Tags: drug abuse

Defining Addiction: What are the necessary attributes?

09/15/12 | by the professor [mail] | Categories: General, Nomenclature

Link: http://AddictionScience.net

We have chosen to define “addiction” as a behavioral syndrome where drug use and procurement seem to dominate the individual’s motivation and where the normal constraints on behavior are largely ineffective. There are other important attributes of addiction that are usually included in various definitions of this term. The question of interest is whether other attributes are necessary components of a formal definition or whether they add needlessly to the number of terms used to define what we mean by “addiction.” Succinct definitions not only ‘save words,’ but they keep the focus on the primary variable(s) of interest and help to prevent confusing effects with causes in our definitions. The definition adopted here is less than 25 words, and there are definite advantages to keeping definitions sufficiently short so as to simply memorization and to facilitate accurate conveyance amongst those discussing the same phenomenon. One of the biggest challenges to any discourse, whether it be lay, academic or professional, involves semantics or making sure that all parties are actually discussing the same thing. Succinct, consensually accepted definitions facilitate conversations at all levels.

The “Pizza and beer” syllogism is perhaps the most famous example illustrating how a statement that seems logically correct leads to an erroneous conclusion.

  • Pizza and beer are better than nothing.
  • Nothing is better than going to heaven.
  • Therefore, pizza and beer are better than going to heaven!

The syntax is logically correct, but there is a breakdown in semantics involving the meaning of the word “nothing” that invalidates the apparent conclusion. In the first context “nothing” refers to “the absence of anything,” while in the second context it refers to “no-thing.” It is critically important to avoid these types of semantic breakdowns in discussions of addiction, and thus the need for a concise definition that identifies the defining attribute(s) of an addiction while relegating the others characteristics often included to descriptive text.

Addiction is often defined as “a chronically relapsing disorder” or “disease” (whether addiction is indeed a “disorder” or a “disease” is a point of considerable debate in itself; see Drug Addiction as a "Disease"). The phrase "chronically relapsing" certainly describes an important characteristic of an addiction, but is it necessary in a concise definition? The intense motivational strength of an addiction not only predicts the high relapse rates, but it also predicts other attributes of addiction such as motivational toxicity which describes the drug’s impact on normal motivated behaviors such as eating and sexuality. The fact that a single attribute (i.e., motivational strength) can predict from simple logical deduction several other characteristics that are commonly seen in addiction makes this single attribute more valuable as the defining characteristic than is compiling an unnecessarily longer list of characteristics for inclusion in the formal definition of addiction. These other commonly observed features are perhaps best considered simply “characteristics” of an addiction because they can all be derived from the single defining attribute (i.e., high motivation for drug administration). This same logic also applies to adding “motivational toxicity” to formal definitions of addiction. While it may appear to be a defining characteristic, the motivational toxicity inherent in an addiction can also be predicted by simply understanding that addictive drugs produce an intense motivational state and thus even if they lacked their ability to blunt the rewarding impact of natural rewards they would still seemingly overtake the normal motivations in the individual’s life. The same might be said for the second characteristic included in our definition, specifically, that “the normal constraints on behavior are largely ineffective,” but this phrase not only underscores the intense motivation to obtain the addictive drug but also reminds the reader that motivational strength is reflected not only in how hard one will work for the goal object but also by the willingness to overcome aversive conditions which might normally inhibit goal-directed behavior.

Other considerations for inclusion in a comprehensive definition of addiction include the addict’s perceived sense of a “loss of control.” Again, this variable might be deduced simply by considering that the normal choice perceived when several, closely competing goals which vie for the individual’s ‘attention’ and behavior are obviated by a single, overwhelmingly strong motivator—the addictive drug. In other words, the cognitions associated with classic approach-approach and approach-avoidance conflicts might give rise to a sense of ‘choice,’ and these conflicts are less prominent in cases where the motivation to ‘approach’ the goal object (in this case, use the drug) is so strong as to dominate unquestionably the other motivations. In such cases the perception of choice might be absent and the individual may feel that they no longer have control over their own behavior, but rather, that they are being driven by some external force. In a sense they are correct—the stimulus properties of the drug and other cues in conjunction with the (largely unconscious) anticipation of reward engage the individual’s behavior in a manner consistent with the notion of “enslavement” to the external agent (i.e., functionally the drug is serving as the ‘master’ and the addict as the 'slave'). As discussed elsewhere, this apparent “enslavement” is consistent with the etymology of the term “addiction” and adds credence to the use of the term in this fashion as opposed to the popular misconception of “addiction” as physical dependence upon a substance.

The last consideration that might be addressed by our definition of addiction is whether we consider it a disease or a disorder. The definition used here avoids this debate by simply defining “addiction” as a “behavioral syndrome.” Whether it is truly best considered a disease or a disorder is moot for our definition which emphasizes the behavior of the individual as being the primary descriptive variable and hence is consistent with the term’s etymology of "addiction" as "enslavement." As discussed elsewhere, the disease-disorder debate resolves down to one largely of who ‘owns’ the territory—the medical establishment or psychologists, counselors, and social workers (see Drug Addiction as a "Disease"). There are of course other important considerations for whether a pathology is considered a disease or disorder, such as locus of control—biological or more “psychological”—along with the ensuing implications of how to best approach treatment and the degree of individual responsibility for their own ‘problem’ (e.g., the use of the term “disease” implies that the individual has relatively little control over the course of the pathology and that some external treatment is necessary to remediate the problem). There would appear to be no advantages to including the term “disorder” in a formal definition of addiction, but additional characteristics conveyed by the use of the term “disease” merit further consideration for future revisions to our ‘working’ definition. On the other hand, the use of the term disorder would imply that addiction is not a disease, while the description as “a behavioral syndrome” avoids pronouncement on this hotly debated topic.

It is always tempting when formulating definitions to be all encompassing or at least to describe enough of the phenomenon under discussion to vividly illustrate its many facets. Indeed, the more one knows the more eagerly one tries to share their knowledge with anyone and everyone who will listen. Understanding the many aspects of addiction, something shared by more than a few researchers and clinicians, seemingly implores one to offer mini-lectures or tutorials at every opportunity. And when it comes to formal definitions, the desire to share all often gets the best of even academic scholars who should understand well the need for concise definitions devoid of superfluous adjectives. Nonetheless, multifaceted phenomena like addiction are often described from the perspective of individual disciplines studying only one or a few of its many features without trying to identify a common underlying variable responsible for the various attributes.

In this way most definitions focus too much on the vicissitudes of addiction which distract from the core phenomenon responsible for these other, secondary characteristics. Indeed, this often overshadows the primary characteristic of an addiction. In other words, the motivational characteristic of an addiction (which is used here as the basis for its definition) produces the other features such as “chronically relapsing disorder,” the addict’s “perceived loss of control,” and even the “motivational toxicity” inherent in an addiction. Inclusion of these other, secondary characteristics tends to obscure the primary characteristic of the addiction and in some respects seemingly confuses its effects with its cause (i.e., the intense motivational strength can be viewed as the cause and these other features as effects of the addiction!) This is an example of why good science strives to simplify things, to render them in their simplest, not most complex, terms; good definitions like good theories retain a vision of “the forest for the trees,” hence not letting the details obscure the bigger picture. In case anyone is still wondering whether a useful definition of addiction can be resolved down to just 25 words or less the answer is yes, indeed it can, and we are better off ‘keeping it simple stupid’ to ensure the semantic integrity of our discussion of this seemingly complex, multifaceted phenomenon.

So what do we have nearly 1400 words later when we’ve finished with this relatively brief examination of the terms frequently used to define addiction? We’re right back where we started: “addiction” can be defined as a behavioral syndrome where drug use and procurement seem to dominate the individual’s behavior and where the normal constraints on behavior are largely ineffective. The difference between the closing and beginning positions of this discourse lies in the certainly with which we succinctly define addiction—acknowledging the phenomenology of these other important attributes, but rendering their incorporation into a formal definition of addiction (albeit a ‘working’ one) unnecessary.

The podcast of this presentation can be downloaded from our ASNet Podcast Directory.

Click here to listen to the podcast without downloading (length: 11min48sec). Click on the ASNet podcast logo (Anpu) to pause the imbedded player.

Other related commentaries:
A Primer on Drug Addiction
Distinguishing Drug Abuse from Drug Addiction
Drug Addiction as a "Disease"

Permalink

ASNet Updates 09D11

04/11/09 | by the professor [mail] | Categories: Announcements

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.

AdSense is being added to most web pages. The revenue generated by participation in this program is very small even when people do click on the advertisements. The primary purpose of incorporating AdSense into the ASNet website (and into the Discussion Forum in the future) is to provide real-time data on Internet traffic for the corresponding pages. No information is collected regarding individual visitors—only information regarding the number of visitors to a page. This helps to direct limited ASNet resources to where they will have the most impact: working to improve the impact of pages with little traffic but important content, and working to further enhance the impact of already popular pages. Please note that the Addiction Science Network does not accept advertisements nor does it collect any fees from any of these ‘sponsors’ directly—the content of the AdSense displays are controlled by Google and should not be interpreted as an endorsement of any kind.

Finally, near the bottom of the AddictionScience.net home page there are acknowledgements of open source software, specifically the Sea Monkey and b2evolution programs that are used to develop this website and to provide the Discussion Forum, respectively. A link to the popular Firefox Internet browser is also included as is a link to the OpenSource.org consortium. These are unpaid, unsolicited ‘advertisements’ for these non-profit projects that provide free software for the Internet and thereby help keep the costs low at the ASNet—free is good, free is appreciated, and free is gratefully acknowledged.

Below is an example of the Google AdSense Advertisements that may appear in some postings. Clicking on these links take you to websites not affiliated with the ASNet.

Permalink

Recreational Drug Use: Do People Living in a Free Sociey have the Right to use Psychotropic Substances "Recreationally"?

04/08/09 | by the professor [mail] | Categories: Drug-Regulation Policy, Recreational Drug Use

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

Permalink

“Recreational” Drug Use: A New Discussion Category on the ASNet Forum

04/08/09 | by the professor [mail] | Categories: Drug-Regulation Policy, Recreational Drug Use

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

Permalink

Why Distinguishing between Drug Dependence and Drug Addiction is Important

03/30/09 | by the professor [mail] | Categories: General, Nomenclature

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 with 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, SSRIs), 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).

Click here for the podcast of this commentary via streaming audio which doesn't require downloading.

Click here for our directory of all available podcasts.

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

Permalink

Dr. Phil's "Addiction"

03/23/09 | by the professor [mail] | Categories: General

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.

Read more »

Permalink

Why Distinguishing between Drug Abuse and Drug Addiction is Important

03/11/09 | by the professor [mail] | Categories: General, Nomenclature

Link: http://AddictionScience.net/ASNabuseAddiction.htm

The terms "drug abuse" and "drug addiction" are often used interchangeably, but in fact, they denote very different conditions. The term "drug abuse" refers to the use of a substance in a manner that deviates from the culturally acceptable norms, while the term "drug addiction" describes a disorder where the drug appears to be the dominant influence on the individual's behavior. More specially, drug addiction is behavioral syndrome where the individual’s motivation is dominated by the procurement and use of a drug and where the normal constraints on the individual’s behavior are largely ineffective (Bozarth, 2009; see also Bozarth, 1990). This condition may or may not be accompanied by physical dependence, but it does seem to be invariably accompanied by psychological dependence. Psychological dependence, however, is NOT equivalent to addiction. Psychological dependence, like its physical dependence counterpart, simply means that the individual requires the substance for normal psychological functioning. That is, abstinence from the substance produces withdrawal reactions that disrupt normal psychological (or in the case of physical dependence, physiological) function. Of course psychological dependence has an underlying neurophysiological basis; therefore the syndrome describing disturbances in normal physiological function other than psychological aspects (such as disturbances in autonomic nervous system producing nausea, chills, tremors, etc.) are better denoted as physical dependence and withdrawal. There are undoubtedly cases of psychological dependence without addiction to the substance—the substance is necessary for ‘normal’ psychological functioning, but the motivation to obtain the substance is insufficiently strong to constitute an addiction to that substance (e.g., daily caffeine use for many people).

There are many cases where the use of a substance constitutes drug abuse but not addiction. For example, any use of an illicit substance is considered drug abuse even if the substance is used only rarely and the individual retains control of their substance use. There are even numerous cases where the individual seems to loose control of their substance use, but it still doesn’t constitute true addiction to that substance (see below). Drug abuse is defined by the society in which it exists; what is considered drug abuse in one culture may be perfectly acceptable in another. Drug abuse does not necessarily imply that the motivation to continue use of the substance is strong.

The causes of drug addiction and of drug abuse are often quite different. Drug addiction, although the more intense motivational condition, is actually less complex than is drug abuse. Drug addiction involves the drug’s action on brain reward and motivation systems whereby it produces neurochemical disturbances that result in the drug becoming the dominant motivational factor for the individual. This involves an “incentive contrast” where there is a dramatic increase in the incentive value or attraction to the drug reward and a marked decrease in the incentive value or interest in other, normal rewards (Bozarth, 2009). The ensuing motivational toxicity is a characteristic of addiction that requires no pre-existing conditions or special personality types—simply the neurochemical action of certain (i.e., addictive) drugs on brain reward systems.

Drug abuse, on the other hand, involves the ‘misuse’ of a substance (according to social norms) that may or may not be accompanied by a strong motivation to continue the use of the substance. In cases where drug abuse appears to be strongly motivated, the motivation actually depends on characteristics of the individual or of the social setting to produce these strong motivational effects. That is, apparent “addictiveness” in cases of strongly motivated drug abuse without addiction does not actually involve an attribute of the drug per se. Rather, some set of psychosocial factors account for the strong motivation to engage in substance abuse. In many cases of pathological drug abuse where the motivation to continue the substance use seems strongly motivated, other psychiatric disturbances are present. These comorbid disorders are much different than actual addiction to the substance and need to be carefully distinguished from true drug addiction when considering the appropriate treatment approach.

There are obviously many cases of drug abuse that do not constitute drug addiction. In contrast, most cases of drug addiction involve drug abuse; however, there are even a few cases where drug addiction does not constitute drug abuse such as prescribed high-dose opiate medication for chronic pain.

Determining whether the use of an illicit substance constitutes simply drug abuse or true drug addiction can seem daunting, but it’s actually quite simple. If the substance use is intensely motivated as is inherent in the definition of addiction AND if the motivation for the substance use arises from its action directly on brain reward systems, it constitutes drug addiction. If special, pre-existing psychosocial factors are necessary for the substance use to develop (regardless of how strongly that behavior seems to be), then it constitutes drug abuse which involves more than just the substance’s action on brain reward systems and therefore is not truly an addiction to that substance. In cases of compulsive drug abuse comorbid disorders are very likely to be present.

Related Topics on the ASNet
A Primer on Drug Addiction
Biological Basis of Addiction
Hard and Soft Drugs
Medical Marijuana

Permalink

Pages: << 1 2 3 >>

July 2018
Sun Mon Tue Wed Thu Fri Sat
 << <   > >>
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31        

An open, unmoderated discussion forum for the Addiction Science Network, promoting free and open exchange of evidence-based information and promoting scientific analysis of drug addiction and related topics.

Search

Addiction Science Network

powered by b2evolution free blog software