What Is Addiction? Rhetorical Analysis

Rhetorical Analysis of “What is Addiction?”

In “What is Addiction?” William Miller takes the reader first through the dimensions of addiction, followed by the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and ends with the etiologies of addiction.  Miller claims that “the concept of addiction has expanded to describe so many behaviors that is has almost lost its meaning” but he goes on to describe the science and health care perspective of addiction (Miller 10).  The purpose of this article is to educate the reader on the idea that addiction isn’t simply “black or white;” it is a disease with multiple dimensions and causes that falls upon a continuum of severity defined by the DSM (Miller 21).  In line with the purpose, Miller’s argument is that the fifth edition of DSM should resort back to the continuum on severity in order to better classify the symptoms of addiction and improve the chances of treatment. 

William Miller has an abundance of ethos on the science and health care side of addiction as he has a PhD and is an Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico.  He has “developed and evaluated various methods for addiction treatment, including motivational interviewing, behavior therapies and pharmacotherapies” (Guilford Web).  Miller is very involved in the topic of addiction treatment, as he established and evaluated various methods of treatment including motivational interviewing, behavior therapies and pharmacotherapies.  On top of all this, he is also one of the world’s most cited scientists, according to the Institute for Scientific information. 

Miller begins his article by stating that there is a plethora of distinct dimensions that fall along a continuum when classifying addiction and that people tend to overlook these dimensions and only focus on the stereotypic, “severe levels of use and consequences” (Miller 11).  Use, problems, physical adaption, behavioral dependence, cognitive impairment, medical harm, and motivation for change are the seven dimensions of addiction that Miller defines within the article.  Each of these dimensions is considered when diagnosing a person for addiction but they are each independent of each other.  For example, use has to do with the quantity, frequency and variability of addiction, while motivation for change takes into consideration the importance of change for the person.  In this section Miller challenges the reader to “think more broadly about addiction and its causes” by introducing multiple dimensions of addiction and their severity along a continuum (Miller 12).  By establishing seven dimensions of addiction and visually showing that these dimensions fall along a continuum, Miller makes a persuasive argument that there are more levels of addiction than the stereotypic examples we see in the media. 

In the History of DSM section, Miller takes the reader through the history of the DSM, updated every decade, which “offered criteria for deciding whether specific diagnoses fit a particular person’s case” depending on the severity of the illness (Miller 17).  The first edition of the DSM was established in the 1950s, and stated that the issue of addiction, mostly classified by alcohol and drug use, was a personality disorder.  Unlike the DSM editions today, edition one of DSM mostly just spoke about the causation of addiction and only had two types of addiction, alcoholism and drug addiction.  DSM-II expanded the definitions of addiction into subcategories and classes of alcoholism and drug addiction but continued to classify addiction as a mental disorder claiming that it “represented a disorder of the personality that caused the individual to use alcohol and other drugs excessively” (Miller 17).  The third edition of DSM not only acknowledged that substance abuse and dependence were two separate entities but also that the etiologies of addiction needed to be expanded to include environmental influences.  Due to researchers such as Griffith Edwards and Brady and Lucas, DSM-III was revised to even out the influence of behavioral aspects of addiction and physiological components.  The fourth edition of DSM expanded on DSM-III’s abuse/dependence terminology to “define over 100 different substance related disorders for 12 different classes of drugs” (Miller 20).  Lastly, DSM-V (coming in 2013) is contemplating retreating back to a general term of addiction with categories of severity rather than the abuse/dependence terminology.  The departure away from abuse/dependence terminology and into the severity of addiction is something Miller approves because it is has less of a derogatory tone and the use of the continuum of severity meets the needs for all potential “diagnostic orphans” (people that don’t meet prior categories but still have significant addiction problems) (Miller 20).  In my opinion, by waiting until the end of the section to voice his opinion, Miller made a weak persuasive argument; however, he did counter-act the opposing argument by stating that the abuse/dependence terminology resulted in “diagnostic orphans.”  This section was mostly just history of the DSM with a few sentences on Miller’s opinion in the end.  It would have made for a stronger argument if he had stated his opinion in the beginning and used the history of DSM to reiterate his claims.

   In the section Where is the Line for Addition, Miller reiterates the importance of recognizing addiction is a disease that should be diagnosed on a line of a continuum rather than simply having the disease or not having it.  He also discussed the term “kindling,: “the first episode makes that person more vulnerable to future episodes” when he states the importance of making the addict get help before the problem becomes more severe (Miller 22).  Since treatment practices should be different depending on how severe an addict’s problem is, it is important to measure addiction on a scale of severity rather than trying to use one treatment to cure everyone with addiction.  This argument makes sense, someone with a severe case of addiction or depression or any disease should not be treated in the same way as someone with an acute case of the same disease. 

Miller finishes his article with a section on the causes or origins of addiction: personal responsibility models, agent models, dispositional models, social learning models, sociocultural models, and the public health perspective.  Through these models, the blame varies from the person to the drug to the environment.  The public health perspective “takes all important factors into account and considers their interactions with each other” (Miller 26).  Within the public health perspective, Miller explains how the host, the agent, and the environment each contribute to the overall problem of addiction independently and jointly.  The multiple causes of addiction help to reiterate why addiction is so hard to understand because there are so many dimensions to the disease.

 Although Miller repeated his arguments in different sections throughout his article, he made a mistake by not concluding with a summary and reiteration of his claims. The audience, according to Guilford Press, are “practitioners and graduate students in clinical psychology, clinical social work, psychiatric nursing, counseling, and psychiatry” as well as anyone who is interested in addiction or wanted to help a friend or relative (Guilford Web).  The order of the article improved his argument but Miller could have been more persuasive if he would have appealed to the pathos of the reader by telling a story that invoked emotion rather than simply listing facts.

Works Cited

“About the Author.” Guilford Press. Guilford, 1997-2011. Web. 12 Feb. 2012. <http://www.guilford.com/‌cgi-bin/‌cartscript.cgi?page=pr/‌miller11.htm&sec=aboutas&dir=pp/‌addictions&cart_id=399334.9953>.

Miller, William R. “What Is Addiction?” Treating Addiction: A Guide for Professionals. By William R. Miller, Alyssa A. Forcehimes, and Allen Zweben. New York: Guilford, 2011. 10-28. Print.