Gabor Maté

“What, then, is addiction? In the words of a consensus statement by addiction experts in 2001, addiction is a “chronic neurobiological disease… characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.” The key features of substance addiction are the use of drugs or alcohol despite negative consequences, and relapse. I’ve heard some people shrug off their addictive tendencies by saying, for example, “I can’t be an alcoholic. I don’t drink that much…” or “I only drink at certain times.” The issue is not the quantity or even the frequency, but the impact.

“An addict continues to use a drug when evidence strongly demonstrates the drug is doing significant harm…. If users show the pattern of preoccupation and compulsive use repeatedly over time with relapse, addiction can be identified.” Helpful as such definitions are, we have to take a broader view to understand addiction fully. There is a fundamental addiction process that can express itself in many ways, through many different habits. The use of substances like heroin, cocaine, nicotine and alcohol are only the most obvious examples, the most laden with the risk of physiological and medical consequences.

Many behavioural, nonsubstance addictions can also be highly destructive to physical health, psychological balance, and personal and social relationships. Addiction is any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addiction involves: 1. compulsive engagement with the behaviour, a preoccupation with it; 2.
impaired control over the behaviour; 3. persistence or relapse, despite evidence of harm; and 4. dissatisfaction, irritability or intense craving when the object — be it a drug, activity or other goal — is not immediately available. Compulsion, impaired control, persistence, irritability, relapse and craving — these are the hallmarks of addiction — any addiction.

Not all harmful compulsions are addictions, though: an obsessive-compulsive, for example, also has impaired control and persists in a ritualized and psychologically debilitating behaviour such as, say, repeated hand washing. The difference is that he has no craving for it and, unlike the addict, he gets no kick out of his compulsion. How does the addict know she has impaired control? Because she doesn’t stop the behaviour in spite of its ill effects. She makes promises to herself or others to quit, but despite pain, peril and promises, she keeps relapsing. There are exceptions, of course. Some addicts never recognize the harm their behaviours cause and never form resolutions to end them. They stay in denial and rationalization. Others openly accept the risk, resolving to live and die “my way.”

Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction
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In the Realm of Hungry Ghosts: Close Encounters with Addiction In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté
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