We used to think of addiction as a moral sin — something that happened to people who were weak, or sinful, or broken in some way. Over time, this view grew into the perception of addiction as a moral failing, or some type of personal deficit that made some people become addicts and others not. The first few haphazard attempts to medically describe the disease of addiction still held onto this viewpoint, that addiction was caused by an inborn character weakness; eventually this gave rise to the idea of an “addictive personality”, a vague series of personality traits thought to cause addiction.
The concept of an “addictive personality” as a cause of addiction has been discredited for years, ever since physicians have begun to think of addiction as a physical disease and not an inbred moral issue. It became clear that certain chemicals had the potential to addict anyone, regardless of personality, and before long most serious medical discussions had abandoned the concept of an addictive personality altogether.
Now, as we struggle with the concept of addiction as disease of the brain, those who work with addicts still have to deal with the many “bad” behaviors that those with addiction display. We have also started to realize that to some extent many people with addiction display many of the same characteristics — poor judgement, poor evaluation of risk/benefit analysis, impulsevenss, easy boredom, craving for excitement, difficulty learning new
behaviors, lying, and others. These clusters of behaviors seem to be common to many suffering with addiction; in other words, they appear to form a pattern of behavioral symptoms that are linked to the physical disease.
Do these behaviors arise because of the addiction and the neural damage it can cause, which would make them a set of acquired cognitive deficits secondary to the development of addiction? Or are they a set of dormant, inborn characteristics that exist in our patients that are pre-disposed to developing addictions (which we know have a genetic component)? We don’t know the answers to these questions, and they will be very difficult to study, partly due to the complexity and misunderstood nature of addiction, and partly because it develops at a very early period of life when a person’s full personality is not yet formed. If, at some point, it can be proven that these behavioral traits come before addiction and contribute to its development, then perhaps there is a definition for an addictive personality disorder after all.
The discussion of a possible “addictive personality disorder” is not about developing a new way to label addicts, or trying to go back to the concept of addiction being some type of inbred defect. If there were a cluster of personality traits that we could recognize as being suggestive of the development of an addictive disorder, then perhaps it would lead to early
recognition of a “pre-addiction” condition that might be amenable to early recognition, intervention, and prevention. Even if we can prove that an “addictive personality” exists, it should still not be seen as a defect or a moral failing; like other potential personality disorders, it is due to factors beyond a person’s control and merits treatment, not punishment.
The brain is such a complex system that there are certainly undiscovered connections between chemicals and behavior still waiting to be uncovered. I am looking forward to physicians and patients moving forward together to advance treatment and prevention of this disease.