Psychology of Addiction

Lecture 1, Jan. 29, 2009

• Current understandings of the

nature of addiction

• History of the term ―addiction‖

• The American Psychiatric

Association’s account (DSM)—to
be used in this course (with a
modification).

• A few key epidemiological findings

• Course topics and mechanics

 Views of addiction

• The class

• Drug users

• History of the term ―addiction‖

• APA (DSM-IV)
William Burroughs’s (1914-1998) account of
addiction:

Junk yields a basic formula of “evil” virus: The

Algebra of Need. The face of “evil” is always
the face of total need. A dope fiend is a man in
total need of dope. Beyond a certain frequency
need knows absolutely no limit or control. In
the words of total need: “Wouldn’t you?” Yes
you would. You would lie, cheat, inform on
your friends, steal, do anything to satisfy total
need. Because you would be in a state of total
sickness, total possession, and not in a position
to act in any other way. Dope fiends are sick
people who cannot act other than they do. A
rabid dog cannot choose but bite. (p. 210)
Patty: Mother of two girls; was set up for
arrest for selling cocaine, by a fluke is not
arrested. She quits selling.
Oh, for a time my nose opened up when I
went out partying and drinking, but I
learned how to handle it. You know, I never
really decided to quit using. I just quit
selling. Once I stopped selling I didn’t have
the money to buy it anymore. I would have
literally had to say, “ Sorry, girls, you don’t
eat this week” to buy some. I would have
exactly $80 for two weeks of food.1 p. 201
1 Waldorf, D., Rienerman, C., &
Murphy, S., (1991). Cocaine changes:
The experience of using and quitting.
Philadelphia, Temple University Press.
Addiction as compulsion, what experts say....
Alan Leshner recent head of Nat. Institute on
Drug Abuse (NIDA):
“Addiction is a brain disease . . . For most
people, it [addiction] is a chronic relapsing
disorder . . . . addiction must be approached
more like other chronic illnesses.”
“A metaphorical switch in the brain [is] thrown
as a result of prolonged drug use. Initially,
drug use is a voluntary behavior, but when that
switch is thrown, the individual moves into a
state of addiction, characterized by compulsive
drug seeking and use.” p. 46, Science, 278,
1997.
Nora Volkow: current head of NIDA:
“The key symptoms of addiction...are
compulsive drug intake and intense drive to
take the drug....” p. 318, Cerebral Cortex, 10,
318-325.
 On the history of the term
―addiction‖

• How has the word ―addiction‖ been

used

• When is it linked with ―drugs‖

• When does it first refer to self-

destructive, compulsive drug use
―Addiction‖ from ancient Rome to
the 16th century

• In Roman law an ―addictus‖ was a

person who had been ordered by
the court into servitude because of
his or her debts.

• Over time, the domain of the

―addictus‖ expanded before settling
down to its modern association with
drugs.

• ―We be virgins, and addicted to

virginitie.‖1
– 1(1590, in Oxford English Dictionary,
2nd edition, 1989).
 When does the idea that ―addiction‖ refers to self-
destructive drug use emerge?

In 1609, an Englishman, Mr. Downame,

describes persistent heavy drinking in the
following terms:

The last spirtuall euill which the drunkard

brigeth vpon himslefe, is finall impentencie;
for they who addict themselues to this vice,
doe finde it so sweete and plesasing to the
flesh, that they are loth to part with it, and by
long custome they turne delight into
necessitie . . . and howsoeuer the manifold
michiefes into which they plunge
themselues, serue as so manie forcible
arguments to disswade them from this vice,
yet against all rules of reason, they hold fast
their conclusion, that come what come may,
they will not leaue their drunkenness.1
– 1 (In Warner,1994, p. 687)
 When do the ideas that ―addiction‖ refers to drugs
and disease coalesce?

As is the case today, these descriptions

were accompanied by the claim that
addiction is a disease.
In 1619, Robert Harris described habitual
drunkenness as this ―Dropsilike disease.‖
In 1622, Samuel Ward writes of the
―drunkard’s disease,‖ and in 1628,
William Prynne notes that drunkenness is
a ―dangerous dropsie and disease.‖
(―Dropsie‖ was a term for various
disorders.) Moreover, it is pointed out
that, also like today, it is a disease that
has no cure and is spreading.
John Bury (1677) writes: drunkenness is a
disease ―so epidemical‖ that ―all the
Physicians in England know not how to
stop it.
 Addiction as compulsive drug
use is part of public discourse in
early 17th century

• Who are the commentators?

• What drove them to the idea that

alcoholism is a disease?
 How to proceed

• We need a ―working‖ definition of

addiction that does not commit us
to either WB’s or Patty’s position

• We want to be able to identify

people who are addicts, without
committing ourselves to an
interpretation of why they take
drugs.
The Diagnostic and Statistical Manual of
Mental Disorders, IV (DSM-IV)

Background

Virtues:

1. Reliable
2. Widely used
3. Can be modified to provide a “working”
definition.
DSM IV

The essential feature of Substance Dependence is a

cluster of cognitive, behavioral, and physiological
symptoms indicating that the individual continues use
of the substance despite significant substance-related
problems. There is a pattern of repeated self-
administration that usually results in tolerance,
withdrawal, and compulsive drug-taking behavior.
APA definition of addiction, three or more of
the following in a 12 month period:
1. Tolerance
2. Withdrawal
3. Substance taken in larger amounts than
was intended
4. A persistent but unsuccessful effort to quit
or curtail drug use
5. A great deal of time is spent seeking drug
or recovering from its effects
6. Important social, occupational, or
recreational activities significantly reduced
7. Continued use despite knowledge of
persistent physical or psychological problem
that was caused by substance
Summary of American Psychiatric
Association (APA) Criteria for
addiction:

1.High level of drug use:

a. Tolerance
b. Withdrawal
2.Continued use despite recognized
adverse consequences:
a. Health risks
b. Loss of job
c. Adverse social consequences

3.Compulsive use:
a. Takes more drug than intended
b. Tried to stop or curtail use
++++++++++++++++++++
Is there another interpretation of
the evidence for compulsion?
Dictionary:
Compel (tr. verb): To force..., to
necessitate...by force
Compulsion (noun): An irresistible
impulse to act, regardless of the
rationality of the motivation
Compulsive (adjective): Caused by a
compulsion
Some basic facts about addiction

• How to find out about a disorder

• The first step is descriptive:

– Correlates of onset
– Correlates of persistence
– Correlates of cessation
– Key natural history facts, such as
duration
– Biological correlates
– Treatment approaches
 % of US Population,
National Comorbidity Study

0%
20%
40%
60%
80%
100%
C
ig
ar
et
te
s
Al
co
O ho
th l
er
D
ru
M gs
ar
iju
an
a
C
oc
Am ai
ph ne
et
am
and Dependence

in
Ever Used

e
H
er
oi
Ever Dependent

n
Addictive Drugs: Experimentation
 % PERSONS REPORTING
COCAINE USE PAST MONTH
10%
Age 12-17
% National Population

Age 18-25
Household Survey

8%
26+

6%

4%

2%

0%
1972
1974
1976
1977
1979
1982
1985
1988
1990
1992

YEAR
TABLE 2.10, 2.11, & 2.12 NHSDA
MAIN FINDINGS 1990
 Prevalence and Age-Cohort,
ECA Survey
14% Born 1917-36, 45-64 Yrs Old

ep /
D us e
Born 1952-63,
Lifetime Prevalence

12%

Ab
18-29 Yrs Old

10%
or e

8%
r
de
is iv

n
D ec t

io
ss
f
Af

6%
re
ep
D
ety
xi

4%
An

D
c
ni

zo
O
Pa

hi
ia

2%
Sc
an
M

0%
Psychiatric Disorder
Summary:

Likelihood that drug use leads to addiction

also varies as a function of the type of
drug [?]
Drug effects (including addiction) vary as
a function of age and cohort (historical
period)
Cohort effects for addiction are larger than
for other psychiatric disorders.
Course Topics:

History of drug use:

Opiates/Alcohol precede written history
Does drug abuse precede written history
If not why?

Aspects of brain function:

Is it possible for ideas e.g., the mind,
to influence drug effects?
If so, how? The two are incommensurable.

Biology/Pharmacology
How do drugs work?
How can drug molecules alter perception,
mood, self-regard, action?
Drugs change the brain. How does this
come about? Implications?
Genes/Behavior
Predisposition for alcoholism
What is inherited (mechanisms)
Does this mean alcoholism is a disease?
Different drugs
Opiates, cigarettes, alcohol, stimulants,
marijuana
Course topics, continued

The addiction experience.

Are autobiographical accounts reliable?
Are they representative?
Subjective effects of drugs

Scientific research on addiction:

Epidemiological research
Ethnographic research
Experiments
Clinical experience:
A little on types of Tx, including AA
The clinical impression of addiction

Social Policy
Despite its drawbacks, is the current
approach the best one?
Why have societies been more likely to
outlaw opiates than alcohol?
What would happen if current
restrictions were relaxed
 Course mechanics

• Lectures, readings and course

website

• Reaction papers & reading

• Exams (if one or more cumulative

questions on 2nd exam, you will be
warned)

• Graduate student term paper

 Why study addiction?

• It is prototypical modern ―disease‖

• It provide a window into the nature of

voluntary behavior

• It forces us to think through the

relationship between biology and
psychology

• It has a fascinating literature

• It is socially and personally important