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treat, and neuroleptics provide limited help. Support groups such as Alcoholics Anonymous can successfully encourage the refusal to act on the basis of faulty reasoning and provide recurrent exposure to a process that stresses the need for continued awareness of the ever-present potential to forget negative consequences. Successful therapies, such as cognitive-behavioural therapy, promote increased awareness and vigilance about “stinking thinking” and “negative tapes,” which are metaphors for impaired cognition. Spontaneous re- covery without treatment can be explained as the regaining of normal cognition and, hence, healthy volition, for any reason. Ultimately, this improves the access to memory associated with the addiction.

Summary Because addiction has been obscured by various psychosocial and biological problems, as well as by the great variation in the types of addictions, we lack understanding of the disease. The problem of considering a volitional disorder as a disease has been a major stumbling block when studying many mental disorders.

With a single etiology as the form of the disease (a volitional disorder based on impaired memory access), development of an addictive disorder can be related to the genetic background and environment of the individual and to exposure to those substances or actions that improve feelings, while at the same time, resulting in negative consequences.

The concept that the etiology of addiction is volition caused by impaired access to memory suggests that addiction is a mental disease, albeit induced by the addict’s own impaired volition and behaviour.

It is difficult to perceive that addicts have a disease. Acts of will or volition are usually not accepted as diseases, because voli- tion is an act of choice or free will. Nevertheless, addicts do have a volitional disorder based on cognitive impairment caused by impaired memory access. Further, when actions and results are looked at rationally, addiction is a serious and poten- tially fatal problem. If there is a common etiology for addiction, it should be one that is basic and fundamental to the healthy functioning of a human being. A disorder of volition, based on impaired cognition, associated with impaired access to mem- ory, and resulting in negatively valued actions is just that.

The diagnosis of addiction is so coloured by the negative moral and social values entailed with the illness that this, un- fortunately, has prevented medicine from discovering its eti- ology and effective treatment. Addicts always describe their problem as one in which they know that their behaviour is illogical; however, the negative social and moral overlay,

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

Addiction: A Disease of Volition Caused by a Cognitive Impairment

combined with the complexity of the disease presentation, has obscured its underlying common etiology and resulted in a long delay in its determination.

The concept that addiction is a disease of faulty volition caused by cognitive impairment should enable the medical profession to provide more effective and compassionate treatment for ad- dicts. Rather than attempting to treat the social, personal, emo- tional, legal, spiritual, and physical symptoms that are the consequences of the disease, identifying the etiology of addic- tion will allow treatment to focus on the cause of the symptoms. Treating volitional diseases may be difficult and controversial, but until the problem of addiction is recognized as one caused by a cognitive impairment resulting in faulty volition, treatment will continue to have limited success.

While the issue of whether addiction is a disease is of interest medically and philosophically, it is of vital significance for the addict or alcoholic who still suffers from the disease of ad- diction. Recognizing that addiction is a disease in which im- paired access to memory causes faulty volition should encourage research into treatments that are effective and that address the addict’s significant brain dysfunction. This will eventually allow the addict to receive the treatment that is re- quired from the medical community. Obscure for various rea- sons, the etiology of addiction is a cognitive impairment based on impaired memory access and resulting in faulty volition. This has been shown as necessary and causal to all addictions.


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