Definitions of Addiction
The latest Definition of Addiction by the American Society of Addiction Medicine (ASAM)
We will address and hope to add to these definitions in this blogsite!
Below we address the limitations of ASAM’s latest attempt at defining Addiction
Addiction now defined as brain disorder not behavior issue
In this blogsite you will find a comprehensive worldview of what we believe addictive behavior to be; in terms of altered neurobiology and in terms of cognitive-affective mechanisms prompted by a stress and emotion dysregulation which, in turn, manifest as emotion processing deficits which result in the cognitive distortions and maladaptive decision-making commonly seen across a variety of addictive behaviours from substance addiction, to gambling, eating and hypersexual disorders.
In order to explain our world view of addictive behaviour, we will first critique existing diagnostic definitions of addiction.
Then, secondly, we offer criticism of the most prominent neurobiological models of addiction, offering our own compromise model which unites most of these theoretical models in one comprehensive theory of addiction.
Thirdly, we posit a theory of addiction which explains how these neurobiological factors are manifest in terms of stress and emotion dysregulation and how it this disorder of emotional responding, which is evident premorbidly, which prompts and perpetuates the addiction cycle. In other words, we explain the neurobiological impairments in terms of the cognitive-affective mechanisms which also perpetuate these neurobiological impairments.
We believe any comprehensive model has to explain various strata from neurobiology to psychological mechanisms, as well as genetic and environmental influence, in order to more fully explain addictive behaviour.
We also attempt to show how these models contribute to a more comprehensive understanding of craving and relapse.
We believe that existing theories have not achieved this requirement thus far and are lacking as a result in linking models to successful treatment outcomes.
We hope to outline a world view of addiction which will enable the people suffering from addictive behaviours to recognize their condition in a clear manner, to realize what needs to be treated and how best to treat this condition.
Many people who suffer addictive behaviours may also be discouraged in seeking treatment for their condition by how addictive behaviours are described in various treatment regimes and mutual help groups and the seeming lack of commonality in these treatments.
Thus the recovery/treatment package suggested as a result of a particular definition of addiction may confuse or discourage those who need treatment from seeking it.
We hope that the factors in addiction that we postulate here can be accommodated in all the various treatment models and will encourage all to understand an underlying condition they can relate to themselves and their condition.
Understanding these underlying mechanism and their pertinence to ALL addictive behaviours may also help in reconciling seemingly different models and treatments of addiction.
We believe it, within our framework, it is possible utilize all treatments, often simultaneously, in a comprehensive package that not only treats underlying conditions pertinent to all addictive behaviours but also their co-morbid conditions.
We believe that emotional dysregulation is pertinent to the addiction and co-morbid condition and that distress, as a result of these factors, is the underlying factor in all mental disorders including addictive behaviors, thus any treatment needs principally to treat this inherent distress state.
Treatments of other mental and and personality disorders thus has an increased utility that is often not recognized, explored or included to existing “treatment” plans.
We believe these factors all need to be included in individualized treatment plans and that treatment model itself should change from an “acute care model” to a “managed condition” or recovery model in which their addiction and co-morbidities are treated over a much longer period of five years within “after care” arrangements and within extended recovery communities.
If you have any questions or comments please feel free to contact us via the comments section – we would love to hear for you!
Issues with diagnostic definitions of Addiction:-
These two blogs highlight some of the issues with DSM V definitions of Addiction –
1. Translating Accurate Diagnosis into Effective Treatment.
2. Diagnosis: Towards Validity and Consistency
Now we consider the two main neurobiological theories of addiction before critiquing them and combining them into one comprehensive neurobiological theory of addiction.
We then set out another cognitive-affective theory of addiction to show how this impaired neuro-biology is affected by and affects the stress and emotion dysregulation to initiate, sustain and perpetuate the addiction cycle.
We complete our worldview of addiction in terms of theoretical contributions by providing a theory of craving and relapse using these models.
We believe all one needs to know about the manifestation of addictive behaviour can be found in these three theoretical, but interacting, models of addiction.
We will also link to blogs with highlight the inherent commonalities in all addictive behaviours.
Neuroscientific Models of Addiction
The following blogs are taken from this Comprehensive Neurobiological Theory of Addiction –
Combining Stress and Dopamine Based Models of Addiction
A Critique Of the Dopamine Model
A Critique Of the Stress Model
A Combined Stress and Dopamine Model of Addiction
A Neuro-anatomical Theory of Addiction
Diagrams of above Neuro-endocrinological Model of Addiction (to follow)
Our Stress-Emotion Dysregulation Model of Addiction
Addiction as a Brain Disorder of Affect Regulation
This Neuro-Psychological (Affective) Model of Addiction overlaps with the above Neuro-Biological Model Of Addiction, to illustrate that the inherent stress dysregulation in Addiction is prompted and perpetuated by the pathomechanism of affective dysregualtion.
A Brief History of Treating Addiction as an Emotional Processing Disorder
Negative urgency mediates relationship between alexithymia and dysregulatedbehaviors
Explaining how negative “negative urgency” can be
Intolerance of uncertainty prompts compulsive decision-making
Decision Making Deficits in Addicts
Lack of emotion differentiation propels negative urgency
The need to act via non recognition of emotional states
Understanding emotional processing deficits in addiction
The predictive value of alexithymia in patients with eating disorders
Alexithymia, emotional dysregulation and recovery from alcoholism
Ego Defense Mechanisms
Difference between Alcoholics and Addicts: In terms of Ego Defense Mechanisms
Our Cognitive-Affective Model of Craving and Relapse
How do recovering alcoholics appraise their alcohol related thoughts?
Negative repercussions of suppressing automatically occurring thoughts about alcohol
Extent of obsessive thoughts about alcohol related to addiction severity?
Our blogs on the commonalities of all addictive behaviours can be found in these blogs.
Commonalities Across Various Addictive Behaviours
In this blogsite we will be asking and attempting to give answers to the following questions
1. What is addictive behaviour?
2. How is it defined?
3. What are the neurobiological models of addiction –
dopaminergic positive reinforcement models,
stress based negative reinforcement models
and thirdly a model of addiction which combines both these models – the model we subscribe to in this blog and which we have contributed towards in a comprehensive theoretical review article, outlining our model.
4. Are there are additional factors which need to be included in a theory of addiction?
What are these factors e.g do cognitive-affective mechanisms interact with altered brain neurobiology in the addiction cycle?
Again we believe that cognitive-affective factors such as stress and emotion dysregulation play in intitiating and sustaining additive beahaviour?
Also we have recently submitted a theoretical article which shows how people with addictive beaviours use these behaviours to regulate negative emotions and negative self schemata.
This negative emotion regulation is also linked to altered stress systems in the brain which results in an altered and impaired ability to process emotion, i.e. identify, label and use emotion to guide adaptive decision making.
Instead substance and behavioural addicts seem to engage in distressed based impulsive decision making, recruiting more sub-cortical “flight or fight ” parts of the brain when making decisions rather than prefrontal cortex parts of the brain used in reasoned and evaluative thinking and decision making.
5. Are their underlying similarities in all addictive behaviours? If so, what are these common underlying mechanism?
6. Does environment play a role in the risk of later addictive behaviours?
7. Do genetics play a role in these theories of addiction?
8. Are present definitions and theories of additive behaviour accurate or adequate enough?
9. Our proposal for a re-definition of addictive behaviour?
10. The two theoretical models to which we subscribe?
Decreased Dopamine is seen in all addictive behaviours?
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