Intended for healthcare professionals


US must address addiction as an illness, not as a moral failing, Surgeon General says

BMJ 2016; 355 doi: (Published 22 November 2016) Cite this as: BMJ 2016;355:i6265

What is Addiction?

Addiction is a rebellion against the metabolic basis of life. Metabolism needs nutritious food to satisfy hunger and create health. But addiction replaces food with fun, hunger with euphoria, satisfaction with craving, and health with sickness. So addiction is a foodless flight from hunger to euphoria, with a stopover in craving, and a crash landing in sickness.

Euphoria is a false, fleeting sense of well-being, which makes us feel high but masks the craving and sickness of addiction. Ironically, addiction enlivens us with euphoria, while it deadens us with craving and sickness. So addiction is a bad bargain with imaginary gains and real losses.

The most popular addictions are sweets, chocolate, vanilla, cola, coffee, tea, alcohol, tobacco, and drugs. Although some of these seem comforting, they all create insatiable cravings and sickness with Jekyll & Hyde mood swings that reinforce other addictions. So addictions are seductive saboteurs that masquerade as familiar friends.

Put poetically, addiction is a poison pill that makes us ill, with sinister sequelae that go right to our belly, turn our mind to jelly, and make us silly willy-nilly.

Competing interests: No competing interests

22 November 2016
Hugh Mann
New York, NY, USA