A New View of Addiction: Simple and Complex

Published in Social Policy Magazine (Vol 27, No. 2, Winter 1996)

Our societal battles to overcome addictions—ranging from compulsive eating to substance abuse—are severely hampered by the widely held view that addiction is a single entity that varies only in degree. We postulate that there are really two kinds of addiction—simple and complex—that are different in nature and require entirely different approaches to overcome.

Consider the prevailing social atmosphere. Enormous anxiety and media attention focus on the dangers of becoming addicted to drugs, alcohol, nicotine, sugar, or caffeine. Recovery is often portrayed as an agonizing, life-sentence struggle with no guarantee of success. The implicit message is that addiction is an irresistible and pitiless force that once contracted, is nearly impossible to break.

Yet, over the past 25 years, 50 million Americans have quit smoking, and 90 percent of them did so on their own without professional help, medication, or support groups. Similarly, a 1990 Gallup poll showed that 70 percent of people who changed their drinking habits did so on their own. Studies of heroin addiction show that a portion of veterans who returned from the Vietnam War addicted to heroin spontaneously remitted and broke the habit within a year.

How do we reconcile these two realities? The answer lies in distinguishing between simple and complex forms of addiction.

Defining the Two Modalities

The American Psychiatric Association’s diagnostic manual defines addiction through symptoms like tolerance, using substances to relieve withdrawal, persistent unfulfilled desires to cut down, and continued use despite knowing of harm.

Simple Addiction

Simple addiction represents a superficial physical or habitual dependence. While it involves physical cravings and withdrawal symptoms when the substance is removed, this form of addiction can be modified without in-depth, long-run group approaches or professional rehabilitation. It is reversible by means of willpower, behavior-modification techniques, and individual effort. Simple addiction touches only a part of the addict’s personality, leaving other, healthy parts of the self intact to lead the recovery.

Complex Addiction

Complex addiction, on the other hand, is deep-seated, self-camouflaging, and self-protecting. As researcher Robert DuPont notes in The Selfish Brain: Learning From Addiction (1997), complex addiction is marked by:

1. Profound Good Feelings: Generating mental or physical sensations that mask or temporarily eliminate unpleasant feelings.
2. Loss of Control: Overpowering the individual’s ability to self-monitor.
3. Compulsion to Continue: Persisting despite ruinous consequences for family, career, and physical health.
4. Extreme Denial: Denying the existence of a problem.

In complex addiction, the driving force is an attempt to use an external substance or behavior to enchain, alter, or repress a painful inner psychological mood (such as depression, trauma, or anxiety). It is highly resistant to rational, self-administered intervention. Willpower alone fails because the whole person is involved.

Case Studies in Dependency

1. Smoking and Depression

Nicotine is uniquely difficult to quit; heavy users of heroin often say tobacco is harder to give up. Yet, while millions have quit, only 5 percent succeed on their first attempt.

In a pioneering study by Dr. Alexander Glassman (1993), researchers screened out smokers with active mental illnesses. Nonetheless, 60 percent of the habitual smokers selected turned out to have a history of major depressive disorder. Smokers with past depression were twice as likely to fail in quitting.

For simple nicotine addicts, the habit is physical and casual. For complex nicotine addicts, the cigarette acts as an “anchor in the storm” or a “friend,” masking underlying pathology. Successful treatment in these cases often requires treating the underlying depression concurrently.

2. Alcoholism

A portion of former problem drinkers are capable of returning to moderate social drinking; these individuals experienced a simple addiction.

For complex alcoholics, however, alcohol provides biological, physiological, or genetic benefits they desperately need. Dr. James Milam, author of Under the Influence, argues that a biologic susceptibility lies at the root of alcoholism, where the body metabolizes alcohol differently. For these individuals, moderate drinking is not an option; biological triggers will inevitably reactivate the addiction. Total abstinence and long-term peer support (such as AA) are required.

3. Food Addiction (Sugar)

Some people consume large amounts of sugar simply because they enjoy the taste—a simple addiction. In complex food addiction, people “cathect” to sugar, finding in sweets a deep psychological comfort, security, or self-reward rooted in childhood.

One of the authors (Riessman) provides a personal example: a lifelong consumer of gin, he stopped drinking overnight without withdrawal or craving when diagnosed with diabetes. Yet, he found himself entirely unable to break his nightly habit of eating a half-pint of ice cream, despite knowing it was dangerous for his diabetic condition. The alcohol had been a simple source of relaxation, but the ice cream carried complex emotional symbolism—recalling childhood safety and familial warmth—making it a complex addiction.

Implications for Intervention

Many intervention failures occur because we attempt to treat complex addictions with simple, short-term means, or conversely, apply intensive, expensive treatments to simple addictions that could be self-managed.

Diagnostic Indicators of Complex Addiction

Complex addiction is typically indicated when:

• The user finds it impossible to stop despite multiple attempts.
• The user is in a state of extreme denial.
• The addiction causes severe disruption to relationships and employment.
• Physical illness directly related to the substance does not lead to stopping.

Conclusion

Matching the intervention to the type of addiction allows us to use public health resources more efficiently. When only a habit is addicted, simple behavioral tools suffice. But when the whole person is addicted, the whole person must be treated, requiring the deep support, shared experience, and moral structures found in long-term mutual-aid communities.

References

• Breslau, N. et al. (1992). Nicotine Withdrawal Symptoms and Psychiatric Disorders. American Journal of Psychiatry.
• DuPont, R. (1997). The Selfish Brain: Learning from Addiction. American Psychiatric Press.
• Glassman, A. H. (1993). Cigarette Smoking: Implications for Psychiatric Illness. American Journal of Psychiatry.
• Milam, J. & Ketcham, K. (1981). Under the Influence. Bantam Books.
• Peele, S. (1989). The Diseasing of America: Addiction Treatment Out of Control. Lexington Books.