American Society of Addiction Medicine
+ + + + +/– + + + +
+ + + + – – + + +
– – – – + + – + –
+ + + + + + – + + +
The Canadian Journal of Psychiatry—Review Paper
Table 1 Signs and symptoms of addiction and (or) dependence
Activities given up
Larger amounts, longer periods
Unsuccessful efforts to cut down
Use despite harm
DSM -IV-TR = DSM-IV text revision
of specific behaviours that he called “affective monomanias,” realizing that man’s reasoning ability was subservient to emo- tional needs (3), which in some ways is similar to Socrates’ concept that actions that do not follow a rational or the best course of action are abnormal.
Proposals suggesting that addiction may be a disease appear in the literature as early as 1700, with The Mystery of Opium Revealed, by John Jones (4), followed by Benjamin Rush’s Inquiry into the Effect of Ardent Spirits (5). The dilemma of whether addiction is a disease—and if it is, what type of disease—has continued into the present, with various hypo- theses proposed. No hypothesis, however, connects the con- cept of the disease of addiction with a common etiology.
There have been many significant premises, hypotheses, and findings with respect to addiction. In 1939, Alcoholics Anon- ymous showed that addiction to alcohol or alcoholism could be treated (6). In 1984, Gold (7) suggested that “cocaine must produce a state similar to a delusion in users” and that “our past failure to recognize the delusionary and addictive power of cocaine is in part responsible for the current cocaine epi- demic.” The confusion and use of multiple terminologies with no common etiology of addiction are such that William Miller warned in 1993 that the current disease models were inade- quate to explain or resolve the wide spectrum of alcohol- related problems (8). In 2002, Orford reported that, among a group of heavy drinkers, the perceived benefits outweighed the drawbacks “which challenges both conventional health promotion efforts and motivational models of alcohol con- sumption” (9). In 2002, the endogenous cannabinoid system was shown to have a central function in the extinction of aversive memories (10).
Presently, no model explains the addictive behaviours in a rational, scientific manner or provides any explanation that defines a common cause for the various behaviours that are called “addictive.”
It may be that what is required to expose the etiology of addic- tion may not be found using traditional scientific methods, for some scientific problems may not be answered empirically. In these cases—particularly with problems of conception and causality—philosophy may help analyze and define issues for examination. Linguistic analysis is a philosophical process based on the work of Ludwig Wittgenstein and described as follows:
where science is concerned with facts, philosophy is con- cerned with concepts; where the scientific method for dis- cerning facts is based on careful, comprehensive observations of empirical data, linguistic analysis as a philosophical method is based on careful, comprehensive observations of linguistic data; and where in the case of the scientific method it is possible to go beyond common sense by testing concepts as they are assumed to be against empirical data, so in the case of the method of lin- guistic analysis, it is possible to go beyond common sense by testing concepts against linguistic data, or what it is that people actually say (11).
Linguistic analysis and inductive reasoning will be used in an attempt to discover an etiology of all addictive disorders, beginning with descriptions and definitions of addiction that are in common use.
The analysis will look at 4 contemporary descriptions or defi- nitions of addiction. These include the description of alcohol- ism by Alcoholics Anonymous (6), the definition of addiction by The American Society of Addiction Medicine (ASAM) (12), the DSM classification of substance dependence (13), and the ICD-10 Classification of Mental and Behavioural Dis- orders dependence syndrome (14). Table 1 lists the criteria that are associated with addiction for the descriptions or defi- nitions being considered.
Can J Psychiatry, Vol 48, No 10, November 2003