What is the difference between an addiction and a compulsion? How do people find out which one of these they have problems with?
ANSWER: Hello Hank,
Thank you for submitting these questions to me at AllExperts.com! I can understand how there could be some confusion between the terms addiction and compulsion. Both of them involve a need/urge to engage in some behavior.
A compulsion, according to the Diagnostic and Statistical Manual, IV-TR (DSM-IV-TR), is defined as "repetitive behaviors or mental acts the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification." Compulsions are often related to obsessive thoughts in the diagnosis of Obsessive Compulsive Disorder wherein the individual experiences persistent ideas, thoughts, impulses or images that are intrusive and which cause great distress/anxiety and then engages in compulsive behaviors to reduce these feelings. Compulsions are engaged in to reduce negative experiences of anxiety.
Addiction, on the other hand, is not a diagnosis or diagnostic criteria in the DSM-IV-TR. Instead, the DSM-IV-TR looks at substance disorders as dependence or abuse. Dependence includes a a maladaptive pattern of substance use leading to clinically significant impairment or distress. This includes use that has led to the development of tolerance and withdrawal. It includes the need to consume the substance (or engage in the behaviors) in increasingly larger doses and/or more frequently over time, repeated attempts to reduce use and excessive amounts of time to obtain the substance or participate in the activity. An addiction is generally associated with chasing positive feelings (feeling euphoric, calm, "high," etc...).
For both compulsions and addiction interfere more and more with daily life, which can increase negative feelings about the compulsion or addiction. There may be a compulsive nature to addiction, but they are not the same. Also true of both addictions and compulsions, there is a degree ego-dystonic feelings associated with the behaviors; in other words, the person is aware, at some level, that their actions related to the compulsion or addiction are not healthy.
I know that this is a lot of information, and I hope that this answers your questions. Please write again if you would like additional information.
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QUESTION: I can understand that a compulsion is "repetitive behaviors or mental acts the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification.". To me that seems to be why many people drink alcohol. They drink alcohol just to get rid of the anxiety they have. So do alcoholics have a problem with addiction or compulsion?
Thank you for this follow-up question. An alcoholic may experience compulsions to drink alcohol if their addiction is strong. While the substance use started as something to feel good, over the course of use the individual's body becomes accustomed to having alcohol in their system. This is often illustrated by people who have a hard time getting out of bed without using their drug of choice such as a morning cigarette, shot of alcohol, or shooting up. For these individuals, their body no longer functions without the substance. This is reversible with treatment, though it is not a pleasant experience.
People who use alcohol, for example, to take the edge off of their anxiety could develop a substance abuse problem but this would likely be secondary to their anxiety disorder; that is if either of these concerns reaches clinical levels. Many people use alcohol as a social lubricant, that does not necessarily mean that they are alcoholics. If you are able, please look up anxiety disorders and substance abuse disorders in either the ICD-9 or the DSM-IV-TR. In the DSM, I believe there is a decision tree for distinguishing between the two.