This classic text takes as its starting point the essential similarities between dependence on psychotropic drugs and other forms of problem behaviour (e.g. gambling, hyper-sexuality, over-eating) and poses a serious challenge to traditional conceptions of addiction. In most definitions of drug dependence such as appear in international classification systems, the phenomenon of neuro-adaptation, denoted by drug tolerance and withdrawal symptoms, is given pride of place-without this there is no syndrome, disease or condition. On one hand Orford attempts to demystify and de-emphasize the importance of these elements of drug dependence, and on the other hand to show how similar are the non-substance-related 'addictions' in terms of their phenomenology, distribution across the population, responsiveness to external restraints and consistency with some major theories of human behaviour. Along the way he draws together material from cognitive-behavioural psychology, sociology, anthropology, history, medicine and epidemiology to develop a model to encompass the essential features of what he terms 'excessive appetites'. Do not be fooled - the pejorative term 'excessive' is used deliberately to signal the important contribution of social norms in defining just what constitutes 'excess' at a particular time and place.
There are many enduring strengths to this book. Those who remember it fondly and have the original 1985 text on their shelves would do well to buy the new edition. There has been considerable revision and updating. Of the 640 references in the original text only 280 have survived and another 590 have been added. The ideas are still as fresh, stimulating and relevant as they were 15 years ago and it is well worth the investment of time (and money) in renewing the acquaintance. For those who missed the first, this new edition is a good read and a very good way of being familiarized with a wide range of research and commentary on just what constitutes addiction. The text is enlivened throughout by first-hand accounts of each of the excessive appetites discussed. These are drawn from the rich and famous, from past and present, from clinical and ethnographic studies. They are analysed thoughtfully alongside a scholarly treatment of a wide range of scientific studies.
If there is one idea that I personally take away from the book, it is that addictive behaviour can be understood in terms of the complex interplay between appetite and restraint - both personal and social. This view invites us to consider not only what is it about the statistically unusual few who develop addictions but also what is it about the rest of us that restrains this potential that most of us surely have?
As I sometimes did when I worked with Jim in the 1980s, the book prompts me to want to argue that the essential similarities across these diverse behaviours may also be an indication of there being biological substrates to excessive gambling, sexuality, over-eating as well as drug dependence. I also want to argue that neuro-adaptation cannot be sidelined as having little relevance to the development of problems or of relapse. Mainly, however, I am more than grateful for this rare text which sheds so much light on the riddle of addictive behaviours. It should be of value to any person who wishes to add to their understanding of the area, whether for the purposes of treatment, prevention, harm reduction of for personal education.