Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology

Abstract

The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them" Sir William Bragg (1862Bragg ( -1942 It is common for clinicians, researchers, and public policymakers to describe certain drugs or objects (e.g., games of chance) as "addictive," tacitly implying that the cause of addiction resides in the properties of drugs or other objects. Conventional wisdom encourages this view by treating different excessive behaviors, such as alcohol dependence and pathological gambling, as distinct disorders. Evidence supporting a broader conceptualization of addiction is emerging. For example, neurobiological research suggests that addictive disorders might not be independent: 2 each outwardly unique addiction disorder might be a distinctive expression of the same underlying addiction syndrome. Recent research pertaining to excessive eating, gambling, sexual behaviors, and shopping also suggests that the existing focus on addictive substances does not adequately capture the origin, nature, and processes of addiction. The current view of separate addictions is similar to the view espoused during the early days of AIDS diagnosis, when rare diseases were not yet recognized as opportunistic infections of an underlying immune deficiency syndrome. Our analysis of the extant literature reveals that the specific objects of addiction play a less central role in the development of addiction than previously thought, and it identifies the need for a more comprehensive philosophy of addiction.In this article, we suggest that evidence of multiple and interacting biopsychosocial antecedents, manifestations, and consequents-within and among behavioral and substance-related patterns of excess-reflects an underlying addiction syndrome. We propose, in particular, that addiction should be understood as a syndrome with multiple opportunistic expressions (e.g., substance use disorders and pathological gambling). Our goals in this column are to (1) describe a new, syndromal model of addiction, (2) review the most recent literature that supports viewing addiction as a syndrome, and (3) indicate how this perspective can advance clinical practice and identify areas in which more research is needed. To accomplish these goals, we review the empirical evidence for this addiction syndrome and organize it into three primary areas: (1) shared neurobiological antecedents, (2) shared psychosocial antecedents, and (3) shared experiences (e.g., manifestations and sequelae).

Gambling Problems Among Community Cocaine Users

“…Problem gambling has been linked to a variety of harmful mental and physical health consequences, as well as a wide variety of problems such as high criminality and homelessness (Blaszczynski and Silove 1996;Shaffer et al 2004;Stein et al 2012;Turner et al 2009). These consequences make PG an important public health problem, especially for more vulnerable populations (Gainsbury et al 2014;Korn and Shaffer 1999;Papineau 2010;Shaffer and Hall 2001) such as individuals with a history of problematic substance use.…”

Compulsive Internet use and workaholism: An exploratory two-wave longitudinal study

“…This has encouraged researchers to study patterns of co-occurrence as this can lead to adopt a holistic approach to prevent and treat such problems effectively (Shaffer et al, 2004). However, studies reporting co-occurrence of multiple addictions are scarce, and those that exist, have traditionally relied on teenage samples.…”

“…The model predicts that those individuals who develop an addiction (behavioural or chemical) experience an alteration of their reward system that increases their likelihood of developing new ones in relation to objects that they are frequently exposed to (Shaffer et al, 2004). Similarly, Sussman et al (2011Sussman et al ( , 2012 argue that the type of behavioural addiction individuals are likely to develop following a previous one can be predicted from the individuals' lifestyles.…”

“…According to Shaffer et al (2004), exposure, degree of accessibility, and interaction with a specific object will determine the type of addiction a vulnerable individual is likely to develop. The model predicts that those individuals who develop an addiction (behavioural or chemical) experience an alteration of their reward system that increases their likelihood of developing new ones in relation to objects that they are frequently exposed to (Shaffer et al, 2004).…”

“…The actual mechanisms explaining mutual causation beyond shared exposure were not really unpacked by these authors. In order to understand potential mechanisms between these two behaviours the present authors build on the syndrome model of addiction (Shaffer et al, 2004;Kuss et al, 2014) and more specifically in the addiction interaction model (Carnes et al, 2005).…”