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The word addiction is almost always met with strong emotions. There are several technical definitions, and in my opinion, it’s nearly impossible to adequately define terms without making some form of moral judgment.

Everyone is comfortable with applying the term addiction to people who repeatedly use injection drugs. Less problematic substance use is much harder to define. 

Here’s a relatively simple, non-technical definition that roughly coincides with the current psychiatric definition: addiction is the persistent use of unnecessary substances or gambling in a way that is harmful to the participant or others.

(There’s a lot more that needs to be defined. What about food, sex, video games, and the internet? There are clearly people who have problems with excesses in these domains, but defining boundaries turns out to be a difficult and contentious problem.) 

I like to think of addictive disorders as a broad spectrum of problems. The most severe (and correspondingly less common) addictions can cause disability, death, and chaos. Other problems are much less obvious. 

For example, is marijuana addictive? Yes. Some people have difficulty cutting back, damaged relationships, impaired work, drug tolerance, physical dependence, and the whole range of other problems we associate with addiction. The average harm from cannabis use is small compared to alcohol or tobacco, but it is not wholly risk free. (I’m not arguing that cannabis use results in addiction in everyone. That isn’t true of any drug. At most, cannabis use disorder develops in fewer than one in five people who use it; I suspect the number is closer to one in ten.)

That’s why I call some problems indolent addictions. Indolent processes usually start slow and cause little initial pain. Many benign tumors are indolent and never cause problems. Other indolent processes–like Alzheimer’s dementia–go unnoticed for years and yet still inevitably progress towards death. Indolence defines the process, not the outcome.

Cannabis use disorder (a very real addiction diagnosis) is generally indolent. Most cannabis users don’t use marijuana in a disordered way. Of those who do, the consequences of ongoing use tend to be relatively small. Is it still an addiction if the consequences are small? Technically? yes. Practically? That’s a risk-benefit decision for the individual to decide.

(I have treated people with florid, acute psychotic symptoms related to first-time cannabis use. Those people don’t typically return to the drug, which effectively prevents the development of addiction. I’m more concerned about the correlation between cannabis use and chronic psychosis in adolescents and young adults.)

Tobacco use disorder is another common, indolent addiction. In fact, the indolence of tobacco use led industry executives and lobbyists to argue that tobacco was not addictive at all. But make no mistake: indolence isn’t the same thing as harmless. Tobacco overdoses are rare, but the drug is still responsible for more ongoing deaths than any other psychotropic substance.

Is the distinction meaningful? I’m not sure yet. There are certainly some indolent behaviors in my life that are worth changing. I imagine that’s true for you too. Writing them off as “not a problem” because they are small doesn’t fix anything, and beating ourselves up because we aren’t perfect doesn’t help either. Let’s accept where we’re at and make small, consistent steps to reach our goals.