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If you’ve come to, you or someone you love may suffer from addiction. Addiction is one of the most devastating and confusing illnesses that affects people today. About 8% of the U.S. population meets criteria for substance abuse or dependence, and in 2000, the use of tobacco, alcohol, and illicit drugs were three of the top ten causes of death in the United States.

It can be confusing to understand all the words and turtles used to describe addiction. The manual that doctors and therapists use does not have an “addiction” diagnosis. It classifies addictive behaviors such as pathological gambling, anorexia, and kleptomania under various descriptive headings but provides no theoretical link between them. The “substance dependence” diagnosis comes closest to addiction, but the term “dependence” is also confusing. Physical dependence is just one aspect of addiction and not the most important. Devastating relapse often occurs long after physical dependence on a substance has been ended.

Addiction is a broad category that incorporates substance use disorders and addictive behaviors. In early English, “addiction” was the act of being handed over to a creditor to whom one was delinquent in paying a debt. It could also mean the voluntary submission of one person to another. At its core, “addiction” meant a loss of personal freedom and servitude to an external power. We continue to use “addiction” in this way, only the external powers are not creditors or authorities. They are unhealthy attachments to substances, behaviors, or relationships–attachments that rob people of their freedom and undermine their own values and priorities.

Apart from the diagnostic confusion about addiction, the word is used casually to indicate nearly every type of attachment. People talk about being addicted to television and coffee and books. This overuse can make make the word seem almost meaningless.

In order to understand addiction a little better and to understand whether you or your loved one might suffer from addiction, complete the following exercise.

  1. List all the things you think are most important for a healthy, happy human life. There are no wrong answers, so just list whatever comes to mind no matter how concrete or abstract. If you haven’t listed items like “self-respect” or “safety” you might not be thinking broadly enough.
  2. Now consider an attachment that you think may be addictive—it can be to a substance, relationship, or behavior—any attachment that is both powerful and problematic. Write the attachment at the top of the page.
  3. Finally, circle all the items in your original list that you or your loved one has compromised for the sake of this attachment.

When people in treatment for addiction complete this exercise, they usually circle every item on their list of human goods. You can tell the degree to which you might be addicted to a substance, behavior, or relationship by the degree to which you sacrifice or compromise the things you consider most valuable in human life.

Using this exercise as a foundation, we can provide a general definition of addiction:

Addiction is a disease of the motivational system whereby a person becomes so attached to a substance, relationship, or behavior that his or her own priorities are compromised for the sake of the addictive attachment. The severity of addiction can be measured by the degree and scope of the compromise caused by the addictive attachment.

Ned Presnall

Ned is Executive Director of Clayton Behavioral and Adjunct Professor at Washington University in St. Louis, Missouri. He presents widely on the topics of addiction, mental health, and Medication Assisted Treatment. Ned is passionate about reducing the stigma against persons with addiction and against Medication Assisted Treatment through discourse and public engagement.


Have you seen our animated videos about addiction & recovery?