Today the word "addiction" is applied so loosely and to so many different things as to become almost meaningless. Listen for this word in daily conversation and you'll hear about much more than alcohol and other drugs. People also talk about addiction to gambling, sex, e-mail, work, chocolate, television, shopping, cell phones, exercise, shoes and games.

"Every time I hear people say that they're addicted to something, I feel like shaking my head," says Carlton Erickson, Ph.D., director of the Addiction Science Research and Education Center at the University of Texas at Austin. "When the word is used so loosely, it detracts from the seriousness of problems with heroin, cocaine, alcohol and nicotine."

Professionals in the addiction treatment field generally recognize that "addiction" refers to "dependence on alcohol or other drugs," but the general public does not. Our cultural confusion about "addiction" leaves basic questions unanswered. Despite medical advances, the general public may still wonder whether addiction is a disease or a failure of "willpower."

Erickson offers a solution: Avoid the word "addiction" altogether and make a clear distinction between substance dependence and substance abuse. Distinguishing between dependence and abuse is something that the word "addiction" fails to do, says Erickson. Dependence and abuse are different problems, and they call for different solutions.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the tool published by the American Psychiatric Association to help diagnose substance abuse and substance dependence, distinguishes dependence from abuse, and it avoids the term "addiction." It identifies the main symptom of dependence as impaired control over substance use. People who are dependent on alcohol and other drugs will continue to use them no matter how negative the consequences. They are powerless over those drugs; they have a serious, chronic disease, but it is treatable.

Causes of impaired control include chemical changes in a specific area of the brain called the mesolimbic dopamine system. This area activates when we feel the pleasure of eating, sex and other activities necessary for our survival.

As a result, a person with the disease of drug dependence feels the need for drugs with the same intensity as the need for water, food and oxygen. This person will continue drinking and drugging even when the consequences include loss of work, family and friends. Professional treatment is usually needed to stop the self-destructive cycle.

Drug abuse is a different matter. People who abuse alcohol and other drugs may stop once the consequences get serious enough.

"If we want the public and policymakers to understand addiction as an illness, we need to do a better job of differentiating between people who casually use those substances and those who are unable to stop using them on their own," says William Cope Moyers, executive director of Hazelden's Center for Public Advocacy. "People like me never just abused those substances. We loved them. We protected them. And we would go to any lengths to get them."

The drinking behavior of college students offers an example of the difference between abuse and dependence.

"My town of Austin, Texas, is home to one of the largest universities in the world," Erickson says. "You can walk into downtown bars on any night of the week and see students getting 'hammered.' Are all of them alcoholics? No. Most of them are making bad judgments about their use of alcohol. But about 90 percent of them are alcohol abusers. After graduating, most of these students will choose to reduce their drinking. Only about 10 percent of them will truly become dependent on the drug and unable to stop drinking on their own.

"To summarize, drug dependence is unintentional and involuntary, while drug abuse is intentional and voluntary," adds Erickson. This distinction is already being made in the medical literature, including the International Classification of Diseases from the World Health Organization.

Telling a person who is dependent on alcohol to "just say no" is like telling a person with clinical depression to just cheer up, Erickson says. If we avoid the imprecise language of addiction, we can avoid such ineffective responses.

If you or a friend has a substance use disorder, contact a treatment center or a licensed addiction professional to assess the problem and get help.

Published November 10, 2008