Résumé :
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Addiction is a global problem that costs many millions of lives each year and causes untold suffering. It can involve ingesting licit and illicit psychoactive drugs (e.g. alcohol, nicotine, opioids, stimulants, steroids, prescription painkillers, sedatives or cannabis) or other kinds of activity (e.g. gambling, computer gaming). The science of addiction has advanced to a point at which it is timely to examine the wide range of underlying mechanisms that have been identified and assess what these imply for the development of a comprehensive strategy for combating the problem. This report reviews theories of addiction that have been proposed, with a view to generating an overarching framework or model that captures all the main elements. It then examines how this model can be applied in assessment, prevention and treatment. The main conclusions are given below. The analysis and conclusions in this report are offered as a framework for discussion.Definitions of addiction vary, but all involve the notion of repeated powerful motivation to engage in an activity with no survival value, acquired through experience with that activity, despite the harm or risk of harm it causes. Definitions of addiction include ‘a primary, chronic disease of brain reward, motivation, memory and related circuitry … reflected in the individual pursuing reward and/or relief by substance use and other behaviours’ (American Society of Addiction Medicine) and ‘a condition of being abnormally dependent on some habit, especially compulsive dependency on narcotic drugs’ (www.thefreedictionary.com). Although these definitions do capture important features of addiction, they either focus on just one aspect of it or use terms that cannot be interpreted clearly. Analysis suggests that the key features that definitions attempt to capture are that addiction involves repeated powerful motivation to engage in an activity, it is acquired through engaging in the activity, the activity does not involve innate programming because of its survival value, and there is significant potential for unintended harm. This need not be limited to substance use or abuse.
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