Hey there. It's Dr. Susan Peirce Thompson. In this week's vlog, we're going to talk about the family resemblance of addiction. That might not be in the way you would be thinking that addiction runs in families, which is true, but actually about a much deeper categorization structure that cognitive psychologists talk about. Let me start with a quick story. A few days ago, in the very last deep dive session, it was the last final, final, final workshop for the launch of the book Maintain, which is out everywhere now. This woman named Brenda raised her hand. She's a longtime Bright Lifer™. I've known her name for a long, long time now. And she said, "Susan, what's the difference between dependence and addiction?" I asked her some questions and here's the story she told, and I definitely got her permission to share this with you on the vlog.
She said that years ago she was diagnosed with a condition and she was prescribed a benzodiazepine medication for that condition. At the time she didn't really know much about benzodiazepines. It was prescribed by her doctor. It was helping with the symptoms of this very severe condition, and years later, she discovered that her body was so physically dependent on that benzodiazepine that she had to be put on a two-year weaning schedule to get off of it safely. Now, I know this about benzos. They're a beast. They're highly addictive. They are one of relatively few meds that can kill you if you just take yourself off them abruptly. So, she's very wise to do a slow, protracted weaning off of them. And they're horrific. I mean, they're just horrific. They're really, really damaging meds in a lot of ways. And they get prescribed like candy. I mean, it's kind of a ... I think it's a problem personally. Anyway, I know they also help people with lots of things and lots of people are able to take them moderately. The challenge is the doctor writing the prescription doesn't know who's going to be able to take them moderately. Anyway, that was her question. She said, "I am dependent on this benzodiazepine. My body is, but I don't feel addicted to it. I never wanted to take it. I don't crave it. I don't desire it. I never have. " She said, "This feels very different for me than the addiction, for example, that I feel to sugar and flour," even though she said I kind of struggle with the notion of addiction to food or sugar and flour as well. Although we talked about that and I think she kind of got over that hump a little bit in our coaching session, but she said with food and sugar and flour, she feels the pull. She feels the craving. She knows that she has a hard time stopping sometimes once she gets going. All of that feels fairer to call addiction. Whereas, she's got this dependence, the substance dependence on this other drug, and she just wanted to know what the difference was. I said, "Brenda, I'm so glad you asked this because I'm going to share with you my answer and my thoughts, and I want to shoot a vlog on this because I've been wanting to talk about this topic of what addiction is in terms of its core category structure for a long time. I've had this topic on my list of possible vlogs to shoot for so long, and this is the perfect story to sort of shoehorn into the topic."
Basically what I said is addiction, I believe at its core, as a category of situations that manifest in the world in people where people manifest addiction to some degree or another, to alcohol, to drugs, to food, particularly highly processed foods like sugar and flour, to gaming, to pornography, to shopping, to all sorts of things, and to determine which clusters of behaviors and urges and relationships fall under the rubric of addiction or that you would say, okay, that is clearly addiction versus which ones don't, it's a tricky line to draw and different philosophies or organizations draw that line differently. I would argue that addiction is a family resemblance category and that can help people think through what the addictions are in their life.
What does a family resemblance category look like? Well, it looks like a family resemblance. Let me just explain. Let's imagine there's the O'Malley's. They're Irish and they have lots of kids and so there's lots of O'Malleys running around. You know an O'Malley or you think you do because they look a certain way, right? O'Malleys tend to have red hair. It tends to be straight red hair, straw thin in fact, but very red. They tend to have freckles. They tend to have large noses. They tend to have round faces. They tend to be short. They tend to have stocky bodies. They tend to have high voices and a twitterpated laugh. They tend to have very crooked teeth, the O'Malley's. They tend to have short, stubby fingers. I could go on, right? They tend to be very, very smart. These are all traits that any individual O'Malley may or may not manifest, but when you start to see several of these characteristics, and in particular, if you meet the person in one of the towns in Ireland where the O'Malleys tend to reside, you might start to wonder, "Oh, is this an O'Malley kid?" So, that's the idea of a family resemblance category structure.
Now, in a family resemblance category structure, it may be difficult to determine what are the necessary and sufficient conditions for category membership because there might be plenty of O'Malleys who aren't ginger or don't have freckles or have perfectly straight teeth. Maybe they got braces. I mean, it can be difficult to say definitively by looking at them, "This person is an O'Malley versus not. " But as the features start to accumulate and be more and more and more numerous, you start to become more and more comfortable in your assessment that this is probably an O'Malley. Okay. So, that's what I think addiction is.
In the DSM-5 by the American Psychiatric Association, they take a similar approach. They say that there's 11 features of addiction. These would be the ginger hair, freckles, round face, crooked teeth, kind of 11 of them. They also, though, do give a necessary and sufficient condition, which is that to have addiction, and they don't call it addiction, they call it substance use disorder, but whatever, To have this disorder, someone needs to have a clinically significant degree of impairment or distress, impairment or distress, and then they have to have two, just two, just two of the 11 symptoms. So long as they have a clinically significant degree of impairment or distress. Now, this is still a judgment call because who's to say what clinically significant means? It means quite a lot, but it's going to be a judgment call always. Now, the 11 conditions, I've listed them, you can find them really easily, but one of them is very similar to physical dependence, that physical dependence that Brenda was talking about. They call it withdrawal. If you take yourself off the substance, you have withdrawal symptoms, nausea, dizziness, feeling like you want to vomit, etc. And also, tolerance, like you need more and more of the substance to get the same result. Both of those could be sort of twinsies in the physical dependence category, but the rest of them are more psychological or having to do with behavior or functioning or fitting in in the world. Things like, is it causing problems with your relationships or your occupation or your functioning? Are you experiencing a lot of cravings? Or have you tried over and over again to quit and had no lasting success? Those sorts of things.
Now, the Big Book of Alcoholics Anonymous is much simpler in its diagnostic criteria. It says, if when you honestly want to, you have a hard time stopping altogether, or if when you start, you have a hard time controlling how much you do it or how much you consume, then you probably have this problem. In the big book, it says you probably are an alcoholic, but they say probably, and they leave it up to the reader to decide for themselves. I think that's wise. I think that's wise.
How is this helpful? Well, first of all, it makes clear that physical dependence is just one of many, many, many traits in this family resemblance category structure. It also makes clear that as you get to know addiction better, you can start to see and identify and learn some of the traits that might for you make you feel like, "You know what? I'm an O'Malley." For example, one of them that I think is really indicative of the earlier stages of addiction is that when you engage in the behavior or substance, you don't know what kind of results you're going to get. It's kind of like pulling a slot machine lever where sometimes it pays out, sometimes it doesn't. In this case, the payout is actually bad consequences. You might pick up a cookie and get away with it. Sometimes you might go out to eat at a certain restaurant and walk away not feeling overly stuffed and hating yourself sometimes. Then other times you might have a terrible experience and really regret it deeply and feel like, "This is a problem. Why do I keep ending up here?" And if you learn that that is actually extremely common as addiction develops, that you enter a zone, a state, a period of time, which could go on for years where when you engage with that addictive substance or behavior, you don't know what's going to happen. You don't know what the outcome is going to be. You don't know if you're going to get away with it or if you're going to suffer for it. That Russian roulette crapshoot is part and parcel of the development of addiction. And so, if you learn that, you might be able to diagnose yourself earlier and save yourself a lot of misery.
Basically, I think addiction is much, much, much bigger than a substance dependence. I think that in the case of Brenda, it sounds to me like although there was a substance dependence there, it was missing almost all of the features that make something addiction. It's sort of like someone came into town with crooked teeth and someone said, "Oh, is that an O'Malley?" And it's like, "Not at all. " They don't have any of the other features. I'm pretty certain that is not an O'Malley. Crooked teeth alone doesn't an O'Malley make
I think understanding the fullness of the category structure as a family resemblance category helps an individual to start to get a feel for their own addiction and what features might matter to them. For me, what's become diagnostic ... I mean, I know I'm an addict, but what's become diagnostic lately or what matters to me most lately is whether I feel aligned or I feel off. That's how I tell whether what I'm doing to treat my food addiction is working. At the deepest level, do I feel aligned or do I feel off?
Whatever kind of addiction you might have in play, it almost doesn't matter if you label it addiction as long as you're willing to do what it takes to rectify the situation. The only reason I use the term addiction for myself, I call myself an addict, is because it motivates me to take my medicine, to work a strong enough program to keep the symptoms in remission, and because it gives me a more compassionate explanation for why I do so many of the things that I seem to do, that I know that I have the type of brain that tends to be inclined to act out in certain ways. And I can chuckle and love myself through it much more readily because I understand that I have the brain of an addict. I'm not bad. I'm not flawed even. It's interesting because so many people think that using the label addict means that you're labeling yourself in some pejorative way. I sort of think that if I don't use that label, it makes me inclined to think all sorts of bad things about myself because why would I be doing this stuff otherwise? So, for me, accepting the label of an addict is the self-compassionate path, but hey, pick your own style. I have no horse in the race of however you want to label or not label yourself. I know words are powerful and they matter and choose the beliefs that serve you and think of things in a way that serves you. Maybe the family resemblance structure of addiction doesn't serve you. I don't know, but I find it very helpful. So, I offer it to you in this week's vlog and there you go. I'll see you next week.
