Definitions of Addiction
Psychiatric View of Addiction
From a psychiatric perspective, drug addiction has aspects of both impulse control disorders and compulsive disorders. Impulse control disorders are characterized by an increasing sense of tension or arousal before committing an impulsive act, pleasure, gratification, or relief at the time of committing the act, and regret, self-reproach, or guilt following the act (see early versions of the DSM of the American Psychiatric Association). In contrast, compulsive disorders are characterized by anxiety and stress before committing a compulsive repetitive behavior and relief from the stress by performing the compulsive behavior. As an individual moves from an impulsive disorder to a compulsive disorder, a shift occurs from positive reinforcement to negative reinforcement that drives the motivated behavior (Figure 1.3). Drug addiction progresses from impulsivity to compulsivity in a collapsed cycle of addiction that consists of three stages: preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect. Different theoretical perspectives from experimental psychology, social psychology, and neurobiology can be superimposed on these three stages, which are conceptualized as feeding into each other, becoming more intense, and ultimately leading to the pathological state known as addiction (Figure 1.4; for further reading, see Koob and Le Moal, 1997).