A Rule of Thumb on Addiction By Dr. Andrew Millar Clinical Psychologist Santa Maria, California

The question of whether someone is addicted often comes up in the course of my psychotherapy work.  I use a simple screening protocol to help my clients decide whether they are addicted and what they want to do about it.

There are various beliefs about the nature of addictions.  These have been debated for over a century without resolution, notably regarding alcohol.  Of particular controversy have been the ways the various camps have tried treating alcoholism. 

For example, people who believed that alcohol itself is evil (e.g., “Demon Rum”) promoted the constitutional amendment on Prohibition. 

Alcoholics Anonymous has long been associated with the idea that alcoholism is a disease that can be managed but not cured, as with diabetes.  The program develops a sober lifestyle by means such as the Twelve Steps toward continual self-improvement and a strong social support system. 

Psychology-based theories that alcoholism is a learned behavior have led to attempts to use punishers (e.g. nausea or electric shock) to disconnect the association between alcohol use and pleasure.  It also resulted in the highly contentious studies on controlled drinking.

There has also been some controversy over whether some addictions actually exist.  Although the addicting qualities of alcohol and other drugs are well known, the U.S. Supreme Court judged that the Department of Veteran Affairs could legitimately classify alcohol dependence as “willful misconduct.”  For many years it was uncertain whether tobacco and tranquilizers such as Valium were addicting.  Many people dispute whether activities such as gambling, sex, work, video games and Internet use are addicting, but there are also many who have personal experience that says they are.

One thing all theories about addictions have in common is the focus on the problems caused by the behavior of the addict.  Difficulties occur in major life areas such as marriage and other family relationships, work, financial status, health, social life, and legal status. 

The approach I use to screen for addiction looks at the troubles a client creates and how the client responds to them.  The more times a client has problems and the worse the problems, the more likely the individual is addicted.

Unless the first problem is severe, I usually am not concerned when a client causes a problem through potentially addicting behavior.  I figure that anyone can make a mistake and that it does not necessarily indicate an addiction.  I will recommend that the client learn a lesson from the experience and change his or her behavior to prevent any further problems.

For example, if a young woman is suspended for using marijuana at work, she has caused herself a job problem and she risks legal trouble.  It would be important for her to at least adjust her marijuana use so that she does not break the rules at work.  It would be even better if she stopped using marijuana so she could also avoid the risk of a drug arrest.

My concern increases if a client has a second problem.  The question becomes:  “Why didn’t she learn the first time?”  It is possible that the client has a learning disorder or that the benefits of the potentially addictive behavior outweigh the risk of causing her more trouble.  In treatment I strongly recommend that the client modify or even stop the problem behavior.

In our example, if the young woman continues to smoke marijuana at work, gets fired, and then spends her rent money on a party to make herself feel better, she failed to learn her lesson and has increased her difficulties.  Marijuana was somehow more important to her than was keeping her job or her home.  Maybe she was planning on quitting and moving anyway, so maybe the marijuana use was a dramatic way of changing her life, and she is not addicted.  But the probability that she is addicted is now much stronger.

If the client then causes a third problem, he or she is probably addicted.  For some reason, despite clear warning signs, the individual seems unable to learn from mistakes.  The addiction is probably getting in the way of learning.  To the addict, it is more important than possible consequences.

If the young woman in our example is fired from another job or is arrested for selling marijuana to support her drug use, she is clearly not learning to stop marijuana in order to stop causing herself trouble.  She is probably addicted and is likely to need treatment specifically to help her stop using drugs and to get her life back on track.

Throughout this process it is important to watch for problems that can cause the client, the client’s family or society great harm.  For severe trouble such as stealing to support a habit, a DUI conviction, or use of a toxic drug such as methamphetamine or solvents (i.e., glue sniffing), I strongly recommend that the client stop the behavior immediately.

If you use this rule-of-thumb procedure and detect a possible addiction problem for yourself or someone you care for, please consult someone who can conduct a more formal assessment and help you decide on a course of action.

Helpful resources: Help Line at 928-5818 or 734-2711 for referrals to services; the Alcoholics Anonymous answering service at 925-3782 for locating meeting times and places (they also have listings for Narcotics Anonymous and Al-Anon).