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Review Paper

Addiction: A Disease of Volition Caused by a Cognitive Impairment

William G Campbell, MD, CCFP, FASAM 1

The common etiology of substance and behavioural addictions is one that suggests faulty volition caused by a cognitive impairment. A cognitive impairment that minimizes the re- call of the negative effects of the addictive behaviour is viewed as necessary and causal to all addictions. The proposed definition for addiction clarifies the confusion associated with addictive disorders, explains the many variable presentations, and provides an explanation of comorbidity and treatment outcomes. In addition, this paper suggests why this process has not been previously identified.

(Can J Psychiatry 2003;48:669–674) Information on author affiliations appears at the end of the article.

Clinical Implications

  • Substance and behavioural addictions have a common etiology.

  • A thought disorder related to memory access is the common cause for all addictions.

  • Addiction treatment should focus on treating the impaired access to aversive memories.

Limitations

  • The study uses linguistic analysis and inductive reasoning and is not empirical.

  • No research that has attempted to disprove this hypothesis has been done.

  • Although memory access is necessary and causal for addiction, other determinants are signifi-

cant in developing an addiction and are not directly addressed in this study.

Key Words: addiction, disease, alcoholism, conation, drug addiction, substance depend- ence, impaired volition

Perhaps the mystery is a little too plain.

  • The Purloined Letter. Edgar Allan Poe, 1845

he use of language determines how we understand and evaluate the world around us. The various and complex presentations of those who bear the label “addict” have con- fused our ability to clarify the meaning of addiction and its eti- ology. The negative effects of substance use and addictive disorders are a major cause of morbidity and mortality in our society. Despite some major advances in understanding ad- diction and the enormous amounts of money spent on re- search, there has not been a proportional improvement in explaining its etiology or any significant improvement in treatment outcomes. If addiction does have a cause, it is ob- scure. The cause remains undiscovered, yet a large body of theories and empirical data has accumulated. T

Philosophy and Science

Socrates suggested that normal individuals with healthy minds would not deliberately behave illogically or self- destructively. If they did not act in their best interest, they would not be acting deliberately, and this would be abnormal. If they acted on desires illogically, they would be exhibiting akrasia, or weakness of will (1). Yet addicts repeatedly and consistently appear to follow the worst course. They continue addictive behaviour and appear to exhibit akrasia, or weak- ness of will.

The poet and laudanum addict Samuel Taylor Coleridge rec- ognized the issue of will and its importance as causal to addic- tion when he wrote, “my case is a species of madness, only that it is a derangement of the volition, and not of the intellec- tual faculties” (2). In 1817, Jean Etienne Dominique Esquirol attempted to classify mental illness according to a disturbance

Can J Psychiatry, Vol 48, No 10, November 2003

669

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