Letter to The Oklahoman
October 25, 2012
Your Oct. 22 article “Addiction is Not Easy to Diagnose and Sometimes Hard to Define, Experts Say” raises important issues about the nature of addiction. While the word addiction is used loosely to mean many things, it is critically important to distinguish between behaviors that constitute the disease of addiction and those that reflect a public health problem of risky behavior.
Addiction is a complex disease of the brain’s circuitry related to reward, motivation and memory. This disease is characterized by changes in the brain’s structure and function that are reflected in pathological behavior. While the most common forms involve compulsive use of nicotine, alcohol and other drugs, the scientific understanding of the nature of the disease is changing. The upcoming revision of the diagnostic manual for identifying addiction, the DSM-V, is expected to include compulsive gambling. The updated definition also may acknowledge compulsive Internet use and compulsive sexual behaviors as potential manifestations of addiction that deserve more study. Research also is underway related to addiction involving compulsive overeating. Addiction can be treated and managed by a range of psychosocial and pharmaceutical therapies. Risky behaviors that fall short of this clinical definition may result in a wide range of costly health and social consequences and require public health interventions.
Our failure to make this distinction obscures important differences in the nature and severity of illness and complicates our ability to intervene and treat the disease.
Susan E. Foster
Vice President and Director of Policy Research and Analysis
National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia)