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Keywords:

  • Addictive/diagnosis;
  • adolescent;
  • behavior;
  • decision making;
  • parent–child relations;
  • parenting;
  • substance-related disorders

In their recent review paper, entitled ‘A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use’ [1], Hummel et al. synthesized data from the literature to highlight how adolescents experiencing both poor family functioning and off-time pubertal timing are at particularly increased risk of developing substance use disorders (SUDs). It appears from this review that the occurrence of SUDs in adolescents may be influenced particularly by parenting-related features. Interestingly, Hummel et al. appear to have been cautious in not referring to the concept of ‘addiction’ in their work, whereas this very concept has been largely used in many previous studies dealing with adolescents [2-4].

Currently, the definition of an ‘addiction’ is considered to involve a recurrent failure to control one's own behaviour, which leads to a subject continuing pathological behaviour despite significant negative consequences [5]. This concept is supported by scientific findings demonstrating that neurobiological impairments in the neurocircuitry of the motivation–reward system underlie addiction [6]. Implicitly, to present with an ‘addiction’ and then a loss of control (LOC), it is necessary to have possessed a form of control previously, which supposes the ownership of a form of free will.

However, free will for an adult is a complex issue that has raised countless scientific and philosophical debates [7], which have regularly addressed the epistemological relevance of the ‘addiction’ concept [8]. Indeed, decision-making processes depend largely upon countless and often opposing social factors, including elements of social punishment, social norm conformity, social learning and competition [9]. Furthermore, acquiring free will is a long process throughout the development of an individual. It would appear obvious to everyone that children do not possess ‘free will’ or ‘control’ of their behaviour in the same manner as adults. On the contrary, children's behaviours are much more under the influence of others, particularly their parents. Therefore, it is probably not possible to discuss LOC and ‘addiction’ in a child, i.e. in an individual whose decision-making is so largely dependent upon others, but what about adolescents?

Depending on age and individual factors, an adolescent's behaviour may still depend upon the factors surrounding their upbringing. However, while adolescents mature, they become more independent and begin to make their own choices, albeit under progressively decreasing parental monitoring. Therefore, we believe that ‘control’ of behaviours is shared largely between an adolescent and his or her parents. This is notably applicable to substance use behaviours, because the influence of parenting styles on tobacco, alcohol and cannabis use has been demonstrated [10-13]. SUDs appear to occur preferentially in families in which parental monitoring is too light or, conversely, too great. Adolescent LOC appears to be related largely to parental control.

The current definition of an addiction has focused essentially on adults and is therefore restrained to a very individual approach of the concept. The concept of LOC is largely questionable, even in adults, because it would imply that non-addicted individuals possess total control upon their decisions and behaviours. In addition, because of the relationship between parental control and adolescent self-control, we would like to note that assessing LOC in an adolescent without exploring the features of family functioning is pointless based on the findings of Hummel et al.

Assessing addiction in adolescence should require a systematic evaluation of family functioning, using either a complete scale including such criteria [14] or an additional specific scale [15, 16]. Integrating features of parenting styles in the diagnostic criteria of addiction for adolescents may have direct therapeutic repercussions that could impact upon systemic care schemes.

Furthermore, some authors have recently proposed the abandonment of the notion of LOC and the consideration of addiction as a multi-factorial process that includes an acquired motivation to engage in a behaviour [17]. Such a standpoint could bridge the philosophical conundrum between free will and social conditioning that has been the basis of the LOC concept.

Declaration of interests

None.

References

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