Is the concept of compulsion useful in the explanation or description of addictive behaviour and experience?

Abstract

The concept of compulsion, in which addictive behaviour is said to be carried out against the will, is central to the disease theory of addiction and ubiquitous in modern definitions. The aims of this article are: (i) to describe various meanings of compulsion in the literature; (ii) to compare the part thought to be played by compulsion in addiction with its suggested role in obsessive-compulsive disorder; (iii) to critically examine the place of compulsion in influential neurobiological accounts of addiction; (iv) to summarise the empirical evidence bearing on the usefulness of the compulsion concept, evidence that seems at first sight incompatible with the notion of compulsion. This is followed by a discussion of which possible meanings of compulsion can survive an empirical test and what role they might play in understanding addiction, paying particular attention to a distinction between strong and weak senses of compulsion. A conclusion is that addictive behaviour cannot be considered compulsive at the time it is carried out, though other possible meanings of compulsion as an explanation or description of addictive behaviour and experience are discussed. Among other conclusions, it is suggested that, although in some senses of the term it may seem arbitrary whether or not ‘compulsion’ should be retained, its use has important consequences for the public understanding of addiction, and is likely to deter people's attempts to overcome their addictions and their chances of success.

A transdiagnostic dimensional approach towards a neuropsychological assessment for addiction: an international Delphi consensus study

“…Considerable evidence exists supporting compulsivity as a core feature of addiction (although see [68]), representing an ongoing and repeated difficulty in refraining from drug-seeking or -taking despite negative consequences. In total, seven constructs reached consensus as being primary constructs in understanding addiction, including RDoC reward valuation, expectancy/ reward prediction error, action selection/preference-based decision-making, reward learning, habit and response selection/inhibition.…”

Are animal models of addiction useful?

“…Nonetheless, these rats developed symptoms of addiction, similar to those captured in the 0/3 crit model. The implication is that novel drug self-administration procedures reveal findings that are fundamentally incompatible with the dogma that addiction is a disorder of compulsive and habitual drug self-administration [11,12,31] but, rather, it can involve problem-solving and complicated sequences of behaviour, just as it does in humans [32,35].…”

“…For present purposes, the critical question is: to what extent can human drug-seeking behaviour be characterized as compulsive or habitual? Heather [32] summarizes several observations that clearly contradict this characterization. For example, drug use is an operant behaviour that remains sensitive to its consequences, as evidenced by the effectiveness of contingency management for the treatment of addiction [33].…”

“…That is, people with addiction are able to refrain from using drugs if they receive monetary rewards (or other incentives) for doing so. Therefore, drug use is not ‘compulsive’ at the time it is carried out . Furthermore, people with addiction report high levels of problem‐solving in order to obtain drugs , rather than being the inflexible automatons that are portrayed in some of the aforementioned theoretical accounts.…”

“…Another recently developed animal drug self-administration paradigm also questions the importance of habitual and inflexible behaviour in the development of addiction. Building on observations of the extent of planning and problem solving reported by human addicts in order to obtain drugs [32], Singer et al [45] developed a novel cocaine self-administration procedure that required rats to solve puzzles in order to obtain access to cocaine. The rats were required to solve different puzzles each time, which prevented drug-seeking from becoming habitual and inflexible.…”