The old-fashioned concept of "addictive personality" has also collapsed. Today, the word addiction does not appear in standard psychiatric nomenclature. Rather, addiction seems to character- ize neither a substance nor a personality type, but a form of rela tionship. Clinicians now speak of addiction to gambling, sex, aero- bic exercise, work, day-trading, eating carrots, shopping, even excessive drinking of water. The term is vastly popular: people laughingly refer to themselves as "TV addicts" or "chocoholics." But Bertha Madras, professor of psychobiology in the depart- ment of psychiatry, objects: "The word is grossly overused. Ad- diction is a neurobiological disorder. Clinically, it's a very clear syndrome. If you look at all drug addictions from tobacco to heroin, there's only one clear statement that applies to all of them: uncontrolled use despite negative consequences." Classically, drug addiction means tolerance (the need for in- creasing doses to obtain the same effect) and withdrawal (psy- chic and/or bodily ailments, sometimes lethal, that accompany sudden cessation of use). Both signs indicate neuroadaptation: re- peated intake of a drug alters the brain in profound ways that both stimulate more drug use and render choice more difficult. Yet "pathological gamblers show physiological signs of tolerance and withdrawal, just like narcotic addicts," says Shaffer. "And hospital patients medicated for pain can develop tolerance and withdrawal, but don't show signs of addiction, such as drug- seeking behavior. We can't be sure if it's the drugs or the behav iors that are changing the brain chemistry." The emerging con- sensus, he says, is that both factors are at work. Such riddles suggest why addiction research spans many disci- plines, from neurobiology to social policy. The Division on Addic tions, founded in 1993, is one of nine such divisions focusing on areas that do not fit well into the Medical School's regular acade mic departments. Addiction is as old as human history, and re- mains one of the costliest and most intractable of all social prob lems. It confounds rationality: millions of addicts persist in their blatantly self-destructive behavior despite the loss of family, friends, jobs, money, and health. (Some studies have shown the death rate for untreated heroin addicts to be as high as 7 percent annually.) To use the analogy of professor of psychiatry George Vaillant '55, M.D. '59, the addict can resemble a cigar smoker in an elevator, oblivious to something that is obvious to everyone else. Research is now begin- 1) What are the three criteria that must be present for an activity to be considered gambling and why is it important for governments to agree on this definition? 2) Which three errors in thinking contribute directly to disordered gambling problems and why are they so common among human beings, who are intelligent beings? 3) Why has the concept of "addictive personality" become old-fashioned and described in the Lambert article as having "collapsed"?