the patient. Before starting the substance, the addict was a loving, contributing family member. Addiction made him callous, impulsive and immoral. It is as if the over-use of alcohol and some drugs damages the brain centers involved in maintaining the Inner Triangle.