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CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
The Clinical View
by PE Hoffsten, M.D.
8/16/2001

“HOW ADDICTION HAPPENS”

            Last week, the column commented on the relationship between motivation and freedom.  It was pointed out that our motivation comes from our choosing a given activity and then being satisfied with  the result of that activity.  In the healthy individual, if the activity is not satisfying, the individual modifies their response and tries to achieve success again.

            But what happens when an individual’s freedom to succeed is frustrated.  As an example, suppose an individual has a normal desire or need to be accepted and approved of by companions, classmates, or individuals at a place of employment.  Suppose that for whatever reason, that individual is unable to achieve that acceptance and approval.  The reason could be that performance doesn’t measure up, or it could be simply that the approval offered isn’t as much as the individual wants.  For whatever reason, the individual isn’t receiving the approval or the acceptance that is wanted.  Anyone who has experienced this (and we all have) knows how frustrating and painful this can be.  This person’s freedom to be satisfied is now denied.  It may seem strange to say that the person is lacking freedom, but in fact, they are not free to receive the acceptance and approval that they are seeking.  They are free to try but their efforts just don’t seem to work.

            So now what do they do?  A person can then try some different endeavor maybe something they are better at;  but some people note that one or more alcoholic beverages relieve the pain of the rejection and allow the person to “feel better”.  For some reason, some individuals then repeat this behavior when they encounter future frustrations.  The alcohol thus becomes a substitute motivation as it becomes easier and easier to use alcohol at times of frustration.

            What alcohol provides is one of the vivid examples of addictive behavior in our society.  That same addictive behavior can involve the use of food, drugs, cigarettes, or gambling.  One of the really strange addictions in our society are those addicted to their work.  When an individualencounters lack of needed satisfaction or acceptance in their home, simply staying at work where they are more accepted and successful,  provides the relief and satisfaction that they need.  It has the additional benefit of being noble because the person is “working hard”.  That this individual becomes separated from their own family is often missed.

            Thus, what is addiction?  It is that state in which the individual is unable or unwilling to control a behavior that damages the individual’s health, performance, and/or relationships.  Addictive behavior grows from the frustration of an individual’s freedom.  The need to be free from feelings or guilt or shame or outside control lead to the person substituting behaviors that they do have control over.  The good feelings may be only temporary but are enough to lead the individual back to those behaviors again and again.  Usually, the individual is not proud of their addictive behavior and try to hide it.  This leads to an avoidance of close relationships in order to avoid revealing their addictive behavior.

            It seems strange to say that addictive behavior comes from frustration of our freedoms.  But basically, that’s what  happens.  Our freedom to be approved of, to be accepted, to be successful, are often frustrated by our environment and other individuals in it.  When we begin to rely on substitute behaviors such as excessive alcohol, excessive food, cigarettes, drugs, physical or verbal abuse, or addiction to our occupation, our addictive behavior very frequently becomes quite destructive.

While it is relatively rare that a person’s addictive behavior comes to legal considerations, it is very common for addictive behavior to lead to destruction of personal relationships, severe health problems, and/or the impairment of occupational endeavor.

            Next week, the column will be devoted to measures one can take to deal with addictive behavior and avoid the destructive effects of same.

            As a final note, addiction may be divided to physical addiction and psychological addiction.  Physical addiction leads to severe illness if the addicting drug such as heroin is not provided.  The person develops a fever, low blood pressure, fast heart beat, delirium, nausea and vomiting if a physically addicting drug is not provided.  Drugs that can do this include the heroin/morphine family, demerol, cocaine, barbiturates, and alcohol.  True physical addiction is unusual in our society.

            Psychological addiction is quite different.  it is a feeling that the addicting substance is important or even “necessary”.  But if the food or cigarettes or alcohol that are involved in the addictive behavior are not provided, the addicted person does not develop physical illness as described above.  The addicted person may get a little owly and vigorously go seek the addictive material.  Trips to the convenience store at 2 AM for a pack of cigarettes or a candy bar, are an example.  But psychological addictions are purely in the mind of the addicted person and being without the addictive substance or behavior does not cause physical illness.