anys en dansa; per molts anys, Ananda

The word addiction is derived from the Latin verb “Addicere”: to give or bind a person to one thing or another (Nelson, Pearson, Sayers & Glynn, 1982).

Addiction is thought to manifest psychologically and behaviourally, in feelings of compulsion to behaviour and a difficulty in resisting those compulsions. For example, definitions of drug addiction typically involve a pattern of uncontrollable drug-seeking and drug-taking behaviour which takes place at the expense of other activities, despite the user’s knowledge of the damaging health and social consequences (Robinson & Berridge, 2008). Despite a common discourse of ‘addictive substances’ (Volkow & Wise, 2005) it is important to note that use does not always lead to addiction, and that addiction                                                                                                                

6 ‘Expert’ refers here to a position taken up to profess extensive knowledge or ability on a topic.

Specifically here it relates to the authoring of clinical and academic text on the topic of sex addiction.

7 Throughout this study the concept of sexual addiction is appraised critically. The terms ‘sex addiction’/’addiction’ and ‘sex addict’/’addict’ are used throughout for pragmatic reasons given the wide range of terms that could be used to reference these individuals and behaviours. The continued use of inverted commas to signal the problem of the addiction diagnosis may be distracting or confusing for readers and so sex addiction will be employed here despite the risk

is though to be the consequence of complex interactions between stimulus effects, environmental and neurobiological factors (e.g. Meaney, Brake &

Gratton, 2002; O’Brien & McLellan, 1996). Knowledge and understanding of such factors in addiction is constantly expanding and evolving. Understandably, this has led to a number of shifts in theoretical perspective. Some of the main biomedical and social science approaches to addiction, primarily developed in the field of substance addiction, have included the hedonia hypothesis, incentive-salience, rational choice models, response inhibition and salience attribution, and component models, outlined briefly below.

Early theories of addiction focused on the positive affective states that a number of drugs of abuse cause, and the resultant motivation to achieve and maintain these positive states. Essentially these theories saw drug addiction as due to the euphoria and pleasure experienced when drugs are taken. The

‘hedonia hypothesis’ suggests that dopamine, acting primarily in the nucleus accumbens acts as a ‘pleasure neurotransmitter’. Developed chiefly by Roy Wise and colleagues in the 1970s and 1980s, the theory continues to be influential in explaining addiction (see Wise, 2009), and its ideas are echoed in contemporary neuroscience theory (Berridge et al., 2009; Volkow et al., 2009).

However, this characterisation does not fit with the social and psychological problems apparent for most addicts and so the hedonia hypothesis is arguably better suited to explaining initiation or recreational use, as opposed to problem use or addiction (cf. Koob & Le Moal, 2005).

In order to account for drug use despite negative consequences, some theories of addiction have sought to differentiate the rewarding aspects of drugs, specifically distinguishing the hedonic liking and motivational wanting of drugs.

The incentive-salience theory of addiction focuses on the latter wanting of drugs and specifically how drugs and drug cues trigger excessive incentive motivation to seek and consume drugs, leading to compulsive drug seeking and drug taking (Robinson & Berridge, 2000). It is thought that this influence is mainly implicit, e.g. administration of doses of drugs too low to produce any experience of pleasure can increase drug seeking (Lamb et al., 1991), and so implicit wanting of drugs does not require conscious awareness. Some have explained this wanting as a strong stimulus-response formation, others via neurobiology,

although it is likely to be a combination of both factors (Berridge et al., 2009).

Couched, neurobiologically driven, wanting of drugs may therefore explain a great deal of addiction. However, many openly describe their continued addictive behaviour as a conscious choice.

Rational choice theories argue that addictive behaviour is entirely self-governed and, even if counter-intuitively, rational (Weinberg, 2013). The Rational Informed Stable Choice (RISC) model of behaviour describes actions as based on perceptions of their benefits (cf. West, 2006). The model states that we know about and are willing to accept the adverse consequences of our actions. This does not mean that the individual sees addictive behaviour as a definitive good option, but rather “among the options that s/he sees actually open to him or her, (addiction) is judged to be the best on offer at the time” (West, 2006, p.29). An important point worth noting is that rational choice does not have to be sensible or adaptive, and is often an unwise choice (Bickel & Marsch, 2001; Reynolds, 2004). In its most extreme version, this theory portrays addicted individuals as having no biomedical abnormality, but instead making a conscious decision based on sociocultural options, dismissing the notion of uncontrollable, compulsive addiction (Davies, 1998).

The RISC argument makes good theoretical sense and builds upon the hedonia hypothesis to explain how negative influences can initiate and exacerbate drug use, although it has a number of problems. Again, its subjectivity makes it hard to operationalise and test. Chiefly however, the theory has problems in explaining the dynamic process of addiction. Although, some drug addicts continue to use drugs at a stable level in order to ‘manage’ their environments.

Addicts typically report an escalation of behaviour beyond their initial intentions, and continue to increase or abruptly stop (Koob & Le Moal, 2005). Addicts typically cycle through consumption and abstinence, bingeing and purging, and addiction typically manifests in parameters of either high levels of consumption or abstinence, not a rational, steady behaviour. Addiction therefore is commonly constructed as illogical, irrational, and senseless. Indeed, despite a great deal of work and commitment, many report failing to change their addictive behaviour.

This incongruity may be moderated by individual expectancies. Expectancies are important in initiation and escalation of addiction. For example, positive expectancy of alcohol to help with social situations, can promote usage (Cooper, Russell & George 1988), and positive expectancies of social facilitation from drinking is thought to mediate the effects of extraversion on drinking behaviour (Fischer, Smith, Anderson & Flory, 2003). Similarly, tackling addiction through generalised campaigns to inform the public can be problematic due to an inherent variability in peoples’ view of how relevant the message is to them, based in part, on their ideographic experiences and expectancies. Indeed, whereas most smokers greatly over-estimate the risk of lung cancer in smokers generally, most underestimate the likelihood of lung cancer affecting them as individuals, and so continue to smoke (West et al., 2010). There is therefore a great importance of personal meaning and understanding within addiction.

Despite this ideographic quality to addiction, most biomedical theories of addiction are inherently reductionist and so minimise individual meaning and socio-cultural context in their constructions of addiction. For example, one of the most well known drug addiction theories is the opponent-process theory of addiction, Here universally predictable neuroadaptations as a result of drug use cause diminished reactions to drugs, and a new ‘allostatic’ basal state. This is thought to ground an increased tolerance to drugs of abuse, whereby increased amounts are needed to gain the ‘high’ a normally functioning neurobiological system can achieve. In line with rational choice perspectives, the individual escalates their behaviour in order to maintain a set rewarding affect and in order to avoid or escape deficiency or withdrawal symptoms. This theory promotes a cyclical construction of addiction, where individuals choose to use drugs as an escape from unpleasant circumstances and emotions such as depression, anxiety and boredom, though their long term drug use can generate depression, anxiety and in turn, can lead to escalated drug use and dependence in order to reach these previous goals of escape and avoidance.

Developments on the original opponent process theory, show that the complex state of allostasis not only involves the down regulation of systems involved in producing the initial reward, but also loss of executive control, and increased impulsivity via deregulation of neurotransmitters and prefrontal cortex-striatal

loops (cf. Koob & LeMoal, 2008). It is thought that addicts’ abnormal frontal cortex function is a neurological correlate of their difficulty in controlling their exaggerated pre-potent seeking and using behaviour (Goldstein & Volkow, 2002; Jentsch & Taylor, 1999). Thus addiction may be a disorder of impaired response inhibition and salience attribution (I-RISA), whereby the drug addicted individual has both an amplified desire to take the drugs, combined with a decreased ability to inhibit the behaviours this desire produces (Berridge et al., 2009). Such theories have promoted the common construction of addiction as a brain disease, with secondary behavioural and social aspects (Leshner, 1999).

The reduction of the complexity of addiction to a disease of the brain has also led some to argue for the amalgamation of problematic users of different substances into the general classification of ‘addict’. Furthermore, as Griffiths states “there is now a growing movement which views a number of behaviours as potentially addictive including many behaviours which do not involve the ingestion of a drug … such diversity has led to new all-encompassing definitions of what constitutes addictive behaviour” (2005, p.192). The term addiction is now used to reference an ever-growing number of behaviours (commonly called behavioural addictions) (Juhnke & Hagedorn, 2006). Griffiths and others promote the way of determining whether behaviours are addictive, in a non-metaphorical sense, is to compare them against clinical criteria for established drug addictions. Therefore there has been a recent trend for the research and theories, outlined above, to be applied to numerous behaviours provided they meet certain diagnostic criteria. Amalgamating the features of addiction literature has produced component models of addiction, which aim to operationalise features thought to denote a ‘true’ addiction, which are generalisable across substances and behaviours. These components typically include tolerance, withdrawal, mood modification, the behaviour becoming the most important thing in a person’s life (salience), conflict with other aspects of life or psychological conflict, and relapse following cessation (Griffiths, 2005).

Should the person’s behaviour meet such diagnostic criteria, it is deemed an addiction, and aligned with the aforementioned biomedical and social science theories of addiction. Framing behaviour as addictive clearly has implications

not only for treatment of such behaviours, but also for how the individual and society perceive such behaviours.