Lately the word "addiction" has gained usage so wide as to appear unbounded. Whole societies are said to be addicted. Infants are said to be addicted to crack (amorphous cocaine base for smoking). Many observers conclude that addiction is a myth.1 Is "addiction" truly unbounded, so as to be a useless word? If it has meaning, does it describe a condition that actually exists, could possibly exist, or is logically impossible? And if it exists, is it good, bad, or indifferent?

The idea of cocaine addicted newborns can be quickly dismissed as journalistic opportunism. This new usage has been seized on and promoted by propagandists.

The usual propaganda meaning of addiction is behavior which the person engaging in can't stop. This understanding is belied by the supposed existence of former addicts. By this usage, to say that someone was addicted to behavior X, and then stopped being addicted, is simply to say (with bad connotations noted below) that the person engaged in behavior X for a time, then stopped. But then there's no need for the word "addiction".

My understanding of addiction is as follows. There are complex patterns of human behavior which are learned. When someone engages regularly, or has a history of engaging regularly, in one of these behaviors, someone who expresses disapproval of this behavior or history may call it an addiction. The person using the word may be the same person whose behavior is referred to — called an addict — or someone else.

If it's the same person, that person is saying, "I'm doing something I don't want to." This is either a self-deception, or a lie, or it means, "I have reasons for not doing what I'm doing." However, the person must have weightier reasons to do than not to do whatever it is.

If it's someone else, it means, "That person shouldn't be doing this, or doing it so often. No right-thinking (i.e., thinking like me) person would do that." This meaning is like "abuse" — meaningless, inconsequential.

If it's the addict him/herself, then, by two of the interpretations above, it's a lie. Nobody can engage in complex behaviors involuntarily. However, some people are still anguished over their strong, simultaneous desire for things and their opposites — eating their cake and not eating it, too. They may inflate their contrary motivations into the false ideas that they must continue doing whatever-it-is and must not continue doing whatever-it-is. This is "must-urbation" according to Albert Ellis, inventor of rational emotive therapy.2 They may have bought the propaganda of addiction, and are deluded into thinking they can't stop whatever-it-is. They may also have bought the propaganda of abuse, and are deluded into thinking they're bad people for doing whatever-it-is.

About ten years ago a friend said he thought he had a problem with alcohol. (His concern didn't last long.) I told him that if he thought he had such a problem, then he did, and if he didn't think so, then he didn't. My assessment is at odds with that of the alcoholism treatment industry.

Let's explore reasons for the self-delusion, or misimpression, of the addict who says, sincerely though not truthfully, "I habitually do something I don't want to do." This calls for a thought experiment. Imagine a triangle. Make it a purple triangle. Now see that purple triangle whistling "Dixie". Do you see it? Hear it? Is it vivid?

Now erase the triangle, and imagine yourself hungry, or at least with appetite. (This won't work if you already feel like eating when you do this.) Is the feeling vivid? If you're like me and most people I've asked, the conjured impression of the purple triangle whistling, though an unfamiliar experience, is much more vivid than the imagination of appetite, a familiar percept.

The lesson is that for most people some percepts, including appetites, are much harder to imagine than others. The phenomenon is manifest every time I try grocery shopping on a full stomach. In evaluating what foods to buy, and how much, I rely on my memory or imagination of how good it would be to eat. But my imagination can't easily penetrate the sensation of fullness in my stomach, though it can easily penetrate a world of lights and sounds to produce the purple triangle whistling "Dixie".

I'm fat. I like eating. But after a big meal I sometimes wonder, why did I eat (all) that? The problem is that I actually can't remember the appetite or its satisfaction, the good feeling that came with eating. I can't imagine the feeling. Were I not familiar with this defect of imagination, I could easily persuade myself that I habitually do something (eating, or eating more than a certain amount) that I don't want (at that time) to do. (Similarly I might think I could get much more out of life if I just slept less. I can't imagine sleepiness; all I can do is remember that sleepiness does come regularly, and needs to be dealt with by sleeping.)

It's common in life for short- and long-range considerations to clash. A pediatric cardiologist taught me about an apparent paradox. Birth defects and infections can leave children with heart impairments which weaken the children, stunt their growth, and severely shorten their lives on a statistical basis over a population. Surgery is possible to correct or substantially palliate these defects. The child also stands a chance of dying instantly, or almost so, from the surgery. Should the operation be done?

Considering just the day of the operation, it's always better not to operate. But in the long run, the operation may be a very good choice. The trouble is, life's decisions are always made, or effective, at the margin (in economic terms). We may make plans for the long run, but our decisions, our actions, are always under instantaneous control and consideration. Our muscles don't move in response to a decision to have the operation this year or this month, but only now. This bite of food, this moment to lie down, this thought to write in this essay.

Someone may regularly do something whose benefit is ephemeral, but which has negative effects in the long run. During an interlude the person may reflect on the practice to see whether the negative is worth the positive. If the positive effect is a satisfaction which the person can't easily imagine, the person may falsely conclude that s/he's been behaving irrationally by repeatedly doing whatever-it-is.

Some have classified addictions as obsessive-compulsive behavior. But people who are obsessed-compelled don't know why they keep thinking and doing whatever-it-is. Addicts know perfectly well why they do.

Now to the propaganda of addiction. It has been to the advantage of various parties to have certain behaviors thought of other than as acts of will. Among those parties are "addicts". Say you're doing something other people say is "bad". One way to deflect criticism is to deny volition. No volition, no responsibility. No responsibility, no blame; maybe even sympathy. (But maybe not, according to a recent survey.)3

It has been pointed out that "to addict" once carried no negative connotation.4 The negative connotations of addiction seem to have become dominant at about the same time that consumption of drugs for direct hedonic effects came under criticism.

In this century there have been circumstances under which an "addict" could legally have "medically" administered materials which otherwise would be illegal to give for such effects. Maybe insurance or the taxpayers even pay for the "treatment". And all that's needed to "diagnose" addiction is the addict's history. For this reason alone it's clear that abolishing narcotics Prohibition and ending addiction "treatment" will instantly diminish the prevalence of drug addiction.

Meanwhile enough people have been fooled by the propaganda of addiction to fertilize an industry. If someone can be persuaded that a behavior (her own or someone else's) is an addiction, and that addiction is a problem, medical or otherwise, then a vein of money and power is there for tapping. As Newman observed, "Nothing is as valuable as a good myth to control people."

The field is especially lucrative when legal coercion is employed. A rational emotive therapist I know uncovered a dishonest-to-goodness racket in Dutchess County, New York. People convicted there of statutorily driving while intoxicated are referred under coercion to an evaluative-"therapeutic" program wherein a prejudice exists in favor of diagnoses of problems with alcohol and drug consumption. The convicts are further referred to, and at the mercy of, psychologists and psychiatrists on an approved list. My friend received such referrals, and pronounced them "cured" after one visit. Word got around to the convicts, who favored my friend's group practice. But the news also reached the other therapists, who, fearing the loss of their meal tickets, forced an end to this preferred way out.

The addiction racket is especially remunerative when addiction can be said to be a disease. About this so much has been written and argued, that I've only one contribution I haven't seen elsewhere as to why this fallacy persists among people of good will. This is the word game of equivocation, in which the same word is used with two different meanings, to conflate them.

There's equivocation on "-ism" in alcoholism. On one hand, "-ism" is used similarly to "-osis" as "condition" or "disease". Alcoholism is thereby analogized with salicylism, cinchonism, etc. as a type of poisoning. At least one medical dictionary defines "alcoholism" as the biologic condition of intoxication and its effects, acute and chronic.5 Acute alcoholism is drunkenness. Chronic alcoholism is hepatitis, cirrhosis of the liver, pancreatitis, encephalopathy, whatever, due to long term alcohol poisoning.

On the other hand, "-ism" is used in the sense of tendency, belief, etc., to indicate a pattern of behavior or its cause. Dorland's defines alcoholism this way: "A chronic behavioral disorder manifested by repeated drinking...6 Equivocating these two meanings, confusing effect with cause, "proves" this behavior to be a disease. Please get it straight: drinking causes drunkenness, not vice versa.

Because of my skepticism about addiction in general, and especially as a disease, I've expressed doubt about "cures". I've scoffed at the ibogaine treatment, 7 for instance. But such a rite may work for those fooled into thinking they can't stop doing whatever-it-is. The "trip" may be like a Wizard of Oz prescribed ordeal through which one "earns" (discovers) one's will. Such wizardry is the opposite strategy to that taken by rational emotive therapy.

Elements said by some to be important features of drug addiction are tolerance and an abstinence syndrome. In other words, repeated administration of the material causes a rebound process opposed to the direct effects of its administration. Tolerance is the diminution of the direct response by their summation with the rebound process, and the abstinence syndrome is the rebound effect unmasked when the material is withdrawn.

However, many interventions into the body cause rebounds. Homeostasis is the general tendency for our bodies to maintain a physiologic course, whether we like that direction or not. Many drugs not generally said to be addictive produce rebound effects. Meanwhile, many drugs are said to be addictive before any such rebound processes are discovered; the attribution may then lead to a search for justification by discovery of such rebounds.

Funded by a Proxmire-inspired NIMH grant, Richard L. Solomon did such things as tossing M&Ms to dogs, to observe what everybody knows."8 The commonplace conclusion is expressed by (Tennyson to the contrary), "'Tis worse to have loved and lost than never to have loved at all, and, "I'm hitting myself with a hammer because it feels so good when I stop." We're most affected by an experience when it's new. After repeated exposures, we become jaded, diminishing the pleasure from them, or become inured to the pain from them. When the experiences stop, we feel sorry and miss them if they were good, or are relieved if they were bad.

Solomon's studies are no more than a version of such physiological psychology experiments as the one where you spin in a swivel chair, describing the apparent motion with your eyes closed, and having someone observe your eye motion with your eyes open — but with affective percepts. Whether the observations are psychologic or physiologic doesn't matter. That they are now applied to addiction shows the concept to be a banality, which "experts" have inflated by mixing this word, "addiction", with disapproval and lots of money, white coats, and magic.

Still, the operation of an opponent process doesn't explain all behaviors people describe as addictive. A friend told me of someone said to have an addictive personality. Whatever this person consumes — aspirin, cocaine, gazpacho soup — he does to excess. From the stories I gathered that the opponent process is sluggish in this person. Where others would quickly tire of gazpacho soup, and feel stuffed, this man's enjoyment was undiminished, so he kept going. He felt the negative effects —but later than most people.

The rebound or opponent affective process must often work to demotivate us from continuing activities beyond a certain point. Once you've adapted to the experience of eating one M&M at a time, you could try to renew the kick by eating two at a time. Or, bored with the taste, you could switch to a belt of scotch. In economic terms, repeated hedonic experiences have a declining marginal utility function.

Suppose the presumption of disapproval, which ordinarily accompanies the word "addiction", is stripped from the above account of repeated learned behavior. Is the behavior pattern then a bad thing? There's one immediate sense in which it's bad "news". Solomon observes this to be a puritan's theory, such that all pleasure wears off and leads to pain, while pain wears off and leads to pleasure.8

Addiction sounds like a characteristic of someone you'd want as an employee. The addict is persistent, regular in her habits, and ambitious, wanting more all the time.

Addiction is a selling point. "Boggle", a word game of letter dice, used be advertised as "the fun addiction", in a way that satirized both the moralistic and "mental health" concepts of addiction.

An ad in Computer Gaming World quoted comments from players, from which I'll select here: "Great game! I'm hooked." "I've got SimCity syndrome!" "I find SimCity to be the most addicting, educational, and the best game I have ever played!" "SimCity should be outlawed!! It's addictive." "Excellent game! But I've been  losing a lot of sleep since I bought it." "Excellent program! Learning can be fun and addicting."

Notice the ambivalence, real or ironic. In a magazine column, a child psychiatrist answered a complaint about someone's nephew's addiction to video games by strongly suggesting "the entire family get professional help" to uncover the "real problems" relating to "turmoil in his family". The doctor also noted: "Addiction to video games isn't based on a physiological dependency like drug and alcohol abuse is. But there's evidence that video game programmers seek to create a psychological dependency in the players."9

If addiction is good, as the ads suggest, why do people fear it? Because it presents hard choices. (Another SimCity comment: I may quit my job so I can play more...well, nah.") Hard choices anguish people who musturbate on those choices. (I was driving a friend who claimed to be addicted to alcohol, when we approached a liquor store. He asked me to stop there, then to pass it, then to stop, then to pass it; I don't know how many times he changed his mind in about a minute, while I maneuvered in traffic, willing to satisfy either choice, until I got fed up and drove on. Then he brooded on whether it was good or bad that I hadn't stopped.) There is fear of regret at having made an inferior choice. This is the frame of mind of the person who, having to choose between going on a picnic and going to a movie, hopes for rain.

People, including those said to be addicts, choose according to their judgement of what's best among options available to them. That the frequency of narcotics, etc. use by people 1,10 and even animals10 depends in large part on their life circumstances is unsurprising. There's nothing in principle making drugs any different in terms of "addiction" than any other pursuit.

Robert Goodman is Senior Biomedical Engineer and Scientist in Research and Development at National Medical Care, Inc., Medical Division and can be contacted at 1402 astor Ave., Bronx, N.Y. 10469.

References

1.1990 New York presentation by Fred Newman. Reported by Mary Fridley, "Just Say No...to the Addiction Industry", National Alliance 11(18), 1, May 10, 1990.

2. Ellis A, How to Stubbornly Refuse to Make Yourself Miserable About Anything —Yes, Anything! (Lyle Stuart, New York 1988).

3. Crawford JR et al., "Does the Disease Concept of Alco-holism Predict Humanitarian Attitudes to Alcoholics?" The International Journal of the Addictions 24(1), 71-7, 1989.

4. Szasz TS, Ceremonial Chemistry (Anchor, Garden City, NY 1974).

5. Original reference lost. However, Nancy Roper, Livingstone's Pocket Medical Dictionary, 12th ed. (Churchill Livingstone, Edinburgh 1974) concurs: "Alcoholism: alcoholic poisoning...."

6. Dorland's Illustrated Medical Dictionary, 24th ed. (W.B. Saunders, Philadelphia 1965)

7. Lotsof HS, U.S. patents 4,499,096 (1985), 4,587,243 (1986), and 4,857,523 (date unk.).

8. Solomon RL, "The Opponent-Process Theory of Acquired Motivation: The Costs of Pleasure and the Benefits of Pain", American Psychologist 35(8), 691-712 (August 1980). Does not include the M&M experiment, done earlier.

9. Novello JR, "You and Your Child", Woman's World 11(22), 30, May 29, 1990.

10. Peele S, The Meaning of Addiction (D.C. Heath, Lex-ington, Mass. 1985).