Addiction Science Forum

Laymen and professionals alike often ask for a quick synopsis of what causes addiction—a succinct summary resolved down to 25 words or less. The problem is that addiction, like many behaviors, is far too complex for such a simple rendering that is easily understood beyond its most superficial context (see the closing remark for a brief, 25-word summary of the cause of addiction). And ironically, what is perhaps the most complex endeavor of science (i.e., the study of human behavior) is usually considered so simple by most people that anyone without proper training should be able to grasp instantly its most complex principles and corresponding explanations of behavior. So goes the science of addiction.

One of Einstein's most famous formulations in theoretical physics is expressed simply as E=mc(2). This elegantly illustrates how complex theories in science can sometimes be resolved down to very simple expressions. And while most well-educated students may be able to recite the terms in this equation (i.e., "the amount of energy released equals the mass times the speed of light squared"), few really comprehend its meaning beyond the most superficial terms.

Psychology is far more complex than theoretical physics. Not because of the detailed mathematical derivations upon which it is based nor even the I.Q. points necessary to seriously ponder its most advanced principles, but because of the number of variables that must be considered with even a seemingly simple behavior. (In physics, this is analogous to the number of simultaneous equations that must be solved to resolve the problem.) Einstein is reported to have considered physics relatively simple (pun added , apologies to Prof. Einstein), but he considered behavior complicated. So if Einstein considered what most of us consider complex as simple and what most people consider simple as complex, how confused is the state of science today?

Understanding drug addiction, like understanding most aspects of psychology, requires years of careful study which builds upon certain elementary principles and extends to theoretical formulations which fill the gaps in present knowledge. Some topics like drug addiction require additional training in behavioral neuroscience and in psychopharmacology to really understand 'how drugs work in the brain' to produce the strong motivational effects that define addiction. One of the most surprising aspects of my course on Drug Addiction for many undergraduate psychology majors is that "drug addiction involves the action of certain drugs on the brain!" And may the gods of knowledge protect the educator who attempts to explain to the average drug addict that THEY are not the ultimate expert on their addiction: people like to retain the misbelief that they somehow understand and control their own behavior even when faced with overwhelming evidence to the contrary. (Considering addicts, or any other individual for that matter, to have a real understanding of the causes of their own behavior derived from an amateurish 'self-examination' is tantamount to returning the pre-20th Century psychology of introspectionism. Regression is one thing, but losing over 100-years of progress in the field of psychology is inexcusable.)

The tele-psychologists pander to this desire for a quick and simple explanation to a rather complex behavior. The attention span of their audiences, and indeed the attention span of many tele-psychologists themselves, does not permit a more detailed, scientific explanation of the behavior, and it profoundly objects to the notion that some basic understanding of fundamental principles of psychology and psychopharmacology are requisites for understanding why people take drugs. By seeming to provide quick and easy explanations for drug addiction, they do a considerable disservice to the science of addiction and to the addicts themselves (See Dr. Phil’s “Addiction”.).

True drug addiction is relatively simple to understand for those with the appropriate training. The many causes of drug abuse and misuse are more varied and are therefore much more complex. (This is one of the reasons distinguishing between drug abuse and drug addiction is important.) Even alcohol addiction is more complex than addiction to other drugs. And experimental drug use (to a limited degree) is too often seemingly a 'normal' part of adolescent behavior. The desire to understand complex behavior often exceeds the empirical database for establishing cause-and-effect by traditional scientific criteria. The extension of 'understanding' into the realm of the unknown requires sound logic based upon careful examination of the available empirical evidence and systematic theory development; such constitutes the science of addiction today. An understanding of this process simply cannot be conveyed meaningfully in a concise 25-word summary to those not adequately trained in the field, much to the frustration of the specialists, laymen and ‘professionals’ alike.

In conclusion, addiction involves differential perturbations in mesolimbic dopamine and other neural systems mediating incentive motivational processes that produce a profound incentive contrast with consequential motivational toxicity. Or stated even more simply, E=mc(2)!

Related on the ASNet
Primer on Drug Addiction
Biological Mechanisms of Addiction
Distinguishing Drug Abuse from Drug Addiction
Dr. Phil's "Addiction"

Announcements

1. Corrections to web pages containing ‘typographical’ errors.
2. Introduction of the ASNet Discussion Forum and RSS feeds.
3. Participation in the AdSense program.
4. Thanks to Sea Monkey and b2evolution.

The transfer of the ASNet website to another platform by the hosting service introduced a number of errors into various web pages throughout the site. A “bit” here, a “byte” there led to toggling bold print, centering lines, or dropping some HTML code into the middle of the text. Many of these problems were undetected and unreported—some just took a long time to correct because of a lack of staff. Still others are awaiting their ‘fix’ some time in the future when resources permit. (For example, numerous corrections have been made to the individual chapters of the online book on Assessing Drug Reinforcement; additional corrections and enhancements are planned.) If you have difficulty accessing a page or if you find typographical errors, problems should be reported to webmaster@AddictionScience.net for correction.

The most significant recent addition to the Addiction Science Network is the ASNet Discussion Forum. But if you’re reading this ASNet Update, you’re already well aware of the Forum. The Discussion Forum has two purposes—to educate by ‘discussing’ various terms, concepts, and other issues in drug addiction and to open some topics for general discussion and comments. Postings that specifically seek opinion are easily identified by the question or questions bold printed near the end of the posting. Commentary is always welcomed, but it is especially appreciated on these ‘open questions.’ Also, remember that RSS feeds from the ASNet Discussion Forum Announcements will take the place of the old ASNet Updates e-mail notification by the end of the year. Both the Firefox and the Sea Monkey browsers have RSS readers built into their applications as does the latest version of Microsoft’s Outlook.

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This post was actually planned for a later date after the groundwork was laid by exploring basic topics regarding drug abuse and addiction on the ASNet Discussion Forum. However, the recent post on Salvia Divinorum (and to a lesser extent the medical marijuana post) propels this topic to the forefront a bit ahead of schedule. When discussing this topic it is essential to keep in mind the differences between drug abuse and drug addiction and their underlying causes (i.e, the biological basis of addiction vs. the psychosocial factors that often govern drug abuse). A lot of confusion arises from simple problems in semantics when discussing psychoactive drug use, the effects of such drugs, and the rights of individuals. Some of the essential concepts have been presented already on the ASNet Discussion Forum or the Addiction Science Network website (see Related Topics on the ASNet below), but others have not yet been explored adequately. Thus, this topic is a somewhat premature.

The question open for comment is: “does the individual living in a free society have the right to use psychotropic substances?” There are a number of secondary questions that arise from this topic.

• What right does society have to infringe upon the rights of the individual (cf. constitutional “right to pursue happiness”)?
• Under what conditions do people have a right to use drugs recreationally?
• Under what conditions does society have an obligation to regulate drug use?
• What types of psychoactive substances should be permissible?

Background

The ASNet drug-regulation policy stands firmly behind the strict control of highly addictive drugs. These substances (e.g., 'hard drugs' such as cocaine and heroin) compromise the individual's ability to 'choose' whether to use the substance or not by altering the individual's motivational hierarchy in such a way as to thrust the addictive drug near the top of the person's motivational priorities (see A Primer on Addiction). On the other hand, some psychoactive substances (e.g., caffeine) clearly do not compromise the individual's self-control in a significant way and therefore can be considered part of 'life's little pleasures.' Between these two extremes lie substances that cause considerable alteration in perception, cognition, and/or affect (e.g., 'soft drugs' such as marijuana and LSD) that potentially pose a risk for the individual and for society by impairing judgment and impulse inhibition of the individual while they are experiencing the psychotropic effects of the substance (e.g., intoxication, hallucinations). This is in contradistinction to truly addictive drugs where the risk to the individual and to society is primarily when the individual is not experiencing the psychoactive effect of the drug.

Addiction science can contribute to the development of rational drug-control policy by differentiating drugs that a large proportion of individuals might be expected to ‘lose control’ of their ability to regulate their own drug-using behavior from substances that most individuals experience little difficulty in regulating their own substance use. Other issues that determine society’s acceptance of its citizens’ use of psychotropic substances involve safety (a rational consideration) and moral control (usually a non-rational consideration). Addiction science and the reporting of experimental findings should not present biased information to conform to moral control issues dictated by society or by its government agencies—it should clearly present the facts as the facts, letting individuals make rational decisions regarding personal use on the individual scale and regarding the development of rational drug-control policies on the societal scale.

Related Topics on the ASNet
A Primer on Drug Addiction
The Nature of Addiction
Distinguishing Drug Abuse from Drug Addiction
Distinguishing Drug Dependence from Drug Addiction
Biological Basis of Addiction
Hard and Soft Drugs
Drug Classification
Salvia Divinorum
Medical Marijuana

A new category for commentary on the ASNet Discussion Forum is being introduced to address drug use other than addictive drug use. Specifically, this category includes the use of psychoactive substances to which the individual hasn’t developed an addiction. In some cases this will involve the use of substances to which addiction is unlikely; in other cases this will involve early-stage use of an addictive substance before an addiction has actually developed.

It is not the intent of the ASNet to encourage illicit substance use by openly discussing this topic. However, it is rather obvious that people do use illicit substances, often in a “recreational” fashion, and that such substance use will continue despite relentless government efforts for social control. It is also possible that the regulations regarding some substances that are now illicit should be relaxed and individuals should be permitted to use these substances freely or under somewhat restricted circumstances.

Before posting or commenting in this category please read the materials recommended below to learn how addiction is defined on this discussion forum, the important difference between drug abuse and addiction, and the relationship of drug dependence to addiction and to drug abuse. Misunderstanding fundamental concepts and breakdown in simple semantics contribute much to the confusion regarding the discussion of these issues.

Addiction science should withhold moral judgments regarding the use of licit or illicit psychoactive substances. Science should provide the unbiased data from which others can make rational decisions regarding their own personal use and regarding the development of formal drug-regulation policies. Within this context, the forum ‘owner’ will occasionally offer comments relevant to the science of addiction or to psychopharmacology in general, but the moral issues regarding psychoactive substance use is left for debate elsewhere (or at least confined to a single, specific ‘thread’ and not interwoven through the pages of the other topics). The topics of interest here include:

• what substances are being used “recreationally” and how they’re being used,
• the desired and undesired psychotropic effects of these substances,
• the perception of relative risk for various substances and for their methods of use, and
• the identification of safer practices for using unsafe substances.

(This latter topic is related to the ASNet harm-reduction initiative and comments may be incorporated into the ASNet webpage listing “safer practices for using unsafe substances.”)

Recommended Readings on the ASNet
A Primer on Drug Addiction
The Nature of Addiction
Distinguishing Drug Abuse from Drug Addiction
Distinguishing Drug Dependence from Drug Addiction
Biological Basis of Addiction
Hard and Soft Drugs
Drug Classification

Salvia Divinorum and its concentrated extracts are enjoying unrestricted trade on the Internet and in most states throughout the United States. The Drug Enforcement Administration (DEA) is currently considering whether this substance (including its concentrated extracts and synthetic analogues) should be “scheduled” and placed on the controlled substance list. Because there are no medicinal uses of Salvia Divinorum recognized by the Food and Drug Administration (FDA), Salvia Divinorum and related compounds would most likely become Schedule I substances with access restricted to investigational use by DEA licensed researchers. (Click here for more information on the CSA/DEA Drug Classification System.)

The question open for comment is: Should Salvia Divinorum and its extracts become controlled substances? Secondary questions involve: How strong are the effects of this substance and its related analogues?

(Thanks to John Panos for suggesting a posting on this topic now open for commentary. Also thanks to my Advanced Topics in Addiction class for encouraging an interest in this substance.)

Related Topics on the ASNet
Distinguishing Drug Abuse from Drug Addiction
Drug Classification
Hard and Soft Drugs

The terms drug dependence and drug addiction are often used interchangeably, but this practice leads to confusion among professionals regarding the diagnostic implications of these terms and also contributes to misunderstanding the underlying causes of substance use. As described earlier, drug addiction refers to a behavioral syndrome where the procurement and use of a drug seem to dominate the individual's motivation and where the normal constraints on the individual's behavior seem largely ineffective. Inherent in this definition is the overwhelmingly powerful motivation to obtain and self-administer the drug. And as noted earlier, drug abuse simply means that the substance is used in a manner that does not conform to social norms; the motivation to use the substance may or may not be particularly strong compared with other motivators. The causes of drug abuse and drug addiction can be the same, but they are very often much different. Specifically, drug addiction involves the biological action of a drug on brain reward and motivation systems, while drug abuse often involves other psychosocial factors with only modest direct effects on brain reward systems.

Drug dependence, in contrast to the two terms described above, refers to a state where the individual is dependent upon the drug for normal physiological functioning. Abstinence from the drug produces withdrawal reactions which constitute the only evidence for dependence. Drug dependence can involve disturbances in general bodily (i.e., somatic) function such as vomiting, diarrhea, sweating, and the resulting symptoms indicate a physical dependence syndrome which is usually specific for a given class of drug. Drug dependence can also involve disturbances in psychological functioning, such as inability to concentrate, anxiety, depression, and the resulting symptoms indicate a psychological dependence syndrome which often shares common features with other abused drugs. It is important to note that psychological dependence has a physiological basis and thus it is preferable to use the term physical dependence to refer to disturbances in somatic function to avoid confusion.

A number of substances produce psychological and/or physical dependence without producing an addiction. The therapeutic uses of certain steroids, antidepressant medication of the SSRI class, and even some antihistamines all produce characteristic withdrawal syndromes when their use is abruptly discontinued. However, there is no strong motivation to continue the use of these substances for most patients; some patients even refuse to resume treatment of such drugs because of their adverse experience during unsupervised withdrawal.

Other substances can produce a notable psychological dependence without producing an exceptionally strong motivation to avoid abstinence. Caffeine has desirable stimulating effects that involve general arousal accompanied by a mild mood elevation for many daily coffee drinkers. And while the avid coffee drinker usually chooses not to miss their morning or afternoon ‘brew,’ many voluntarily abstain when the cost is too high ($8 for a cup of coffee in NYC?) or access is difficult. The ensuing abstinence syndrome has both psychological (e.g., lethargy) and physical (e.g., mild headache) withdrawal signs, but the motivation to abate this condition is far below the level produced by highly addictive drugs such as cocaine and heroin.

Physical dependence often occurs without addiction (e.g., therapeutic use of steroids), and addiction can occur without appreciable physical dependence (e.g., cocaine). Similarly, psychological dependence can occur without addiction (e.g., morning coffee for millions of regular users), but it’s not clear whether addiction ever occurs without psychological dependence. And of course drug abuse may or may not be accompanied by drug dependence and addiction.

The fact that notable signs of physical dependence occur with some of the more addictive drugs (e.g., heroin, barbiturates, alcohol) has lead many to mistakenly attribute the motivation for substance use to the avoidance of withdrawal discomfort. Other drugs, such as the psychomotor stimulants, do not produce these characteristic withdrawal reactions and have helped to debunk this common misconception. Of course there are other compelling lines of evidence that physical dependence is not the primary cause of drug addiction (see Bozarth, 1989, 1990, 2009; Bozarth & Wise, 1984; Wise & Bozarth, 1987) although it can contribute to the overall motivation for continued drug use (see Bozarth, 1994).

In summary, drug addiction describes the motivational strength of substance use; drug abuse describes the misuse of a substance without explicit reference to motivational strength; and drug dependence describes the necessity of using a substance to maintain normal psychological and/or somatic functioning without reference to the motivational strength of the substance use or to whether the substance use violates cultural norms. These three terms have distinctively different meanings although there are obvious and numerous cases where all three apply to the same drug-use situation (i.e., the individual may be dependent upon a drug which they abuse because they are addicted).

Related Topics on the ASNet
A Primer on Drug Addiction
Biological Basis of Addiction
Hard and Soft Drugs
Distinguishing Drug Abuse from Addiction
Medical Marijuana
The Nature of Addiction

Dr. Phil and other tele-psychologists promote fundamental misunderstandings about addiction. Playing out in a type of public psychodrama, the inflicted guest is usually told how the problem is easily solved “if you only . . .” as the ‘all-knowing sage’ offers insight (and often resolution) within a single 60-minute episode. This kind of 'pop psychology' is replete with misinformation about addiction—what it is, its nature, and its treatment. Increased sensitivity to the problem of addiction notwithstanding, the misinformation promoted on such popular television programs as Dr. Phil and Oprah does a considerable disservice to addiction science as well as to the addicts themselves. Much of the misinformation may be promoted out of ignorance but some is motivated by commercial interests. The sad fact is that the pain and misery of addiction ‘sells’ and the turmoil of those affected both directly and indirectly is commonly exploited by the popular media: rating points go up as the tissues come out.

Addiction technology transfer attempts to narrow the gap between what is known from the science of addiction and what is commonly practiced in the clinic, promoted on talks shows, and believed by laymen in general. A primary mission of the ASNet is to help narrow this gap through its addiction technology transfer initiative. Indeed, this ‘thread’ is part of that effort. Other efforts include the Addiction Science Network website, university courses, and public lectures. And although this work may seem to have a small impact against the rising tide of tele-psychologists exploiting addiction for rating points, “it’s better to light a single candle than to curse the darkness.” So here’s a flicker of a flame which hopefully contributes to the work of others slowly narrowing the gap between knowledge and ignorance.

Some of the common fallacies promoted by 'talk show' psychologists and other popular media include the following.

1. Addiction describes any obsession with something that is stronger than the desire most people experience. This type of fixation can occur to almost anything because it is an attribute of the individual and not related to the actual object being desired.

   This is one of the most fundamental misunderstandings about addiction and the proper use of this term. There is a wide range of motivational levels individual people express for normal rewards. Being on the upper tail of a normal distribution remains part of that NORMAL distribution. For example, a particularly strong desire to improve ones life by attending college despite personal hardships may be atypical but it is not pathological!Addiction describes a behavioral syndrome where the use of a substance seems to dominate the individual’s motivation and where the normal constraints on the individual’s behavior seem largely ineffective. This is caused by disturbances in normal brain chemistry that can be produced by the use of certain types of drugs (i.e., addictive drugs) and may also occur with the use of some other substances and even with non-chemical rewards in some people predisposed to developing an addiction. It does not involve any kind of psychological fixation caused by arrested psychosexual development in the Freudian sense nor does it involve the same process as that found with obsessive-compulsive disorders. Addiction is distinctively different from normal motivation and from other mental illnesses and therefore merits its own unique classification as a behavioral disorder. The single most prominent feature of addiction is the intense motivation to take the drug, motivation that exceeds the motivational level seen for most natural rewards. Consequential to this is a disruption of the individual’s normal motivational priorities (i.e., motivational toxicity) which is subjectively experienced typically as a sense of “loss of control” over ones own behavior.

2. Common gateway drugs propel the individual to seeking stronger and stronger psychoactive substances to escape reality or to self-medicate some underlying psychological disorder. Use of marijuana or even tobacco products is a necessary step in developing an addiction and suppressing the use of these substances would prevent most cases of addiction.

   A corollary of this premise is that the distinction between hard and soft drugs becomes blurred because soft drugs are actually just one step below the use of hard drugs in the genesis of an addiction. And it also follows that the medicinal use of marijuana is unacceptable (despite its demonstrated effectiveness in certain disorders) because it will lead not only to marijuana addiction but addiction to hard drugs such as cocaine and heroin as well. Of course most people who experiment with hard drugs have first experimented with soft drugs, but this is no reason to assume that soft-drug use was a necessary first step or that it somehow goaded the individual into using hard drugs. (For another example of falsely attributing cause-and-effect from similar data, see The Power of the Blog: We did It—Medical Marijuana is Almost Here!) People who experiment with drugs tend to ‘experiment with drugs!' This leads to an increased likelihood of trying a highly addictive drug and developing an addiction. However, people can easily side-step experimentation with soft drugs and begin experimentation with heroin or cocaine if those are the only drugs available. The use of soft drugs such as marijuana in no way ‘propels’ most individuals into hard drug use. It’s even possible many that people who experiment with soft drugs somehow satisfy some adolescent need to try drugs as an expression of independence and social defiance, and if only hard drugs were available the incidence of drug addiction would be even higher.

3. Drug addiction is caused by a lack of respect for oneself and other psychodynamic factors like those involved in some other cases of abnormal behavior not involving drugs. If the individual develops "self respect," their drug use will simply fade away.

   This and the following false premise are related to the "denial of brain disorder" problem addressed by ASNet's addiction treatment-facility rating project. Part of the problem may be one of semantics and failing to distinguish drug abuse from drug addiction. But this distinction is often deliberately blurred to incorporate the severe emotional and behavioral turmoil of addiction with simple cases of drug abuse which are more easily remediated.

4. Once the addict obtains insight into their own addiction, the addiction rapidly abates as they rebuild their lives unimpaired by their drug abuse.

   The notion of the curative power of 'insight' is used to justify the seemingly endless 'psycho-rumination' which discusses over-and-over the addiction in telling emotional terms until the 'flash of light' illuminates the true source of the problem and the desire for drug use stops. There are cases where this type of 'psychotherapy' may be useful, but it has little impact on true drug addiction which has a biological basis.

5. Addicts are whisked away to treatment centers that magically cure their addiction at least for most people. Relapse to drug use is uncommon once 'propper' treatment is provided.

   Most addicts relapse to using drugs. If this were the sole criterion for treatment effectiveness, drug addiction treatment would be deemed ineffective. But effective treatment does increase the time before relapse, and drug addicts often re-enter treatment making progress each time towards eventually remaining drug abstinent for a sufficiently long period to consider the treatment overall effective if not 'perfect.' So treatment does work even though addicts typically relapse, but there's no 28- or 90-day program that magically saves the addict from their addiction. Too many treatment facilities promise unrealistic results and focus on treatment approaches that are known to be ineffective while enhancing the psychodrama aspects of addiction.

On the positive side, the portrayal by tele-psychologists often promotes:

• an increased awareness and sensitivity to the problem of addiction, and
• a greater tendency to seek help for addiction and to enter treatment programs.

So the question open for comment is:

Do tele-psychologists like Dr. Phil do more harm than good for understanding and treating drug addiction?

And subtopics include specific examples where the popular portrayals of addiction help and hinder a better understanding of this disorder. Of course general comments on "Dr. Phil's [portrayal of] Addiction" are also welcomed.

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