What addicts do involves either a substance such as alcohol or a behavior like gambling, but that’s just the surface. Addicts often describe themselves as crazy; non-addicts look on in horror and agree. Once again, however, let’s listen to what the addict is saying and admit they could be at least partly right because an addiction can be defined as a state of mind, and not usually a happy one at that.

I’ll be using the term dark feelings as short hand for the emotional soup in which addictions grow; more about all that later. The addiction makes this bad thing—dark feelings—worse over time by undermining beliefs, values and the ability to reason. Although we don’t like to admit it, addictions are mental disorders if not medical diseases. An addicted state of mind is far more disabling than most people want to admit, especially for the person who happens to own the mind in question.

With long experience, a person gets used to how one is even if how one is would not be described as a voluntary or happy existence. Even dark feelings can come to be a kind of security blanket, something that gives permission to do weird things in an effort to make these feelings go away for a little while. There is always resistance in making changes in how we think because many of our thoughts are like comfortable old furniture; the springs are busted and the padding is hanging out, but they’re ours and we trust them to hold us up, at least for a little while longer. One gets used to a certain mental landscape. New thoughts or ideas can be very scary.

Research on the human brain shows that addictions can be defined in terms of brain chemistry. Those advances, however, will not end our search for causes since scientists will next have to find out how chemistry, genetics and experience all work together to set the stage for addiction. They will have to explain how some people with the same personal characteristics as addicts manage to avoid addiction. Even with respect to genetics, many who share a family history differ in their susceptibility to addictions. If we had some magic bullet from medicine to stop the craving, once the addiction is put away we would still have to learn new and sometimes uncomfortable ways of thinking and acting. While we wait for the imaginary magic bullet to do the job for us, we can and should do something to change our thinking—to change our minds, if you will. And changing a mind is one of the hardest things in the world to do, especially if it’s your own mind that needs changing. This is where programs such as the Alcoholics Anonymous Twelve Steps work their benefits; they offer the ideas, concepts and values that are so necessary in the mind changing business.

The list of possible addictive agents and activities is long, and seems to grow longer every year. We seem to be devoted to inventing or discovering new addictions. Over the years Alcoholics Anonymous inspired such off-shoots as Overeaters Anonymous, Gamblers Anonymous, Narcotics Anonymous, Emotions Anonymous, Sex and Love Anonymous, etc. The multitude of different Twelve Step groups is interesting and their very existence yields insight into the nature of addiction itself.

Psychologists love to snoop around and walk in the minds of others. We’re generally pretty harmless, sometimes even helpful. Some years ago, at the Nevada Veterans Administration Medical Center in Reno, Nevada where I was Chief of the Addictive Disorders Treatment Program, we developed a measure of overall addictive activity; it was really just a simple list of all the different possible addictions our patients with drug, alcohol and gambling problems might have. People coming into our program usually were focused one only one addiction, the one thing that was causing the most pain in their lives, or at least the one thing they were willing to admit to. However, we treated all addictions in a single program as if each different addiction were but a sign of some underlying and more fundamental disorder.

When I came to work on the program it was called the Alcohol and Drug Treatment Program (A.D.T.P.). I renamed it the Addictive Disorders Treatment Program and we didn’t have to change the lettering on the walls since we were still known as the ADTP. See, some government workers save the people money. Gradually, however, our behavior began to change as we became more alert to the possibility of important cross addictions. Our language began to mention addiction more often than alcoholism or any particular drug.

In the 1980s, the Reno V.A. was a small hospital that could devote only about ten beds to the Addictive Disorders Treatment Program, so there were practical and financial reasons to combine with larger hospitals that had separate programs with more bed space and different specialized staffing. But I also had fancy theoretical ideas, ideas that will be spelled out in as I go along.