Definitions

Abuse behaviors are positively motivated (essentially pleasure-seeking) and often performed wholeheartedly, with little internal conflict at the time. This occurs despite the possible awareness of the individual that the behavior is in some way "bad". "Bad" may be defined as behavior that goes against the prevailing culture, is harmful to others, or is unhealthy to self, etc. The primary purpose of abuse behavior is to feel good or at least better. The abuser appears to exercise some control; i.e., abuse behaviors stand side by side with other positively perceived behavior options. If there is a special reason not to abuse, an individual will usually abstain. In other words, there are other choices the abuser perceives as comparably good.

Addiction is an essentially normal psychological response to exposure to abusable drugs "at the wrong time" with consequent increasing abuse. Addiciton develops when there are no protective factors; that is, when the person has no strong reason to refrain from the attractive abuse behavior. Addiction is not "compulsive." It is a pleasure-seeking (positively motivated) behavior pattern that dominates much of the addict's life and is continued despite negative consequences. To the addict, pleasure and avoidance of temporary withdrawal are more important than the negative effects of the abuse pattern. In addiction, the abuse behavior appears to have become a first priority. Addiction is often defined in terms of frequency of behavior. However, the severity of preoccupation is probably more important than actual frequency of use. There are often positively perceived, pleasurable obsessions individuals have, only their frustration and/or moral conflicts act as deterrents. Addiction is a learned, disordered-thought behavior pattern -- a core disturbance of the emotional-behavioral system. Addiction is not a disease in that it does not damage tissue. Normal behavior patterns still exist, are intact, and can be utilized when abuse/addiction behaviors stop; for example when treatment starts or when the patient finds powerful, positive motivation that acts as a deterrent.

Compulsions serve to avoid an irrationally feared occurrence. Insight is not helpful in stopping them. Compulsions are negatively motivated and ego-dystonic; i.e., they do not feel good. They are often performed repeatedly with only gradual or partial relief. Compulsivity usually includes negative obsessions with mental rituals occurring frequently.

Physical habits, such as nail biting, hair pulling, or skin picking, may represent exaggerated primitive inborn behaviors ("reptilian", "over-grooming behaviors"). Their frequency often increases with anxiety but seem automatic with little associated emotion. They do not relieve anxiety.

Habits are basically neutral -- not 'good' or 'bad'. Positive habits are often "compulsively" adhered to because the individual fears getting out of routine and losing benefits. Positive and neutral habits may be valued as part of the individual's personality. Damaging and destructive habits are generally part of psychopathology and/or abuse-addiction patterns.

Positive and non-damaging, neutral pleasurable habits are not addictions. For example, masturbation is an addiction if regularly pursued in spite of a belief that it is wrong or damaging, otherwise it is, generally, a neutral pleasurable habit.

Misuse refers to inappropriate use. Examples include self-medicating with a medication prescribed for another condition, and the use of alcohol or illicit drugs as psychotropic medications for psychiatric disorders.

Cultural use includes regular and structured use of alcohol and other drugs within specific contexts prescribed by the culture. In cultural use, the drug is not used for self-medication or as a form of pleasure-seeking. Cultures may encourage "acting out" and pleasure seeking behaviors during a specific festival or rite. For some people, such cultural drug use may lead to abuse and addiction patterns. Generally, the more structured a behavior is, the safer it is.

Dependence generally refers to a physiological adaptation to a drug, with tolerance and withdrawal occurring on discontinuation. In contrast, psychological addiction generally refers to regular abuse. Many non-abusable drugs lead to dependence, e.g. Aspirin and blood pressure medications, and many people are dependent on abusable drugs without being addicted. Examples include tranquilizer use for treatment of diagnosed anxiety disorders, or opiate pain medication use during prolonged treatment of major burns.

Non-pharmacological abuse and addiction patterns are frequent. Examples include gambling, consumption addiction, "perversions" (inappropriate ways of instinct fulfillment which are in some way damaging and used to relieve boredom and stress or for pleasure) (e.g., addictions to aberrant aggressive, sexual or eating behaviors). Money, representing most forms of instinct fulfillment, can be addicting. Sometimes dynamics are unclear: "workaholics" may possibly be avoiding family or addicted to material wealth rather than addicted to work.