Addiction-as-a-kind hypothesis

Abstract

The psychiatric category of addiction has recently been broadened to include new behaviors. This has prompted critical discussion about the value of a concept that covers so many different substances and activities. Many of the debates surrounding the notion of addiction stem from different views concerning what kind of a thing addiction fundamentally is. In this essay, we put forward an account that conceptualizes different addictions as sharing a cluster of relevant properties (the syndrome) that is supported by a matrix of causal mechanisms. According to this "addiction-as-a-kind" hypothesis, several different kinds of substance and behavioral addictions can be thought of as instantiations of the same thing-addiction. We show how a clearly articulated account of addiction can facilitate empirical research and the theoretical integration of different perspectives on addiction. The causal matrix approach provides a promising alternative to existing accounts of the nature of psychiatric disorders, the traditional disease model, and its competitors. It is a positive addition to discussions about diagnostic criteria, and sheds light on how psychiatric classification may be integrated with research done in other scientific fields. We argue that it also provides a plausible approach to understanding comorbidity.In recent years, the concept of addiction, as it is used both in research and in policy contexts, has been expanded to include new behaviors (e.g., gambling, eating, sex, shopping, exercise, even internet use). There has also been critical discussion about the value of a concept that covers so many different substances and activities. In this essay, we present an account of the conditions under which several kinds of substance and behavioral addictions can be thought of as instantiations of the same thing-addiction. We call this account the "addiction-as-a-kind" hypothesis.The account describes what addiction would look like if it were a legitimate psychiatric kind. We call it a hypothesis because it is an empirical question whether different addictions really constitute such a kind. In this essay, we will not assess the empirical support for the hypothesis, but will focus on describing some of its general characteristics. In other words, we describe what a general theory of addiction could look like.The paper is structured as follows. First we frame our theory by briefly considering some difficulties with the traditional disease model and its alternatives. Then we present our addiction-as-a-kind hypothesis and the underlying causal matrix view of psychiatric kinds. The final section discusses the issue of comorbidity and, based on the hypothesis, offers some suggestions for addiction research. The Problem With the Traditional Disease Model

The images theory of addiction

“…Changes in the body cannot be understood as causes of the behavior any more than the social ones that lead to them (cf. Ylikoski & Pöyhönen, 2015). Addictive behaviors, such as excessive drinking, drug use, gambling-and, to add one emergent type of addiction, internet use-develop from culturally defined and regulated pleasures that must be learned (Rantala & Sulkunen, 2011;Sulkunen, 2007).…”

Addiction: A highly successful, essentially contested concept

“…Although the models represent different approaches to the concept of addiction, they all talk about addiction as a repeated, powerful motivation to engage in a particular behavior despite the experience of risk and significant harm. Ylikoski and Pöyhönen (2015) make addiction into a test case for improving the models of diagnostic criteria. They propose that addiction could be seen as a kind with certain core elements situated in a matrix of causal relations, which would make addiction recognizable despite its many variations.…”