This model of addiction provides a simple, clear definition and description of addiction. It can be used to identify any type of addictive behavior, and provides a basis for understanding and treating addiction. Simply stated, addiction can be identified by two major factors: loss of control and unpredictability.

These two factors can be described in the following fashion.

  Loss of Control

Loss of control occurs in at least one of three ways:

1.How Much: “Once I start, I can’t stop”

 Binge use may be once a month, once a week, or at erratic intervals; the key factor is that some  external condition or event ends the use.  The addict may run out of money, or product, (drugs, etoh,  etc.) or energy; they may pass out, or get arrested or institutionalized. The essential point is that some  external force stops the behavior.

2.When:  “I don’t want it all, I just want it all the time”

 This is the classic picture of the narcotic addict; someone who needs a steady supply of the drug at regular intervals, The behavior is Maintenance Use; if the addict does not maintain a blood (etoh, narcotic, sedative) and/or brain level (cannabis, nicotine) of the drug, they begin to experience physical withdrawal.

3.What Happens:  This category is linked to the first two, but can also stand alone since the use cannot be categorized as either maintenance or “binge”.

 The user suffers from “Pathological Intoxication”, a dramatic mood/behavioral change which occurs when only a small amount of the drug is ingested.

 Loss of control can manifest itself in one of several ways. The life areas which can be affected include:  Physical, psychological, emotional, social, school/employment, legal, family, financial, and spiritual. You only have to have one life area affected in order to be addicted. If you continue to use in spite of negative consequences, that’s addiction.

Unpredictability

Unpredictability means that the outcome cannot be safely assumed.  The addict may state that he is only going to have “two beers” and then winds up intoxicated. No one plans to get a DWI, or be in a traffic accident, or get arrested, or spend his entire paycheck, or have a fight with parent, spouse, child, or significant other. No one plans to lose his job, or become institutionalized, fail school, or sustain physical damage due to his use.  The difference between the addict and the non-addict is that the non-addict can overwhelmingly predict the outcome; his use or behavior does not affect any of the life areas identified. If misuse or negative consequences occur, the behavior is abandoned or corrected subsequently.

Treatment Implications

Effective addictions treatment requires the addict to acknowledge the behavior and be willing to stop or  manage it.  Alcoholism and other drug addictions require abstinence; “behavioral” addictions such as eating disorders, compulsive shopping or spending, Internet addictions, pornography, compulsive sexual behaviors, etc. require management. All require some type of supportive therapy. One must recognize the potential for co-morbidity with mood or anxiety disorders that may require specialized treatment or medication.  As a rule, co-morbid conditions are treated simultaneously with the addiction in order to minimize the possibility of relapse.