May 12, 2023 – The word “addiction” is probably over-used in our culture. Clinically, it means compulsive use of drugs; colloquially, we stretch its use to refer to addiction to things that probably don’t fit the clinical definition, like when we speak of addiction to screens or kombucha.

Now, as the opioid crisis has precipitated a huge investment in a public health apparatus devoted to treating addiction, public health experts have coined a new term: pre-addiction. The idea behind the label is that it could be a useful concept for ascertaining one’s risk of developing a drug addiction. Indeed, some organizations that use the term, such as the National Institute on Alcohol Abuse and Alcoholism (NIAAA), hope that it can be useful in intervening in addiction before it even starts. Yet as the term gains more prominence, experts in the field are torn over whether or not it’s a worthy concept.

One of its most prominent proponents is Dr. Nora Volkow, a psychiatrist who has served as the director at the National Institutes of Drug Abuse (NIDA) for the last two decades. In an opinion piece published last summer in the journal JAMA Psychiatry, Volkow describes pre-addiction as a “missing concept” in the realm of addiction treatment. 


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