2.2 Specific issues in addiction
The term ‘addiction’ carries a number of different meanings. The word is generally used with reference to drugs (e.g. heroin, nicotine, alcohol), where a person is described as being ‘dependent on’ or ‘addicted to’ a substance. Also, substances are described as ‘addictive’ or ‘non-addictive’, implying that addiction is an intrinsic property of the substance. Some people are addicted to food. Given that food is necessary, in what sense is food addictive? There is confusion here, since it is known that some people can be occasional or recreational users of so-called ‘hard’ drugs without this profoundly disrupting their lives or without them becoming apparently ‘addicted’ – they seem to have ‘will-power’ or conscious control over the ‘substance’. Conversely, people can also be described as seriously addicted to non-chemicals, such as one another, music or football, or even television, the internet, computer games, or gambling (e.g. the National Lottery). An important aspect of understanding addiction is trying to establish just what we mean by the term ‘addiction’.
Addiction to drugs has been around for a long time – with fashion and availability dictating use. It is estimated that 1-in-50 people in inner-city areas take heroin or cocaine regularly. As many as 1-in-12 twelve-year-olds are reported to have taken drugs. Drug taking is a serious, escalating problem. ‘Folk psychology’ attempts to provide an explanation. For example, people with an addiction are sometimes described as ‘weak-willed’, lacking in ‘self-restraint’ or ‘self-discipline’; though quite what these terms explain is not at all obvious! It has also been suggested that addicts take drugs because the pleasure that they derive from doing so is greater than any alternative pleasures that life might have to offer. Others might draw attention to the withdrawal symptoms that addicts experience when they try to stop taking drugs, or suggest that addiction is a mixture of pleasure and pain.
In the mid-1990s, a new emphasis to the topic of addiction appeared that was of massive widespread social, legal and economic importance. This was the controversy as to whether nicotine is addictive. The discussion immediately took the issue of scientific definition beyond the borders of learned journals in psychology, medicine and philosophy and placed it right in the law chambers and thereby onto the floor of the Stock Exchange. It is known that rats can be persuaded to press levers for the reward of intravenous cocaine or heroin. Does this behaviour capture something of the nature of human addiction? In a court of law, could we defend the argument that a laboratory rat pressing a lever for the reward of a drug is a valid model of human addiction?
Humans differ widely in their tendency to become addicted. Can we therefore identify an ‘addiction-prone personality’, someone who is perhaps genetically predisposed, or susceptible, to developing a particular addiction? Maybe one day we will be able understand this genetic predisposition, and its subsequent development throughout the whole of a person's life, in terms of all the relevant biological, psychological and environmental factors experienced by the individual.
Scientists are able to identify parts of the brain that are specifically targeted by addictive drugs. Particular, identifiable chemical messengers are implicated. Indeed, through the advances in imaging activity in the human brain, it is now possible to identify the spatiotemporal pattern of neural activity in specific areas of an addict's brain. Therefore, in order to understand addiction you will need to have some familiarity with the structure and function of the nervous system, especially the brain. We suggest that you consult a reference textbook, such as Carlson (2007). (Note: If you are new to neuroanatomy, don't be put off by the strange-sounding Latin names and the seeming inpenetrability of the subject – take your time to learn about regions in the brain and the pathways that interconnect them. In fact, the functional neuroanatomy of addiction relates to only a handful of key brain regions and pathways.)
The background readings and associated sources of information provided in this course will introduce you to the psychology you will need in order to understand addiction. Since in this course we are trying to develop an integrative approach to understanding brain and behaviour, it is important that you adopt an open-minded attitude in reading the material. So, what study approach offers the best prospect of an integrated understanding of the subject of addiction?
The temptation is to suggest that there are physical addictions, such as that to heroin or cocaine, and psychological addictions, such as the emotional attachment to another individual, which we call love. Popular culture suggests this neat division, but we would urge you to consider that all addictions involve both physical and psychological aspects. Presumably, the brain of an addicted lover is different from the brain prior to developing the addiction, just as that of a heroin addict is different from that of a non-addict. Nature does not fracture along neat lines into psychology and biology; in fact, the fracture lines cross many subject boundaries. The study of addiction is truly interdisciplinary, as you will find out. Remember, don't be afraid to ask as many questions as you need to understand the issues, no matter how seemingly trivial – ‘there are no silly questions, only silly answers’. Every good student should ask more questions than there are answers.
You should also bear in mind that all scientific writing is, in part, an act of deliberate persuasion. Each author is trying hard, sometimes too hard, to convince you that his or her point of view is the right one, and in some cases the only one! Therefore, you will need to develop a keenly critical and somewhat sceptical approach in assessing the validity of what you read in the selected readings presented in this course, or indeed on any aspect of the subject matter, for example the general statements in Section 1.1 (above). However, this can lead you into ‘the quagmire of doubt and unknowing’; but don't worry, this is an entirely healthy place to be – a good constructive scientific attitude and approach will get you out.