The nature of addiction: a theoretical framework beyond substance misuse and dependence
Rebecca KippaxPurpose
Despite advances in addiction research, the nature of addiction remains conceptually contested. This paper aims to examine addiction as an ontological question and proposes a theoretical framework that distinguishes addiction from substance misuse and dependence.
Design/methodology/approach
A theoretical analysis of contemporary addiction models, diagnostic frameworks and relevant literature was undertaken to examine whether existing conceptualisations define addiction itself or instead describe its observable manifestations.
Findings
Addiction is conceptualised as an underlying psychological disorder characterised by Psychological Disequilibrium (PDEQ). Within this framework, substance misuse, dependence and diagnostic behavioural characteristics are understood as manifestations of PDEQ, while persistent vulnerability to chronic relapse is proposed to be the defining criterion of an addiction disorder. Recovery is correspondingly conceptualised as the restoration of Psychological Equilibrium (PEQ), extending beyond abstinence and the resolution of dependence.
Research limitations/implications
Rather than a fully operationalised concept, this paper introduces an overarching theoretical construct of PDEQ, requiring further theoretical work to define the model’s constituent psychological processes, developmental pathways, mechanisms of maintenance and the processes through which PEQ can be both disrupted and restored. Further, the theory requires systematic testing across diverse populations and addictive behaviours to evaluate its explanatory power, reliability and clinical utility. Future research should develop measures of PDEQ, examine its relationship with chronic relapse and compare its predictive capacity against existing addiction models. If supported empirically, the framework may provide a foundation for a revised conceptualisation of addiction that distinguishes addiction from physiological and psychological dependence.
Practical implications
Conceptualising addiction as PDEQ rather than substance misuse or dependence may encourage clinicians to focus on identifying and treating the underlying psychological condition that drives chronic relapse. This distinction has the potential to improve assessment, facilitate more individualised interventions and reduce reliance on approaches that primarily address substance use or withdrawal symptoms. By targeting the underlying pathology rather than its behavioural manifestations alone, the proposed framework may ultimately contribute to improved treatment effectiveness, more sustained recovery outcomes and reduced rates of chronic relapse. Recognising dependence and addiction as distinct clinical phenomena may also assist practitioners in tailoring treatment strategies according to the mechanisms maintaining an individual’s presentation.
Social implications
Reframing addiction as an underlying psychological disorder rather than a consequence of substance misuse has the potential to influence public understanding, policy and stigma. Distinguishing addiction from dependence may promote more accurate perceptions of individuals experiencing chronic relapse, encouraging responses that emphasise treatments and psychological support rather than blame or moral judgement. A clearer conceptualisation of addiction may also inform education, prevention strategies and service provision by recognising that repeated substance use alone does not necessarily constitute addiction.
Originality/value
This paper presents an ontological framework that offers an innovative perspective on addiction, shifting attention away from substance dependence and the observable characteristics associated with substance use disorder and towards the underlying psychological processes proposed to precede and perpetuate addiction. By distinguishing addiction from its behavioural and physiological manifestations, the framework provides a foundation for further theoretical development, empirical investigation and recovery-oriented clinical practice.