What Is Addiction?

How do you know if you have a problem with addiction? How do you know if a loved one does? How much is too much? At what point does social drinking become problem drinking, and when does problem drinking become alcoholism? What about illegal substances? Are you an addict if you use them simply because they're illegal? I am going to try to provide a useful way to answer these questions, and I'll also look at why it has been such a problem to come up with a definition of addiction.

A joke that was being told around addiction treatment facilities a while ago went like this: If you want to find out whether somebody is alcoholic, follow him into a bar at happy hour. When he's not looking, drop a dead fly on top of his beer.

If he's a social drinker, he'll leave it alone and go on talking. If he's a problem drinker, he'll wait till no one is looking, then flick the fly off. But if he's alcoholic, he'll wring that sucker out . . .

Since this method of diagnosis is probably not practical in the general clinical setting, clinicians have developed several questionnaires that are used to determine whether someone is addicted. The shortest, and one of the most accurate, is the CAGE questionnaire, which applies to alcohol.

The CAGE questionnaire consists of four questions featuring key words that start with the letters C, A, G, and E.

A positive answer to at least one question suggests a problem with alcohol. The CAGE questionnaire is not standardized for use with other substances or with addictive behaviors, but a positive answer to C, A, or G regarding drugs is a strong indication that there is a problem.

The CAGE Questionnaire
C: Have you ever felt you ought to cut down on your drinking [drug use]?
A: Have people ever annoyed you by criticizing your drinking [drug use]?
G: Have you ever felt bad or guilty about your drinking [drug use]?
E: Have you ever had a drink (eye-opener) first thing in the morning to steady your nerves or get rid of a hangover?

Although several other screening questionnaires have been developed, including the Michigan Alcohol Screening Test (MAST), the Substance Abuse Subtle Screening Inventory (SASSI), and the Addiction Severity Index (ASI), the simple common sense approach of asking people if they have ever had any problems associated with their drinking or drug use probably identifies better than 90 percent of those with addiction.

Denial is a psychological defense mechanism that is found almost universally in people with addiction.

We will look more closely at this phenomenon in "The Course of Addictive Disease" section, but I mention it here because denial is responsible for a lot of the confusion that abounds in trying to answer the question "Am I an addict?" or "Is my (spouse, child, parent) an addict?" Denial is a person's ability to ignore negative consequences in order to be able to continue to use the substance in question. It is ironic that this characteristic sign of addiction is probably what causes the most problems with diagnosis in the day-to-day clinical setting.