Latest developments in causes and treatments



Continuation, the Third C of Addiction

To get the full benefit of this 3-C discussion, we should go back to “Compulsion, the First C of Addiction” to catch up. The author who inspired the coverage here is Jed Diamond, Ph.D., who states that the most harmful drugs are found in food.

Having worked with all kinds of addicts for decades, he has found that the people hooked on eating are just like the others: identifiable by their relationship to three words: compulsion, control, and continuation. He writes,

[T]here is a Continuation of use despite negative consequences. Even when the drug is causing problems in their lives, the users continue to take the drug.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders said that substance dependence is a “maladaptive pattern of substance use, leading to clinically significant impairment or distress.” One of the symptoms is “a persistent desire or unsuccessful efforts to cut down or control substance use,” and of course persistent is a synonym for continuing. But wait, there is more:

The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine‐induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

The more recent edition of the manual, DSM-V, lists for the definition of substance use disorders 11 different criteria, several of which include not stopping as a prominent feature. These include:

Taking the substance in larger amounts or for longer than you’re meant to

Wanting to cut down or stop using the substance but not managing to

Continuing to use, even when it causes problems in relationships

Using substances again and again, even when it puts you in danger

Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance

Continuation, even though it does start with the same letter to make a neat trilogy, is a tricky word to use in this context. Of course, continuing to feed the addiction is obviously bad, and the word itself seems to signify the opposite of recovery. But when the addict undertakes to follow a program to end the addiction, of course what she or he must do is continue with that agenda — continue to attend meetings, to trust in their Higher Power, to face each day one at a time, and so on.

The word shows up in Dr. Pretlow’s book, Addiction Model Intervention for Obesity in Young People:

In our 3rd study a two week problem food elimination period, followed by a four week snacking elimination period concurrent with continued problem food elimination worked well before initiation of a 10 week food amounts reduction period.

The organization Food Addicts in Recovery Anonymous describes the possibility of long-term, continuous recovery from food addiction in their program based on the Alcoholics Anonymous 12 steps. The concept of positive continuation is also found in the requirements for service within the group. For example, for someone who wishes to be a Greeter, Phone List Coordinator, or Connection Representative, the suggested length of continuous abstinence is six months; and for the position of Secretary, or Public Information Representative, one year.

To volunteer as Intergroup Contact, the person is asked to have accumulated two years of continuous abstinence. To be a member of the World Service Conference, a continuous abstinence record of five years is required.

Of course, for any troubled person in any group or individual counseling situation, continuous abstinence is its own reward — the longer, the better.

Written by Pat Hartman. First published May 10, 2024.


“Are Fat, Sugar, and Salt the New Heroin, Meth, and Cocaine?,”, September 22, 2020.
“DSM-IV-TR Criteria for Substance Abuse and Substance Dependence,”, 2000.
“Criteria for Substance Use Disorders DSM-V,”, undated.
“Document 7: Service Positions — Description of Responsibilities,”, undated.

Image Copyright: Dave Crosby/CC BY-SA 2.0 DEED.


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