Habit vs. Addiction

My friend and colleague Glenn Treisman likes to tell about his ongoing debate with patients, students, and other clinicians about what it means to be truly addicted to something.

When he asks whether cigarettes are addicting, Glenn says that many people answer with an unhesitating, "Of course they are!" (Perhaps you're thinking the same thing, especially if you are or have ever been a smoker.) But if you're a smoker, Glenn next asks, "So--you're saying that, to buy cigarettes, you'd be willing to sell your body, or steal from your grandmother, or seek out treacherous armed people in dark alleys?" And then, because no one would do such things for a cigarette, you say, "Of course I wouldn't!"

The key question

According to Glenn, this question--What would you be willing to do to satisfy your craving?--separates those who crave, say, a cigarette from those who crave a truly addicting drug like cocaine or heroin.

Glenn's point is that it's a shame to waste such a handy and valuable word like "addiction" on behaviors that aren't driven by the frantic anxiety and desperation that's behind a true addiction. To be addicted is to be willing to destroy yourself to get the fix you crave.

The cravings of lab rats

Thus, when a laboratory rat will push a button repeatedly or will even tolerate a small electric shock in order to get a dose of nicotine, the rat is demonstrating that it does indeed like nicotine. But the need of a rat for nicotine is nothing like the rampant hunger of a rat accustomed to receiving cocaine. Because cocaine is a genuinely addicting drug, the second lab rat will push a button all day long, to the point of exhaustion, will neglect to eat, and will allow itself to be so cruelly shocked for so long a time that its skin becomes scorched. The craving for nicotine, although painful, is pretty feeble in comparison.

Here are a few other examples that illustrate the difference between a habit that's difficult to overcome and an addiction.

Drinking alcohol

Not signs of addiction: Getting drunk or stoned and doing self-destructive things while high, like driving recklessly or getting into brawls or forgetting to use a condom. These behaviors might make you a drunk or a stoner or an accidental parent, but they don't make you an addict.

Addiction: If you continue to get drunk or stoned every day, despite the fact that these behaviors are bringing your world crashing down around your ears, In that case, your cravings are pushing you across the line into addiction.

Taking prescription tranquilizers

Not signs of addiction: Feeling horribly ill when you suddenly stop taking a tranquilizer like Valium or Xanax, and knowing that you're going to have to take another pill to rid yourself of the misery. These feelings indicate that you've become physically dependent on the drug and are going through withdrawal, but they still don't identify you as an addict.

Addiction: Having to spend large portions of your days finding doctors and pharmacies that don't know you, or forging prescriptions so you can get more medication than your doctor is willing to prescribe for you.

Smoking cigarettes

Not a sign of addiction: Counting the minutes at work until you can go on break and smoke a cigarette.

Addiction: Smoking in spite of your advanced lung disease, and having to puff on your cigarettes through a tracheostomy hole in your throat, which was put there by doctors so you can breathe. That behavior puts you over the top.