Defining "addiction"

For centuries, the word "addiction" meant being "given over" or devoted to something. However, the 19th century temperance and anti-opium movements used it in a more restrictive way, linking "addiction" to drugs, to illness or vice, and to withdrawal symptoms and tolerance. Both the traditional and restrictive meanings survived into the present. In the ensuing uncertainty about its meaning, some authorities now wish to replace "addiction" with substitute terms like "drug dependence", "substance abuse", etc. We hope to show that the term "addiction" is too valuable to discard. Its traditional sense designates the profoundly important, albeit sometimes harmful, capacity of people to become "given over." On the other hand, the restrictive meaning refers only to a special case, which is defined arbitrarily and inconsistently. It is outmoded because of these problems. The traditional meaning remains useful, but can be improved by clarifying the distinction between "positive" and "negative" addictions originally proposed by Glasser (1976). The word "addiction" has too many meanings. This is partly because it contains a fundamental ambiguity. For centuries, "addiction" referred to (he state of being "given over" or intensely involved with any activity. The ambiguity lay in the value attached to this state; addiction could be either tragic or enviable, or somewhere in between. As well, a second meaning emerged in the 19th century, and now coexists with the earlier one. The new meaning is more restrictive than the traditional one in three ways; it links addiction to harmful involvements with drugs that produce withdrawal symptoms or tolerance. Ambiguity in such a basic term confuses the study of psychology, and of drug issues in particular. We believe the confusion can be dispelled by abandoning the restrictive meaning, which does not fit with the realities of addiction, and by clarifying the ambiguity in the traditional meaning. In the first section of this article, historical studies are used to show that the restrictive meaning did not grow from scientific or medical discoveries, but from the rhetoric of the temperance and anti-opium movements of the 19th This project was supported by the Steel Fund, Simon Fraser University. Valuable help was provided by Patricia Holborn, E. Wyn Roberts, Howard Gabert, Maureen Okun, and Kim Bartholomew. Reprint requests should be addressed to Bruce K. Alexander, Department of Psychology, Simon Fraser University, Burnaby, B.C., Canada, V5A 1S6. century. In the second section, contemporary research is used to show that the traditional concept describes the clinical realities of addiction far better than the restrictive concept does. In the third section, new interview data on university students are used to show how the traditional concept also describes the dependent and addictive patterns of non-diagnosed people better than the restrictive concept does. The conclusion of this article argues that the restrictive meaning should be discarded because it artificially limits addiction to a special case. Although fixation on this special case reflects social concern, the restrictive definition has proven not to consistently identify the types of addiction that are harmful. Glasser's distinction between "positive" and "negative" addiction, with some refinement, adds a socially critical distinction to the traditional definition of addiction. Finally, the potential for increased understanding that grows from critically examining the meanings of "addiction" is explored. History of The Word "Addiction" The Latin verb addico signifies "giving over" either in a negative or a positive sense. In Roman law, for example, an addictus was a person given over as a bond slave to a creditor. In its positive uses, addico suggested devotion, as in senatus, cui me semper addixi ("the senate, to which I am always devoted") or agros omnes addixit Canadian Psychology/Psychologie Canadienne, 1988, 29:2 151 152 Canadian Psychology/Psychologie Canadienne, 1988, 29:2 deae ( "he dedicated the fields entirely to the goddess") (Lewis & Short, 1879). The traditional English meaning of "addiction" is similar. The 1933 Oxford English Dictionary defines addiction as: " . . . a formal giving over or delivery by sentence of court. Hence, a surrender or dedication of any one to a master . . . The state of being (self-) addicted or given to a habit or pursuit; devotion" (Murray, Bradley, Cragie, & Onions, 1933, p. 104). A similar definition appears in Webster's original American dictionary (Webster, 1828/1970). Uses of "addiction" over several centuries compiled in the Oxford English Dictionary show that, as in Latin, "addiction" could be used in a favorable sense ("His own proper Industry and Addiction to Books") and an unfavourable sense ("A man who causes grief to his family by his addiction to bad habits"). Our reading of the uses of "addiction" in Shakespeare, Hobbes, and Gibbon suggests that the unfavourable sense was less common than favourable or neutral usage. Prior to the nineteenth century, "addiction" was rarely associated with drugs. Although opium had been well known from earliest recorded history, references connecting it to addiction, or any synonym for addiction, were unusual prior to the 19th century (Parssinen & Kerner, 1980). In pre-19th century Europe, opium was usually referred to as a medicine (Sonnedecker, 1962). The word was generally not applied to alcohol use either. Sometimes, though rarely, habitual drunkards were said to be "addicted to intemperance" (Levine, 1978). The restrictive usage of "addiction" emerged in language of the 19th century temperance and anti-opium movements (Berridge & Edwards, 1981, chap. 13; Levine, 1978; 1984; Sonnedecker, 1963, pp. 30-31). "Addiction" came to replace terms like "intemperance" or "inebriety" for excessive alcohol and opium use. In the process, the traditional meaning of' 'addiction" was narrowed in at least three ways. The new usage linked "addiction" tightly to drugs, especially alcohol and opium, gave addiction an invariably harmful connotation as an illness or vice, and identified addiction with the presence of withdrawal symptoms and tolerance. The 19th century use of "addiction" is sometimes seen as a medical or scientific achievement — an enlightened replacement for an earlier moralistic view of drunkenness. However, it was not scientific, it was only incidentally medical, and, in the end, it was harsher than the view of addiction it replaced (Alexander, in 1987). Prior to the 19th century, at least in the United States, habitual alcohol use was not generally viewed as a sin but as a matter of choice, with relatively little ultimate significance (Levine, 1978). The restrictive definition first appeared in the doctrine of the Temperance Movement where it was part of the rhetoric used to change the image of chronic heavy drinking from an indulgence that might be laughed at, ignored, or possibly punished, to something necessarily sick or evil (Levine, 1978; Shaffer, 1985, p. 67). The application of "addiction," in its restrictive sense, to habitual alcohol use was not"... an independent medical or scientific discovery, but . . . part of a transformation in social thought grounded in fundamental changes in social life — in the structure of society" (Levine, 1978, pp. 165-166). The restrictive use of "addiction" served diverse motives. It was used by anti-opium reformers in the U.S. apparently to frighten people into abstinence by linking opium with horrifying (and greatly exaggerated) descriptions of withdrawal symptoms (Musto, 1973, chap. 4). Later in the 19th century, the Chinese Empress mounted an anti-opium drive and Theodore Roosevelt seized the opportunity to attack opium, partly to curry favour in the "China Market." The American government supported Chinese opium prohibition at international conferences, pressured other nations to prohibit opium use, and pushed the American Congress to lead the way with national opium prohibition laws. Part of this effort to win public support for opium prohibition entailed dramatizing the concept of addiction (see Musto, 1973, p. 33). In 19th century England, public health concerns over excessive opium use were inflamed by health professionals who wished to construe opium-eating as an addictive disease that fell within their professional domains (Berridge & Edwards, 1981). This was part of a process of medicalizing various forms of deviance that eventually expanded the domain of the medical profession (Parssinen & Kerner, 1980). This was also a period of class tension and the English middle classes apparently needed conceptually simple bases for condemning restive segments of the lower class. One basis was created by exaggerating the evils associated with widespread lower class opium use, labelling Defining "Addiction" 153 users as addicts and addiction as something evil or sick (Berridge & Edwards 1981). The interplay of motives in England has been summarized this way: Addiction is now defined as an illness because doctors have categorized it thus . . . It was a process which had its origins in the last quarter of the nineteenth century . . . but such views were never, however, scientifically autonomous. Their putative objectivity disguised class and moral concerns which precluded an understanding of the social and cultural roots of opium use (Berridge & Edwards, 1981, p. 150). Manipulating the meaning of "addiction" has continued into the present, with still other