The Keep it Simple / Stupid Method for Identifying Addiction

First I want to give credit where it is due. My former colleague & mentor, James Kennedy, MD, is who really gave me this straight forward understanding. I learned a great deal about issues involving addiction, the treatment of addiction, and the issues involved in ‘dual diagnosis’ (when a psychiatric and substance abuse problem co-occur) from Dr. Kennedy.

I have often been asked by people if a friend or family member of theirs might be addicted. Occasionally, a patient will ask if I think they are addicted, though I often find that they really already know, and just may be in denial. When I’m asked this, I generally start talking about the difference between substance abuse and dependence. Dependence, by definition will involve physiological withdrawal symptoms if the substance use is discontinued; however, there is also some room for psychological dependence, where there is no issue of physical withdrawal symptoms, but the person’s anxiety may acutely increase due to the fear of a return of symptoms such as being unable to sleep at night, or that they will experience a panic episode, etc. Then the question arises as to how do substance abuse & dependence relate to addiction.

There are plenty of exceptions to this, but from the perspective of keeping it simple, you want to think of addiction as a process that takes place over time. Often, the first step is experimental use of a substance (for example alcohol) which then progresses to abuse (essentially using any substance to the extent that it interferes with functioning in personal relationships, academic or work settings, or health).  When the focus of attention becomes more and more on the use of the substance, to the exclusion of the rest of life you have addiction.

Think of a camera with a lens that can go from wide angle to macro (very close up) views. Before someone is addicted s/he has the ability to go from a wide angle view (having broad interests and involvements), to being very focused on a small part of the environment (e.g., studying for an exam, or watching a movie), and back again; their world covers a broad spectrum. In addiction this ability to move back and forth, and maintain a broad interest deteriorates. It is as if the lens no longer can smoothly and easily go back and forth, and becomes fixed at the macro level of focus; only one thing is in view – the drug or alcohol – to the exclusion of the rest of life. At the most extreme point of addiction, the ability to move back to a wide angle view is lost, and the lens is stuck in the close up, macro mode, and the only thing in focus is the sought after substance (or in some cases the stimulus, such as pornography, sex, etc.). The focus is on when the next drink is available, the time I can use, etc. Think of this like it is the development of tunnel vision to the point that nothing else is seen; only the sought after substance or activity.