The many issues of addiction

From the gnawing headache that creeps in after forgoing your morning caffeine, to the smoker who hides his cigarettes from his daughter, to the alcoholic who drinks in the morning to quell her shakes and prolong her perpetual hangover, to her husband powerless to stop her, addiction impacts the lives of one and all. Whether to substances or behaviors, addiction can permeate all facets of life.

Addiction is characterized by cravings, tolerance and withdrawal symptoms, says Lynn Davison, a psychology professor who teaches human development at Santa Monica College.

“Anything associated with the addiction can trigger neurologically-based cravings for the substance or activity, which may include people, places, objects or emotions,” Davison says.

On Wednesday, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders.

The DSM — a psychiatric bible to some, a manifesto of overdiagnosis to others — classifies and defines mental disorders for diagnostic purposes. The first revision in nearly two decades changes the parameters of certain aspects of addiction.

According to a press release from the APA, the substance abuse and substance dependence categories from the DSM-IV are now merged into a single “Substance-Related and Addictive Disorders” section in the DSM-5. This change allows behavioral addictions to be included as addictive disorders, and also releases the constraint that dependence denotes addiction.

“Eliminating the category of dependence will better differentiate between the compulsive drug-seeking behavior of addiction and normal responses of tolerance and withdrawal that some patients experience when using prescribed medications that affect the central nervous system,” states the release.

David Shirinyan, a psychology professor at SMC who specializes in addiction,notes the significance of the distinction between addiction and dependence.

Dependence is always a component of addiction, but dependence can be seen in chronic pain patients who are not addicted,” Shirinyan says. “Dependence refers to the psychological and physiological reliance on the drug in order to function.”

Although behavioral addictions are now recognized in a separate subcategory in the DSM-5, gambling disorder is the sole syndrome listed. Internet gaming disorder is recognized as a condition that can be manifested as addictive behavior, but more research is needed before it is formally recognized as a disorder, according to the APA.

“Behavioral and substance addictions are similar in that they rely on the same brain system — the reward and pleasure system,” Shirinyan says. “They are both characterized as this compulsive engagement with the problem behavior or drug in the presence of negative consequences.”

While it may seem counterintuitive to keep doing something that is damaging to one’s mind, body or well-being, those in the throes of addiction do just that.

“So a person may repeatedly be reprimanded at work or school, may lose their job or flunk out of school,” Shirinyan says. “People may lose close relationships, their home and livelihood but still continue to use.”

Behavioral addictions can ultimately be just as devastating as substance addictions, though not typically as immediately, Shirinyan says.

Having promiscuous sex with many partners a week can lead to STD, but engaging in intravenous heroin can kill you every time you shoot up,” Shirinyan says. “Gambling debt can ruin a family and has led to many suicides, but meth addiction can kill you in the short term.”

There are some concerns about the revised diagnostic criteria in the DSM-5 initiating more diagnoses.

“The new DSM does not make a distinction between drug use, drug abuse and drug addiction,” Shirinyan says. “One unintended consequence, I fear, will be that because so many people will qualify as addicts, the seriousness of addiction may get diluted.”

Addiction’s gravity can be felt on bathroom floors and street corners. It infiltrates campuses and offices, and can lure anyone into its grasp. Even with treatment, its hold is strong.

“There is a lifelong management of addiction,” Shirinyan says. “You can’t take your eye off the disease because the chances of relapse never completely go away.”