A diction that makes Addiction

Back in 2013, the DSM5 said Gaming Disorder was a “condition for further study” that could become a diagnosis at a later time. According to the ICD-11, that later time is apparently now.

So what’s the basis for reasoning that this is a disorder?

First you have to wade through the vague and inconsistent terminology, but in broad terms there are arguments for a “common addiction pathway”. When this means there’s a physical place in the brain, I don’t buy it, for reasons I’ve talked about elsewhere (see part B here). It’s a Procrustean attempt to universalize behavior into causes, and it is doomed. Brain scans will “show” evidence of addiction because areas associated with pleasure are active – but this is empty at worst, and a tautology at best (see parts C, D, and E here). Similarly, behavioral analysis will be logically circular: animals prefer cocaine to food so cocaine must be addictive, then when a certain food (eg. sugar) is chosen over cocaine it becomes evidence of that food being addictive. If you don’t see this as a problem, may Chrysippus rise from the grave and beat you with a stack of truth tables.

There are also arguments for a common chemical mediator, with the most prevalent theories linking addiction to elevations of dopamine. I’ve talked about this before as well (see part C here). Rationally speaking, dopamine is associated with salience, not just pleasure. Empirically speaking, we don’t fix addiction by focusing on just dopamine. We can reduce dopamine with Haldol but we don’t use it for alcoholics. And there are times when increasing dopamine, such as for ADHD patients, may actually reduce the risk of addiction.

Even if we go as broad and act as generous as possible, these views would amount to taking addiction to be a specific combination of chemicals acting along with a specific combination of pathways. But then anything triggering that causal chain would be desirable, and addicts should substitute addictions. They don’t. Crack addicts don’t do cocaine, and cocaine addicts don’t switch to crack, even though crack is supposed to be more “potent” (which is debatable).

This all stems from putting the cart before the horse. No one denies that a psychological component is present in addiction, but physiology is usually considered primary. But addiction is not physiological reward hijacking psychology. Consider those addicted to anabolic steroids: there is no appreciable psychoactive “high” (users cannot differentiation between the drug and placebo) and yet the vast majority report withdrawal symptoms.

The role of the drug of abuse isn’t necessary: addicts can get physical feelings of withdrawal or a “high” just with presentation of environmental cues, and they pick up on these cues much faster than non-drug related cues. Nor is the drug sufficient for addiction: there is a lack of dependency on painkillers if taken as scheduled (which we’ve known for at least a decade), and in utero exposure can lead to short term physiological withdrawal symptoms for the infant but that doesn’t lead to long term dependency (extant myths notwithstanding). Which means external “addictive” substances are neither necessary nor sufficient as a cause of the disorder.

This means it would be wise to consider a different category for the analysis than the physiological. Luckily, we already have an available term to relocate the malady into the mental: viz. obsessions. These then often couple with compulsions (eg. compulsive gambling). But while obsessions are problematic, they are not an illness, they are symptoms. And what they are symptoms of may not be an illness either (eg. self-esteem, guilt/shame, faulty thinking, cognitive distortions, ad infinitum).

This is important. When you try to treat a psychological problem as if it were a chemical problem you get the baffling array of “solutions” we now have. It’s like trying to treat mental illness with drugs for acne, allergies, and malaria (see part D here). It’s the same reason why the “treatments” for depression have ranged from an antibiotic like isoniazid to stimulants (even as far back as Freud.)

II.

I’m not denying that there’s a common problem. But it’s skewed when presented to us.

Shrinks used to work within a “psychosocial” model, but now everything must conform to a medical diagnosis. The experience of addiction used to be entirely subjective, viz. “is it interfering with your life?” This is relative to a person’s culture to a certain extent. However much relativism has become contemptible in post-po-mo academia, you ignore the relevant relative context at your own peril. For example: when you do, it becomes hard to explain alternative reinforcers, without which it becomes mysterious as to why isolated rats drink more morphine than social-living compatriots. It also means that you encounter otherwise easily avoidable prima facie paradoxes, as exampled here:

“Note that when [scientists] talk about, say, the increase in alcoholism, they never go back before WWII, otherwise they’d have to label most ancient Greeks, all Vikings, and everyone in colonial America as alcoholics.”

However, with a medical diagnosis, there is a search for “pathognomonic signs” ie. symptom-is-disease. Then one makes that symptom a criteria, all criteria other than that one are negotiable, and the symptom becomes the irrefutable axiom of diagnosis. All room for relativity or context has been removed, ie. it is independent of (viz. there is no  Dependency on the part of) the person. Which means it’s all about the substance. It then logically follows that certain objects are always “bad” per se. Next, suspiciously, everything becomes a gateway drug. Then turn to increasing criminalization of drugs to produce a vacuum, fill said vacuum with prescription drugs, and you’ve reached 2018.

So you’ll think context has been shed, but you’ll find at the very next worry our response will depend on the current time period (viz. context). Currently, the growing average hours per week online in South Korea makes people worry about the possibility of being addicted to the internet. As I’ve already mentioned, we fixate on the latest technology, so that’s not what’s interesting. What’s interesting is that years ago, there was a worry in the US that there was too much time watching TV (or reading comic books), however, the foreseeable fear wasn’t addiction but low IQ. This is a difference in the readiness to pathologize, rather than socially intervene towards, behaviors. And once you pathologize the normal, it becomes easy to laugh at people on Fortnite, rather than fix the origin of the problem. Thus the problem is ignored, continues unabated, and grows.

If you don’t think this way then you will be puzzled as to why back in 2008 the head of The Smith & Jones Centre (Europe’s only clinic to treat computer gaming addicts) said the majority of his patients are not addicted, and then a DECADE LATER an official diagnosis is codified to the contrary.

If you do think this way, you won’t be surprised. Better still, you may even be prepared for the next time it happens.

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