Historical and Conceptual Approaches to Addiction

This chapter traces the evolution of the term ‘addiction’ over time, demonstrating how its meaning has altered in the face of social and political changes in society. The second half explores the story behind the diagnostic terminology used in clinical practice today, and describes the recent changes to the addiction section of the major classificatory systems. Addiction is conceptualised as a disorder involving a loss of the normal flexibility of human behaviour, leaving a dehumanised state of compulsive behaviour (‘overwhelming involvement’). It has acquired a variety of terminology over time, much of it inferring moral weakness. Addiction may be associated with psychoactive substances or other pleasurable behaviours and occurs on a spectrum of use and harms, which vary in severity. The term ‘dependence’ may refer to physiological aspects of addiction (tolerance or withdrawal), but is also used to define the severe end of the spectrum. Confusion around this terminology has led to it being removed from the latest version of the Diagnostic and Statistical Manual (DSM-5).