Addiction is complex and so it can be difficult to define or treat. In this article I outline 20 different perspectives on addiction. I hope to help you think of addiction as a complex realty that crosses different dimensions of our lives and not just our biology or psychology.

1. Addiction as culture 

Different cultures use and react to substances in different ways e.g., opium was never considered a dangerous substance in India, where it was grown and used regularly but it quickly became a major social problem in China when it was brought there by the British. Can you think of other examples of how drugs and culture interact?

2. Addiction as a social practice 

Drug use is closely tied to the social and peer groups a person belongs to (Jessor and Jessor 1977). Drug use and addiction becomes a way of engaging in the social world of peers. Addiction can be an expression of social inequality. Drug use can be normalised in sub-cultures as a way of dealing with inequality. Why are certain subgroups of society more affected by drug use that others?

3. Addiction as situational 

A persons desire for a drug cannot be separated from the situation in which the person takes the drugs (Falk et al., 1983) e.g., The majority of U.S service men who were addicted to narcotics in Vietnam did not become readdicted when they used narcotics at home (Robins et al., 1974). Why situations do you see affecting people’s drug use?

4. Addiction as ritual

The rituals that accompany drug use and addiction are important elements in continued use, so much so that to eliminate essential rituals can cause addiction to lose its appeal e.g., the rite of injecting heroin. Some heroin addicts stop using heroin but continue to prick their skin with the needle as if to release tension. So the ritual of drug use goes beyond the use of the drug and incorporates other aspects such as time, location, company, smells, music and dance. Can you think of other drugs with strong rituals?

5. Addiction as a developmental process

People’s reactions to, need for, and style of using a drug change as they progress through the life cycle. E.g., maturing out (Winick, 1962). Young people use drugs at an important development stage and this can have long term consequences. Where do you see drug use affecting peoples development?

6. The addictive personality 

The addictive personality is a popular way of trying to understand addiction. Personality may both predispose people toward the use of some types of drugs rather than others and also affect how deeply they become involved with drugs at all. Chein et al. 1964 concluded that get adolescent addicts were characterised by low self esteem, learned incompetence, passivity, a negative outlook, and a history of dependency relationships. So in many ways drug use is less about personality and more about the multiple factors affecting the persons life. What argument would you make against the addictive personality theory of addiction?

7. Addiction as a cognitive process

People’s expectations and beliefs about drugs, or their mental set, and the beliefs and behaviours of those around them that determine this set strongly influence reactions to drugs. Eckart Tolle believes ‘Thinking is addictive’ what do you think he means by this? I agree with Eckart, thinking increases anxiety and often leaves us vulnerable and less equipped to solve our problems. Overcoming negative thinking is best achieved by being in the present moment, accepting our emotions and physical state, rather than trying to run.

8. Addiction is genetic 

The medical model promotes addiction as genetic. This gives them the access to argue for medical treatments. Cigarette smoking, alcoholism and overweight – like divorce, child abuse and religion run in families, not only because of our physical genes but also due to our social and psychological genes. Our genes are not just physical. The addictive inheritance argument has been most studied in the case of alcoholism (Goodwin et al., 1973). Adopted-away offspring of alcoholics were compared to adopted children with nonalcoholic biological parents, have claimed a three to four times greater alcoholism rate for those whose biologic parents were alcoholic. Do you believe our genes predispose us to addiction?

9. Addiction is the result of exposure 

Underlying the exposure model is the assumption that the introduction of a narcotic into the body causes metabolic adjustments that require continued and increasing dosages of the drug in order to avoid withdrawal e.g., heroin addiction as a metabolic disease. The more we are exposed to a drug, the more likely we will develop a dependence at several levels, physical, psychological, emotional and social. Can we stop people being exposed to addiction?

10. Addiction is the result of conditioning 

Conditioning theories hold that addiction is the cumulative result of the reinforcement of drug administration. We are being conditioned continuously by political, social, cultural and religious systems. Conditioning happens in families, schools, universities and churches. Drug use can be a response to that conditioning and a failed attempt to achieve freedom. What can we stop to resist conditioning?

11. Addiction is learned behaviour

Addiction is learned in social settings (Bandura 1977). This perspective is similar to the conditioning understanding. This perspective combines cognitive, social conditioning, exposure, ritual and learned behaviour. Do you agree?

12. Addiction is a disease 

The disease model of addiction is another popular one within the medical establishment. Benjamin Rush 1774 described addiction as a disease of the will. Abstinence was the only cure. The sick brain has eroded freedom. The medical disease model of addiction states that addiction involves pathological changes in the Brian that result in overpowering urges. Why has the disease model gained such popularity?

13. Addiction is a loss of control 

Linked to the disease theory Jellinek (1946) this idea is based on the belief that one drink sparks a chain reaction leading to a loss of control. This is closely linked to the disease and genetic models of addiction. But do we have a choice? What mechanisms are involved in the loss of control? 

14. Addiction as a choice 

Addiction is a choice. Do you agree? There has to be some element of choice in the process of addiction. I may not be aware of that I have a choice. Did I have freedom before I started to use drugs? Was my drug use a response to my lack of freedom and lack of choices in life. Poverty reduces the choices we have. Abuse reduces the choices I have due to the damage imposed by that abuse. The choice model of addiction is about freedom. When we become aware that our freedom is compromised e.g., by alcohol we can then make new choices.

15. Addiction is an avoidance of psychological and emotional hurt  

Bowlby in developing his Attachment Theory found that healthy attachments as children with our care givers was important in developing as adults. Healthy attachments as children is fundamental in developing health relationships later in life. Poor attachment drives people to search for love and acceptance in others. When drug use becomes part of that search it can lead to deeper hurt and isolation rather than the finding love and acceptance. What else to do we do to avoid feeling our hurt?

16. Addiction is a myth

Addiction is a myth according to (Davies, 1992). This is not to say people don’t use drugs compulsivity, or that they are hurt and hurt others. But it tried to question if addiction really exists? Yes suffering exists, and avoidance of suffering exists, but does addiction exist? If the cause of my chaotic drug use was sexual abuse as a child, but we focus on the drug use and labelling it as addiction, we can avoid the reality of the underlying pain. If pain drives my drug use, then that pain is real. Medicating that pain and calling it addiction does not help. If the myth of addiction gets in the way of healing the underlying pain, then the concept of addiction is not helpful and maybe a myth.

17. Addiction is a form of self medication 

Addiction is a form of self medication. People use drugs to numb their social, psychological and emotional pain. This idea proposes that individuals use drugs to help with their psychological symptoms from which they suffer (Gelkopf et al., 2002). You don’t need to understand the self-medication thesis, to self mediate, but it can help for people recovering from addiction to realise that maybe they were self medicating. What are the risks of self medication?

18. Drug, set and setting 

Drug, set and setting is an idea developed by Norman Zinberg and discussed in his book; Drug, Set, And Setting: The Basis for Controlled Intoxicant Use (1984). This idea sees addiction developing depending on the convergence of certain drugs, people and contexts. Not everyone will be affected in the same way, depending on the drug, the person and the context. How would this model help someone who wants to stop using drugs?

19. Addiction as a biopsychosocial reality 

The biopsychosocial model sees addiction as encompassing our biology, psychology and social experience. This is a useful model as it begins to understand addiction as a complex realty. It is important for people who see the failure of reductionist models that reduce addiction to our biology or gens. By looking at the different social, psychological and biological influences in the development of addiction, we are in a better position to help people recover and overcome. Explain what you think this means?

20. Society as addict 

Society as an addict is an interesting one to conclude this list of 20 ideas about addiction. Some argue that our society is broken leading to a rise in addiction. I think this idea has some merit. Society is producing more addiction. The way we are living particularly in the West, is out of balance with nature and leading to the current climate crisis. At the heart of addiction is consumerism and the myth of happiness from materialism. Capitalist societies promote the idea of happiness in the form of material products. To reduce the number of people affected by addiction, we need to build a society that respects everyone as equal. At the heart of addiction is the experience of equality. Let’s change that and build a society that is inclusive and built on relationships of mutual respect and love. Explain what you think this might mean and if it make sense?