Talk:Addiction/Archive 4

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Archive 4

Involuntary

I thought that it might be a bit clearer if we labeled the disorder as being involuntary, and I believe that is uncontested, so I've done this. I want to point out here that I have written that is the disorder that is involuntary, and not that any specific individual behavior that results from the disorder. WhatamIdoing (talk) 05:36, 15 June 2022 (UTC)

I'm going back-and-forth on what I think about this. I appreciate your distinction between the emergence of the disorder, and the individual behaviors that result from it. But there are also individual behaviors that lead to it. There are clearly involuntary aspects to addiction, but it's important to distinguish between involuntary and compulsive. --Tryptofish (talk) 19:27, 15 June 2022 (UTC)

The trigger for me was a sentence in https://www.nytimes.com/2022/06/13/health/cigarette-smokers-stroke-addiction.html (I think you'll be interested in that), which said "But many people still believe that addiction is voluntary." I don't think anyone sets out to voluntarily become addicted, which is different from engaging in voluntary activities that carry a risk of addiction. WhatamIdoing (talk) 20:09, 15 June 2022 (UTC)

Yes, I saw that when it came out, and it is indeed fascinating. As for the wording here, I feel like "involuntary" goes farther than "not intentionally". --Tryptofish (talk) 20:12, 15 June 2022 (UTC)

I agree with Tryptofish. Calling addiction involuntary is not consistent with the extensive literature on the topic. I think we address the self-control (choice) issue accurately in the intro: "weakens (but does not completely negate) self-control". Here are two books and two articles that discuss the issue in depth (especially the books):

Heather N, Field M, Moss AC, Satel S, eds. Evaluating the Brain Disease Model of Addiction. Routledge; 2022. ("As well as presenting the case for seeing addiction as a brain disease, [this book] brings together all the most cogent and penetrating critiques of the brain disease model of addiction (BDMA) ... Contributors offer arguments for and against, and reasons for uncertainty; they also propose novel alternatives to both brain disease and moral models of addiction. In addition to reprints of classic articles from the addiction research literature, each section contains original chapters written by authorities on their chosen topic. The editors have assembled a stellar cast of chapter authors from a wide range of disciplines - neuroscience, philosophy, psychiatry, psychology, cognitive science, sociology, and law ..."). Comment: Although the editors are not fans of the BDMA, they include important, well-written articles by scholars in the BDMA camp.

Henden E, Melberg HO, Røgeberg OJ. Addiction: Choice or Compulsion? Front Psychiatry. 2013;4. doi:10.3389/fpsyt.2013.00077 ("Our aim in this article has been to argue that a middle path is not only possible but actually quite plausible in the light of the evidence: behavior can be voluntary, chosen, and compulsive at the same time. One way of making conceptual sense of this is to assume that our decision-making system is divisible. If such divisions stabilize due to the entrenchment of some underlying motivational mechanism and cause regular and systematic failures in the person’s decision-making with respect to actions of a certain type, they create compulsive behavioral patterns that may be very difficult for them to override by intentional effort alone. ... However, this view does not mean that it is literally impossible for addicts to refrain from drugs. It only means it is much harder for them than it is for people who are not addicted. Even heavily addicted individuals have the capacity to abstain, although they may need help to learn how to exercise that capacity properly.")

Hogarth L. Addiction is driven by excessive goal-directed drug choice under negative affect: translational critique of habit and compulsion theory. Neuropsychopharmacol. 2020;45(5):720-735. doi:10.1038/s41386-020-0600-8 ("... concurrent drug choice is demonstrably goal-directed, is modulated by decision parameters, and increases with dependence, psychiatric symptoms, and mood/stress induction, and this latter effect is amplified in individuals who report psychiatric symptoms and drug use to cope with negative affect ...."). Comment: Presents a strong argument for the self-medication model (IMHO). The Heather et al. (2022) book has a nice chapter in a similar vein but emphasizing the role of ACE (adverse childhood events) in the etiology of addiction, and how clinicians must understand trauma and its effects in order to best treat addicted persons. The chapter is Beyond the Medical Model: addiction as a response to trauma and stress by Gabor Maté.

Levy N, ed. Addiction and Self-Control: Perspectives from Philosophy, Psychology, and Neuroscience. Oxford University Press; 2013. ("This book brings together a set of papers, many which grow out of presentations at a conference in Oxford in 2009 on addiction and self-control, by a set of thinkers who are united in believing that understanding agency and failures of agency requires engagement with the best science. The papers it collects attempts to illuminate the mechanisms involved in addiction and thereby to understand to what degree and in what ways actions driven by addiction are controlled by the agent, express his or her will or values, and the extent to which addicts are responsible for what they do. Some of the papers focus on the neuropsychological mechanisms involved, especially on the role of the midbrain dopamine system. Others focus on features of the behavior and the extent to which we can infer psychological mechanisms from behavior. The authors debate the best interpretation of the scientific evidence and how the scientific evidence bears upon, or can only be understand in the light of, philosophical theorizing about agency, control and responsibility.") Comment: This book tackles the topic head on with several cogent chapters from a variety of perspectives. Mark D Worthen PsyD (talk) [he/him] 19:29, 23 June 2022 (UTC)

Thanks for that detailed explanation. I think think that it's becoming clear that we should say something other than "involuntary". At the same time, I appreciate WAID's point that we should make it explicitly clear that "belief that addiction is voluntary" is incorrect. I suggest: "Addiction is an involuntary a neuropsychological disorder characterized by a persistent and overwhelming urge to use of a drug...". --Tryptofish (talk) 20:24, 23 June 2022 (UTC)

I've got no objections to that edit, but it's kind of not the point. The point is "Nobody chooses to become addicted in the first place". What you wrote is "After you're already addicted, you will experience an overwhelming urge". WhatamIdoing (talk) 22:35, 23 June 2022 (UTC)

That makes the distinction clear to me, but I'm having trouble seeing how we could fit that into the lead sentence. Although nobody chooses to be an addict – as in it's not what anyone thinks about being when they "grow up", and as in it's not what addicts typically envision when they take the first steps that lead to addiction – what I've been arguing in this talk is that addicts do make choices that, in part, lead to becoming addicted in the first place. One the one hand, addicts don't choose overall to become addicts, but on the other hand, addicts do make unfortunate choices. I don't see how to define addiction in part as something that no one chooses to be, but perhaps there is a way to explain this point over one or more sentence later in the lead. --Tryptofish (talk) 22:54, 23 June 2022 (UTC)

I don't have a brilliant solution to offer, so I leave it in your hands. When you are planning your brilliant solution, see if you can include the "Nobody chooses to stay addicted" concept as well. One might make choices that lessen or deepen addiction's grip on your brain, but nobody's out there saying "You know what I want for myself right now? I really want to have an overwhelming urge to do something harmful." WhatamIdoing (talk) 02:40, 24 June 2022 (UTC)

Anyone who expects me to be brilliant is going to be very disappointed. --Tryptofish (talk) 18:23, 24 June 2022 (UTC)

I took out "involuntary", as we agree on that point. Let's keep discussing - it is very difficult to summarize the "choice" issue vis a vis addition succinctly. What might work best is aiming to explain the complexities within the introduction as a whole, rather than trying to summarize it all in one sentence. That would also give us a chance to correct inaccuracies that remain in the introduction, e.g., the last sentence of the first paragraph ("habits" is a controversial concept as applied to addiction) and much of the 2nd paragraph - too much emphasis on "addiction" vs. "dependence". Of course, the body of the article needs a lot of work - it reads like an essay on how epigenetic explanations supersede almost all other etiological considerations. Yes, that is a bit of an exaggeration--on purpose to make a point. ;-) Mark D Worthen PsyD (talk) [he/him] 14:07, 24 June 2022 (UTC)

I agree with taking that word out, thanks. I'm going to hold back from trying to address the lead as a whole, and try instead to focus on the issues that remain in this talk thread. I still think it would be good to change the lead sentence this way: "Addiction is a neuropsychological disorder characterized by a persistent and overwhelming urge to use of a drug... ".

For the remaining issue, I think we all agree that it cannot be done in that one sentence. In the third sentence of the lead, the sentence that starts "This phenomenon...", I suggest modifying it to read: "... a brain disorder with a complex variety of psychosocial as well as neurobiological, and thus involuntary,^[3] and psychosocial factors that are implicated... ". It occurs to me that those factors that are psychosocial are the ones where it gets complicated as to what is voluntary and what is involuntary. On the other hand, those components that are exclusively neurobiological and not psychological are the ones that current addiction science has come to recognize as a disease rather than as a moral choice. This could solve the problem of wanting "involuntary" to be in there, and it also makes a per-source clarification of the part of the sentence about "... (drugs reshaping brain function), has led to an understanding of addiction...". That new understanding of brain reshaping is about the ways in which "voluntary" has become an anachronistic view. --Tryptofish (talk) 18:46, 24 June 2022 (UTC)

I've added the "urge to use" language, because "persistent use" could encompass someone who takes a drug for a chronic medical condition. (Nobody's addicted to insulin, but lots of people use it persistently.) Also, the characteristic difficulty is that you crave it, not merely that you use it. Some people drink more than is healthy for them, but they don't really have an urge for it; they're not really addicted.

Is the urge always overwhelming? I wasn't sure, so I didn't add that word. I don't mind if someone else wants to. WhatamIdoing (talk) 19:00, 24 June 2022 (UTC)

I think that's a good improvement. I don't feel strongly about "overwhelming"; generally, it wouldn't be addiction without it being overwhelming, especially in terms of doing things that are otherwise self-harmful. On the other hand, drug treatment depends on overcoming such urges. (But is recovery, where it's no longer overwhelming, no longer addiction?) If we make something like the other change, in the third sentence, then "overwhelming" in the first sentence becomes less urgent. --Tryptofish (talk) 19:14, 24 June 2022 (UTC)

An addiction is a compulsion, but IMO "Addiction is a ... persistent and intense urge to use a drug" is more-or-less equivalent to the definition of that term. Seppi333 (Insert 2¢) 21:11, 28 June 2022 (UTC)

I think that "persistent and intense urge" will be easier for people to understand than "compulsion", especially since many readers' notion of compulsive behavior will be the pop-culture notion of OCD, which is pretty much unrelated to actual OCD. WhatamIdoing (talk) 00:20, 29 June 2022 (UTC)

Neurobiological = involuntary?

"This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological (and thus involuntary) factors that are implicated in addiction's development."

We seem to be saying that if a pattern of behavior is associated with neurobiological changes, then that behavior is involuntary. Is that correct?

Define our terms

Since this is a controversial topic, we should define our terms. I suggest the following definitions:

involuntary, adj. 1. a. Not voluntary; done or happening without exercise or without co-operation of the will; not done willingly or by choice; independent of volition, unintentional. b. Physiology. Concerned in bodily actions or processes which are independent of the will.

neurobiology, noun : a branch of the life sciences that deals with the anatomy, physiology, and pathology of the nervous system.

Important questions

Next, we should answer (in the body of the article) questions such as these:

If drug use by addicts is involuntary ...

• why do contingency management programs have high success rates?

• why did 90% of American soldiers addicted to heroin in Vietnam stop using the drug when they returned home?

• why do criminal justice interventions like Hawaii Opportunity Probation with Enforcement (HOPE) enjoy success?

• why do most people addicted in their 20s stop using drugs--without treatment--in their 30s?

Mark D Worthen PsyD (talk) [he/him] 05:30, 1 July 2022 (UTC)

I am interested in your answers the questions above. (I am addressing any editor, not a specific person.) Mark D Worthen PsyD (talk) [he/him] 03:02, 2 July 2022 (UTC)

I think this is an example of Begging the question. You ask "If drug use by addicts is involuntary ...". I say: Drug use isn't involuntary. Drug addiction (=the persistent and intense urge to use, not the use itself) is involuntary.

With that in mind, why do these things work/happen? Because they help people address/control/resist the action that addiction urges them to take. WhatamIdoing (talk) 04:58, 2 July 2022 (UTC)

We're on the same page. :0) Mark D Worthen PsyD (talk) [he/him] 21:23, 3 July 2022 (UTC)

I do consider the use of "involuntary" to be correct as used there. If you disagree, please show me how you voluntarily cause ΔFosB to increase or decrease its modulation of cFos in your own brain. The sentence, as written, is not describing a "pattern of behavior", but rather uses the term "factors that are implicated in addiction's development". It's a neurobiological mechanism that gives rise to parts of the behavioral patterns. --Tryptofish (talk) 17:21, 1 July 2022 (UTC)

I think there is an important distinction between "being an addict" and "using". In this model, an abstinent addict is still an addict. This model lets us say things like "the involuntarily addicted person is voluntarily not using drugs (at this time)."

I don't know whether this model is the best model, the only model, or the relevant model for any individual. But in this model, "being an addict" is an involuntary state, and "using" is at least semi-voluntary. WhatamIdoing (talk) 17:55, 1 July 2022 (UTC)

"... 'being an addict' is an involuntary state, and 'using' is at least semi-voluntary." I agree, and we should make that distinction clear. Mark D Worthen PsyD (talk) [he/him] 00:56, 2 July 2022 (UTC)

Here's a quote from an oft-cited journal article: "Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction."

The author does a lot in that one sentence. For example, he asserts:

• Because a biological process occurs, biological explanations take precedence, they are essential, they're at the heart of the matter;
• Furthermore, since biological explanations are paramount, we can confidently play down the role of poverty, lack of access to quality medical and psychological care, substandard prenatal and infant care, trauma, etc. One of the ways he minimizes psychosocial factors is to overlook the fact that social, economic, and psychological factors increase the probability that a person will have more access to drugs, be drawn to a quick soothing (self-medicating) solution to their problems, and thereby subject themselves to repeated exposure to a drug of abuse. Thus, he begins his etiological analysis at the point where repeated exposure begins to change neurobiological processes and ignores the socio-economic antecedents.

• core, noun ... 2 : the part (as of an individual, a class, an entity) that is basic, essential, vital, or enduring as distinct from the incidental or transient.
• core, n. ... IV. The central or innermost part, the ‘heart’ of anything.

Mark D Worthen PsyD (talk) [he/him] 02:36, 2 July 2022 (UTC)

I wonder if that might be an example of the Is–ought problem, or perhaps just a garden-variety "my field is the most important" POV. We know that drug addiction involves a biological process, but how could anyone prove that this process is "at its core"? If heroin had never been invented (=a social thing), then nobody would be addicted to it now. It might also be a leap to say biology is at its core, but the biology of chronic stress, difficult childhoods, lead poisoning, trauma, inability to tolerate discomfort and boredom, etc. are not at the core.

But I don't think this is especially relevant to the point at hand, which is whether anyone actually "volunteers" to have that persistent, destructive urge telling them to take drugs. WhatamIdoing (talk) 05:08, 2 July 2022 (UTC)

I added an explanatory note (diff) that I hope will be acceptable. Mark D Worthen PsyD (talk) [he/him] 22:12, 3 July 2022 (UTC)

Works for me, thanks. (I added back the cite that had been there, but put it at the end of the sentence.) --Tryptofish (talk) 20:39, 4 July 2022 (UTC)

Woops, I changed my mind, at least in part. I made this change to the note: [1]. My point is that we should not frame it in terms of before-or-after being addicted. It's not like a switch that flips from one position to another once the neurobiological factors kick in, but rather, the neurobiological brain changes are what are involuntary. A person who is already addicted can still make a voluntary choice to try to get help to stop or control the addiction. Also, people can become addicted involuntarily in the first place – as when someone is hospitalized with a condition that causes severe pain, is medically prescribed an opioid analgesic, and becomes addicted to it without ever having made a decision to start using the drug. I hope my revision makes that clearer. --Tryptofish (talk) 18:30, 5 July 2022 (UTC)

Actually, even this doesn't address the involuntary nature of genetic predisposition, although that would be too much detail for the lead paragraph. --Tryptofish (talk) 18:47, 5 July 2022 (UTC)

PREVIOUS: "Before using a drug, an addicted person can control (decide) whether to use the drug, although resisting the urge becomes increasingly difficult as addiction worsens." ==> CURRENT: "A person can make a voluntary choice to start using a drug or to seek help after becoming addicted, although resisting the urge to use becomes increasingly difficult as addiction worsens."

Adding "to use" after "the urge" improves comprehension. Thank you.

Does "a voluntary choice to start using a drug" refer to the choice a person makes before using a drug for the first time? If so, then the sentence implies that the only times an addicted person can make a voluntary choice are (1) before they ever use a drug, and (2) if they decide to seek help.

Of course, in the first instance, the person is not addicted (since they have never used the drug), so I'm not sure how that statement helps explain the voluntary-involuntary issue. (If that was not your intended meaning, then it's simply a matter of copy writing to ensure comprehension.)

The point of the note is to draw a distinction between neurobiological processes over which the addicted person cannot exercise control versus an addicted person's ability to choose on a day-to-day basis whether or not to use the drug. The neurobiological processes are involuntary; the day-to-day choice is voluntary (or semi-voluntary, to use Whatamidoing's phrase).

Finally, "to seek help after becoming addicted" muddies the water because it implies that seeking help is the only rationale choice for an addicted person to make, or that seeking help is the only voluntary choice an addicted person can make. I am not saying that you intended one or both of those meanings, but it is how some people will likely understand the sentence. Better to leave out "seeking help" IMHO. (An additional reason is that wholesale adoption of the BDMA (brain disease model of addiction) often leads to assuming that addicted persons need direct treatment of their brains, e.g., pharmacotherapy, electrical stimulation, repetitive transcranial magnetic stimulation (rTMS), etc. If it's a brain disease, shouldn't treatment concentrate on changing brain functioning?)

I suggest the following revision: "In other words, a person cannot control the neurobiological processes that occur after using a drug. On the other hand, on any given day an addicted person can control (decide) whether to use the drug, although resisting the urge to use becomes increasingly difficult as addiction worsens." Mark D Worthen PsyD (talk) [he/him] 20:58, 5 July 2022 (UTC)

P.S. I am not saying that pharmacotherapy, for example, isn't important. Of course it is, as the success of Suboxone treatment shows. But what we want to avoid is overemphasizing one treatment approach to the exclusion (or minimization) of others. Many BDMA proponents do not hide the fact that in their view, medical treatment is paramount, and that psychosocial interventions are nice and all that, but we really need to treat the diseased brain! Mark D Worthen PsyD (talk) [he/him] 21:17, 5 July 2022 (UTC)

I agree with your PS. For the previous/current comparison with which you begin, the primary difference, as I see it, is that the previous version said "Before using a drug", and I changed it so it does not say that. The problem, as I tried to explain, is that it is not, as a generalization, true that this is something that is the case before starting to use the drug and no longer the case once drug use has begun. It's incorrect to frame it in terms of before and after. I gave examples above of where it's the other way around. So I object to framing it in terms of before using a drug. Your other points all relate to the lack of clarity and/or the inaccuracy of making it sound as though starting drug use and seeking help are the only or main situations where voluntary choice comes into play. I didn't intend to say that, and if it was unclear to you, then it's unclear to readers, so I agree that it should be fixed. I dislike the suggestion of "on any given day", for the reasons that WAID raised at the beginning: we want to correct the widespread misunderstanding that addicts are just making daily bad decisions for which they are at fault. I do think it's correct that there are voluntary aspects to what happens at the beginning of addiction and to what some addicts do when they decide to turn their lives around. But those are examples, not generalizations, and so I made this revision: [2]. --Tryptofish (talk) 23:10, 5 July 2022 (UTC)

References

WP:SPLIT

This article (special:permalink/1095945615): Prose size (text only): 46 kB (6823 words) "readable prose size"

My sandbox with the longest section of this article copy/pasted in (special:permalink/1095902068): Prose size (text only): 9707 B (1376 words) "readable prose size"

@Markworthen: I'm assuming you haven't read through WP:SPLIT and WP:SUMMARY STYLE in detail, given that you insist that the maintenance template should remain. Unless this article is significantly expanded, there is no point in splitting off any sections because the new article very likely won't grow and this article doesn't current need to be split based on its readable prose size. Moreover, the longest section of this article is 9.7 kB; replacing it with a summary style section would only reduce the article size by ~7 kB, which is a negligible reduction in page size.

The last time that content was split from this article, Personality theories of addiction (Prose size (text only): 13 kB (2153 words) "readable prose size") was created. I performed that split years ago. I don't remember the page size of the article at the time I performed the split, but based upon what I now know about what is acceptable information for a featured article and acceptable article sizes, Personality theories of addiction should be merged back into Addiction. If you're fine with that, I'll go ahead and perform the merger. If not, we can just leave it where it is for now.

Moreover, it really doesn't matter how niche the information included in a section of the article is. Amphetamine is a good example to make my point since it's an FA-class article about a psychoactive drug, and you happen to be a psychologist. If you bother to read through all 5 FA nomination pages, you'll learn that I spent an inordinate amount of time expanding and revising different sections of that article to meet what other editors deemed to be sufficient coverage of different subtopics. If you actually read the article, you'll realize some sections contain text with a comparable or even higher (graduate/PhD-level) reading level than this one (e.g., Amphetamine#Chemistry and Amphetamine#Pharmacology). That level of technical detail is perfectly fine for level 3+ subsections of an article so long as the material is summarized in the lead OR a level 2 section (analogous to a lead summary of the body, which is supposed to be written at a grade-school reading level). In the event that's not done, then the section heading or lead simply needs to be edited to include summary text at a lower reading level to permit understanding by a more general audience.

Cutting out content that you disagree with simply because it's very technical isn't a solution that benefits Wikipedia; it just moves problematic (but fixable) material from one article to another - without fixing that problem - for the purpose of removing content with which an involved editor disagrees in an article they edit. However, if the material in question constitutes largely irrelevant WP:COATRACK text (e.g., Special:diff/1095902068/1095946675 - the same could be said about hundreds of other marginally involved proteins), that's another issue entirely and such text absolutely should be removed from the article. Seppi333 (Insert 2¢) 11:26, 1 July 2022 (UTC)

I was going to review the material you suggested and give it some thought, but I see you have already reverted my revert. Since you elected to not discuss this issue on the talk page first, I can see where this would end up, so I'm going to let it go. Plus, I don't find it productive to respond to editors who repeatedly use phrases such as "I'm assuming you haven't read such and such in detail"; "if you bother to read"; "if you actually read"; and "cutting out content you disagree with simply because it's very technical". Mark D Worthen PsyD (talk) [he/him] 02:48, 2 July 2022 (UTC)

Oh, well in that case if you HAVE read them then you're (Personal attack removed). You do understand the policy, you're just choosing to ignore it. Seppi333 (Insert 2¢) 22:41, 7 July 2022 (UTC)

Move discussion in progress

There is a move discussion in progress on Talk:Substance abuse which affects this page. Please participate on that page and not in this talk page section. Thank you. —RMCD bot 15:34, 17 July 2022 (UTC)

Changes

Hello, Today I am going to be revising this article for a neutral tone, checking for grammar and mechanical errors, watching for concise language, making sure the article has a strong lead, organizing the paragraphs, checking sites, and finally I will be summarizing.

Courtneymfoster (talk) 03:01, 27 September 2018 (UTC) Courtney Foster

Hi, I would suggest adding more media to the article in order to cater to individuals with visual preferences and just adding some flavor and appeal to the reading. HurinThings (talk) 23:58, 26 September 2022 (UTC)

Wiki Education assignment: HTHSCI 3E03

This article was the subject of a Wiki Education Foundation-supported course assignment, between 6 September 2022 and 6 December 2022. Further details are available on the course page. Student editor(s): Tylersunnb, Tunnardc, Gethmie.d, Karim wadie123, Allen1426 (article contribs).

— Assignment last updated by Mcbrarian (talk) 20:11, 4 October 2022 (UTC)

Arts and Humanities Approaches to Addiction

Continuing and expanding an old suggestion from 2018 now in archive 3.

Will divide into two sections: Historical A&H approaches and Contemporary A&H approaches. Each will explore A&H perspectives/depiction/understandings of addiction (artist to society) and A&H as a healing intervention (artist as therapist for person living with addiction, person living with addiction as artist). Tylersunnb (talk) 20:18, 18 October 2022 (UTC)

Literature representations, maybe talk about Patrick Lane "Counting the Bones" — Preceding unsigned comment added by Tylersunnb (talk • contribs) 00:07, 4 November 2022 (UTC)

Internet addiction

It exists in neither DSM nor ICD. It isn't a valid medical diagnosis. tgeorgescu (talk) 20:59, 22 November 2022 (UTC)

Hi @Tgeorgescu: Thanks for your contributions to this work. We appreciate feedback from other editors.

I understand that internet addiction is not identified in the DSM or ICD. While I understand a strong preference for medical conditions to be identified in either the DSM or ICD, or both, I have some concern about relying only on these two publications as indicators of what constitutes a valid medical diagnosis. I will place that concern to the side however, and focus on why including internet addiction has merit. There has been significant debate within medical literature with respect to whether problematic or compulsive internet use can be officially considered a valid medical diagnosis under the umbrella of addiction. It might be more constructive to restore the deleted content and have the student editor revise their contribution so that it more accurately summarizes that discussion. I understand your concern about identifying internet addiction as a medical condition since there is no acknowledgement of this kind in the preferred diagnostic manuals. However, it is important to summarize the existing knowledge on internet addiction: it is not yet considered addiction but discussions on the matter are ongoing. I will support the student in their efforts to revise this content. Mcbrarian (talk) 21:21, 22 November 2022 (UTC)

@Mcbrarian: Okay, then go ahead, but please do not restore the unreliable sources mentioned above. tgeorgescu (talk) 21:23, 22 November 2022 (UTC)

Hi @Tgeorgescu,

Looking into that and remedying the situation is next on my to-do list. Agreed that those websites are not MDRS. I am working with the student right now to rectify. She believes it may have simply been an oversight when adding her citations. Mcbrarian (talk) 21:27, 22 November 2022 (UTC)

Epidemiology: Addiction Prevalence vs Usage Prevalence

Upon reviewing the epidemiology section, I've come to find that many sections use prevalence of usage rather than prevalence of addiction, such as daily tobacco users in Europe, or general smartphone ownership in Asia. While it makes sense in the absense of other information, and given the fact that addiction isn't as easily measureable, it is not the same thing. I'm wondering if going forward if it makes sense to keep it exclusively about addiction, or if a more relaxed limitation in favour of filling out the section is better? Tunnardc (talk) 00:07, 28 October 2022 (UTC)

@Tunnardc, do you feel like the difference is clearly labeled in each instance?

IMO talking about daily tobacco users seems reasonable, because I understand there's a fairly high overlap between daily use and addiction. The prevalence of smartphones strikes me as weaker. Especially for people who don't have a personal laptop, you could be a "heavy user" (e.g., to slowly type your homework on a tiny screen) without being "addicted". Clearly identifying each meaning could help. In the case of the smartphone use, the signal might need to be strong: "Although owning or using is not the same as being addicted..." I think the main relevance is that if x% of people have regular access to a smartphone, then that's the maximum number of people who could be considered at risk for smartphone overuse. WhatamIdoing (talk) 15:36, 2 November 2022 (UTC)

agree w/ WAID--Ozzie10aaaa (talk) 12:19, 5 November 2022 (UTC)

Thanks @Ozzie10aaaa and @WhatamIdoing for sharing your insights with this student !Mcbrarian (talk) 19:15, 8 November 2022 (UTC)

I suppose the only drawback to using a prevalence of use statistic is that the fraction of a population of drug users that become drug addicts for any given drug is variable across cultures and over time. Statistics for the prevalence of addiction itself are probably going to be difficult to find and will be subject to potentially large measurement errors for various reasons. Seppi333 (Insert 2¢) 20:31, 21 November 2022 (UTC)

Thanks @Seppi333! We really value your input. I had similar concerns. I don't think there's a definite answer here. Mcbrarian (talk) 21:43, 22 November 2022 (UTC)

Food Addiction

There has been an ongoing debate on whether to classify food addiction as a behavioral addiction or as a substance use disorder/drug addiction. The evidence for food addiction to be classified under a behavioral addiction is through the consensus that eating is the addictive behavior that results in the 'high'. The evidence for food addiction to be classified under a drug addiction/substance use disorder is that the high sugar/fat content of certain foods rewire the brain's reward system, resulting in addiction (similar to many drugs and alcohol). I found it necessary to classify it has a behavioral addiction at first but then moved it up to the 'drug addiction' section because I felt as though it fit the description of a drug addiction better since food addiction was particular to foods with high fat/sugar content and not to disordered patterns of eating. However, I'm curious to know whether other users agree or disagree and how we should classify food addictions such that it is easily understood. --Gethmie.d (talk) 20:49, 22 November 2022 (UTC)

@Gethmie.d: This website: https://www.addictioncenter.com/drugs/porn-addiction/ is not WP:RS. It speaks of really existing porn/sex addiction, while according to DSM-5-TR (March 2022) there is no such thing as porn/sex addiction. Same applies to https://www.addictioncenter.com/addiction/behavioral-addictions/

https://www.advancedrecoverysystems.com/process-addiction/ is not WP:RS for the same reason: it posits a bogus medical diagnosis.

Let me repeat it very clearly: sexual addiction and pornography addiction are not recognized medical diagnoses. Meaning the American Psychiatric Association and the American Medical Association do not recognize them as valid diagnoses. And ICD-11 (meaning the World Health Organization) does not recognize that CSBD would be an addiction.

If these two websites tell their patients that medical insurance pays for treatment for sexual addiction and/or pornography addiction, that's fraud. tgeorgescu (talk) 21:27, 22 November 2022 (UTC)

Hi @Tgeorgescu

I have reviewed your deletions. I am in agreement that the sources cited are not WP:MEDRS. I have connected with the student editor and they will be looking for reliable sources to support the content. If they can find reliable sources to verify the the content, they will restore the deleted content with new, reliable citations. I have direct them to review WP:MEDRS before they repost the removed content. I do wish to point out one thing though: the porn addiction web page was not cited here. But it is no matter, since it is the website, not the web page, that is problematic. Thanks again for your keen eye. Mcbrarian (talk) 21:47, 22 November 2022 (UTC)

Missing info on neurobiological impacts beyond protein-level reward-system changes

I think the article is missing info on neurobiological impacts of various excessive uses of various drugs and addictions, such as neuroanatomical ones and changes that aren't as related to reward systems.

For example:

The craving and deficits in executive function in the so-called preoccupation/anticipation stage involve the dysregulation of key afferent projections from the prefrontal cortex and insula, including glutamate, to the basal ganglia and extended amygdala. Molecular genetic studies have identified transduction and transcription factors that act in neurocircuitry associated with the development and maintenance of addiction that might mediate initial vulnerability, maintenance, and relapse associated with addiction.

Asking because this was recently featured in 2022 in science:

Neuroscientists report PFC-Hb connectivity white matter impairment in both cocaine and heroin addiction.

Maybe a new article like neurobiological effects of physical exercise may also be warranted and/or additions to another article and/or a change of the header "#Mechanisms" to e.g. "#Mechanisms and impacts".

References

Prototyperspective (talk) 20:43, 1 December 2022 (UTC)

Layout

In my edits to this article in the past couple months, I have noticed there are some layout problems (not just sections being out of order, info is duplicated or in the wrong section in some places), as well as missing an Outlook/Prognosis section. I have been moving things around in my sandbox and am going to leave a note here to see what people think about re-arranging things vs. keeping them the same. For reference on what a suggested layout for a medical condition article, see WP:MEDSECTIONS. Lalaithan (talk) 02:14, 7 April 2023 (UTC)

Original research

@7e8y: CodeTalker is right. Even if it is true what you say, it is your own analysis of the ICD, it is not a view explicitly expressed by the ICD. tgeorgescu (talk) 08:16, 16 May 2023 (UTC)

Right, if you want to add a statement that says "the ICD-11 is ambiguous", you need to cite a source that says exactly that. You can't cite the ICD-11 itself along with your own analysis of it. CodeTalker (talk) 18:56, 16 May 2023 (UTC)

Non brain-based theories of addiction

This entry is notably, shockingly devoid of what has become a major cascade of evidence and theory that the brain theory of addiction is grossly misguided: see Stanton Peele (situational, experiential Life Process model), Gene Heyman (choice model), Lee Robins (natural recovery, Vietnam), Nick Heather (“Evaluating the BDMA”), et al. 68.237.106.46 (talk) 22:08, 4 June 2023 (UTC)

Everything added to Wikipedia needs to meet our sourcing standards, which in this case would be WP:MEDRS. Your addition was completely unsourced and apparently espousing a minority viewpoint outside the scientific mainstream. MrOllie (talk) 17:49, 1 July 2023 (UTC)

I agree. But we need more editors familiar with that research to help improve this article. Please consider learning how to edit Wikipedia articles and contributing. For most medical and psychological articles we are able to reach consensus and write good encyclopedia articles supported by references to the research (and related) literature. In my experience, Wikipedia rules and guidelines about reliable sources and related topics are as rigorous as well-respected medical and psychological journals. Our objective here is different--Wikipedia is an encyclopedia, not a professional journal--but the principles regarding sound evidence are the same. Mark D Worthen PsyD (talk) [he/him] 16:58, 29 September 2023 (UTC)

This article is heavy on the biomedical perspective and could benefit from more comprehensive coverage of psychosocial models, along with updated research.

Meadair (talk) 03:57, 26 September 2023 (UTC)

Yes, and at one point we hammered out a consensus for the introduction, which has since been mangled beyond recognition. {See this talk page's Archive 3, and especially, Archive 4.) Mark D Worthen PsyD (talk) [he/him] 07:17, 29 September 2023 (UTC)

So you know of what I speak, compare the current introduction to this one (5 July 2022):

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens (but does not completely negate) self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological (and thus involuntary) factors that are implicated in addiction's development. Classic signs of addiction include compulsive engagement in rewarding stimuli, preoccupation with substances or behavior, and continued use despite negative consequences. [Footnotes omitted, but you can see them at the diff for that date.] Mark D Worthen PsyD (talk) [he/him] 07:32, 29 September 2023 (UTC)

I restored the consensus intro (diff). I suspect someone will revert it, but it would be great if we could discuss this and start with what's there now (after my edit) since that was written after lengthy, detailed discussion and represents consensus. Mark D Worthen PsyD (talk) [he/him] 07:41, 29 September 2023 (UTC)

I'm planning to draft a section in my sandbox about additional psychosocial models (e.g., social learning, affect management model, etc.). I'm not planning to make significant changes to what is already written. Meadair (talk) 21:01, 3 November 2023 (UTC)