Addiction: A Disease of Volition Caused by a Cognitive Impairment

Abstract

Perhaps the mystery is a little too plain.-The Purloined Letter. Edgar Allan Poe, 1845T he use of language determines how we understand and evaluate the world around us. The various and complex presentations of those who bear the label "addict" have confused our ability to clarify the meaning of addiction and its etiology. The negative effects of substance use and addictive disorders are a major cause of morbidity and mortality in our society. Despite some major advances in understanding addiction and the enormous amounts of money spent on research, there has not been a proportional improvement in explaining its etiology or any significant improvement in treatment outcomes. If addiction does have a cause, it is obscure. The cause remains undiscovered, yet a large body of theories and empirical data has accumulated. Philosophy and ScienceSocrates suggested that normal individuals with healthy minds would not deliberately behave illogically or selfdestructively. If they did not act in their best interest, they would not be acting deliberately, and this would be abnormal. If they acted on desires illogically, they would be exhibiting akrasia, or weakness of will (1). Yet addicts repeatedly and consistently appear to follow the worst course. They continue addictive behaviour and appear to exhibit akrasia, or weakness of will.The poet and laudanum addict Samuel Taylor Coleridge recognized the issue of will and its importance as causal to addiction when he wrote, "my case is a species of madness, only that it is a derangement of the volition, and not of the intellectual faculties" (2). In 1817, Jean Etienne Dominique Esquirol attempted to classify mental illness according to a disturbance The common etiology of substance and behavioural addictions is one that suggests faulty volition caused by a cognitive impairment. A cognitive impairment that minimizes the recall of the negative effects of the addictive behaviour is viewed as necessary and causal to all addictions. The proposed definition for addiction clarifies the confusion associated with addictive disorders, explains the many variable presentations, and provides an explanation of comorbidity and treatment outcomes. In addition, this paper suggests why this process has not been previously identified.( Can J Psychiatry 2003;48:669-674) Information on author affiliations appears at the end of the article.Clinical Implications · Substance and behavioural addictions have a common etiology. · A thought disorder related to memory access is the common cause for all addictions. · Addiction treatment should focus on treating the impaired access to aversive memories. Limitations· The study uses linguistic analysis and inductive reasoning and is not empirical. · No research that has attempted to disprove this hypothesis has been done. · Although memory access is necessary and causal for addiction, other determinants are significant in developing an addiction and are not directly addressed in this study.

Psicopatología de pacientes dependientes de cocaína en una comunidad terapéutica

“…Although, contrary to Exner's hypothesis, our patients with a high Lambda were not more likely to be CDI positive, we cannot rule out that a larger sample could reveal meaningful associations. If high Lambdas indeed represent an avoidant style, used to avoid complexity and ambiguity, then our results support Campbell's (2003) proposition that addicts are cognitively impaired: avoiding complexity (e.g. denying memories of negative events), addictive behaviour is allowed to be based on faulty reasoning.…”

Considering the Definition of Addiction

“…A second aspect of addiction considers excessive thoughts about and desire to perform a behavior, excessive time spent to plan and engage in the behavior, and possibly recover from its effects (e.g., from “hangovers”), and less time spent on other activities [29], despite potentially diminishing appetitive effects [30,31]. That is, the addictive behavior “spills over” into several dimensions of one’s daily life.…”

“…According to Campbell [29], the “cognitive impairment” associated with an addiction emerges only when a specific addiction associated with harmful consequences produces a simultaneous positive emotional response. This attentional narrowing minimizes or negates the memory of the negative effects or consequences of previous addictive behavior experiences (or access to aversive memory).…”

From Use to Abuse: When Everyday Consumption Behaviours Morph into Addictive Consumptive Behaviours

“…In order to conceptualize the increased engagement in a broad array of consumption behaviours, we propose a pre-addiction process that examines these behaviours from the perspective of harm and dependence. The pre-addiction process is based on an individual engaging in a behaviour that is relatively benign and without harmful consequences but progressively moving toward being harmful as the individual becomes more and more dependent on the consumption behaviour or product (Campbell 2003;Koob and LeMoal 2001). Consider Sydney, who enjoys online gambling as a way to divert her attention from other stresses in her life.…”