Addiction

 

What Is Addiction?

There is, of course, the clinical definition. In the DSM-5, we’ve moved away from terms like abuse and dependence, and instead speak of substance use disorders or substance-induced disorders. The word addiction is avoided for its imprecision and negative connotation.

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Yet, when someone’s life is unraveling because of heroin or fentanyl, we all know what we mean by addiction.

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But what about food? Experts still argue. Many of my bariatric patients would tell you food is absolutely addictive. Others insist there’s no such thing—that those who struggle with food, weight, or pleasure are simply lacking willpower. Much of it comes down to semantics. In my experience, if I say “you can recover,” I know I’m right. And if you say “I can’t,” I know you’re right too.

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Addiction is a complex disorder. It’s chronic. It’s marked by compulsive engagement with a substance or behavior, despite harmful consequences. It alters the brain. It reshapes motivation.

But I believe addiction also points to something deeper.

 

Addiction as Attachment

In Buddhist thought, suffering arises from taṇhā—craving or clinging. This isn't just desire in the everyday sense; it's the attachment to how things should be. We suffer not just because we want things, but because we need them to go a certain way. This too, is a form of addiction.

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In this broader sense, addiction isn’t just about heroin or sugar. It’s about the

stories we can’t let go of.

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The identities we cling to. The expectations we carry for how our lives, our bodies, our

relationships should look.

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Western lifestyle—especially in consumer-driven, image-saturated cultures—runs on this

engine of craving. More success. More productivity. Better skin. Faster weight loss. Happier kids.

All of it whispers: you are not enough unless… And so we chase. And when the chase becomes

compulsive, harmful, or all-consuming, it becomes indistinguishable from addiction.

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Core Features of Addiction:

• Compulsive behavior: An overwhelming urge to engage in the behavior or substance use.

• Loss of control: Even when we want to stop, we can’t.

• Negative consequences: The behavior continues despite damage to our health,

      relationships, or well-being.

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Types of Addiction:

• Substance addiction: Involving drugs, alcohol, nicotine, etc.

• Behavioral addiction: Gambling, sex, shopping, screen use, eating.

• Existential addiction (my own term): Clinging to identities, roles, or futures we feel we must achieve in order to feel worthy.

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But here’s the hopeful part: addiction, however it shows up, is treatable. We will look at what has worked for others—and what may work for you. Lifestyle medicine offers powerful tools. But so does philosophy. So does silence. So does the ability to question your cravings—not just for sugar or alcohol, but for certainty, control, and self-worth.

Because when we loosen the grip of attachment, the addictive spell begins to break.