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"

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.

Read more »

The Addiction Science Network will discontinue e-mail notification of updates by the end of 2009. Please subscribe to RSS or Atom feeds linked on the bottom right-hand side of the ASNet Discussion Forum to receive notification of updates to the main AddictionScience.net website in addition to new postings to the discussion forum. Please note that RSS/Atom feeds for new postings and for replies to existing postings are separate notifications. You may subscribe to receive only notification of new postings and/or to receive notification of replies to existing postings. If you wish to minimize the number of RSS/Atom broadcasts that you receive, only subscribe to receive new postings which will include announcements about updates to the Addiction Science Network website.

RSS and Atom feeds have set the standards for timely notification of updated web information and for publication of new material online. Those not familiar with these services are advised to learn about them and to use them for keeping up-to-date in their areas of interest. Microsoft Outlook provides automatic downloading of subscribed RSS feeds seamlessly integrated with normal e-mail. More information will be provided later on how to use RSS/Atom feeds to keep up-to-date on the ASNet activities. Meanwhile, "try it, you'll like it!"

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

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

The scientific evidence overwhelmingly favors the medical use of marijuana. After ‘sitting on the fence’ for over a decade (i.e., since the beginning of the ASNet), it’s past time to ‘come out of the closet’ (there’s a pun in there somewhere ) and endorse the medical use of marijuana. The evidence has been compelling for a long time; in fact, several Presidential Committees spanning several decades have uniformly concluded that there is substantial evidence for medicinal effects from marijuana, and heightened interest in the past decade has prompted considerable study both empirical and theoretical. The overwhelming conclusion remains the same as purported over three decades ago with added emphasis on decriminalizing small quantities of marijuana for personal use.

ASNet drug-regulation policy recommendations and interpretations of extant scientific evidence are generally concordant with the major themes adopted by the National Institute on Drug Abuse (NIDA) and by the mainstream medical community except for two prominent issues: the “nicotine addiction” hypothesis” and “medical marijuana.” ASNet strongly disagrees with the assertion that nicotine is a highly addictive substance comparable to cocaine and heroin and that marijuana is similarly addictive. It further advocates the use of marijuana medicinally for appropriate cases and objects to the continued stigmatization and repressive regulation of tobacco products for use by adults. These two discordant positions are not intended to undermine the staunch support ASNet expresses for most NIDA research and policy recommendations: ASNet remains concordant with NIDA on most other issues and continues to respect the many friends and colleagues working for NIDA’s intramural program and those supported by NIDA’s extramural grant program.

The primary reason for remaining silent on these two issues of discordance with the prevailing government opinion is that both positions seem to discredit each other. That is, the pejorative assertions that “not surprisingly ASNet advocates marijuana use because they encourage tobacco smoking too” or “naturally ASNet disagrees with the idea of nicotine addiction because they also recommend marijuana use.” Of course, both statements are false distortions of our actual position. ASNet simply disagrees with the opinion that nicotine is highly addictive like cocaine and heroin and further disagrees with the opinion that marijuana is similarly highly addictive while advocating medicinal use of marijuana. Nonetheless, adopting both of these positions seems mutually discrediting; therefore ASNet has retained a low profile on the “nicotine addiction” issue and has not previously advocated the use of medical marijuana. With this current policy statement, ASNet now ‘steps forward’ and explicitly supports the medical use of marijuana.

We respect the decision displayed by many of our fellow scientists either working for various government agencies or supported by government grants who find it politically inconvenient to similarly ‘come out of the closet.’ Yes, there are many scientists who concur with the ASNet on both of these topics but fear repercussions should they express their opinions publically. And while we refuse to redefine “integrity” to meet the currently popular usage of this term, we do respect their decision to protect and further their careers. (“Integrity” is traditionally defined as “firm adherence to a code of especially moral or artistic values, incorruptibility [Merriam-Webster’s Online Dictionary].”) After all, it’s only tantamount to the Nazi book burning and not really persecuting any specific group of people; or is it?

The ASNet specifically:

(1.) endorses the medicinal use of marijuana for compassionate use including non-terminal but chronic illnesses such as multiple sclerosis, fibromyalgia, and other conditions involving neuropathic pain unresponsiveness to conventional medications,

(2.) firmly disagrees with the National Institute on Drug Abuse (NIDA), the Food and Drug Administration (FDA), the Drug Enforcement Administration (DEA), and other government agencies that purport marijuana to be a highly addictive substance similar to cocaine and heroin (in fact, we consider this assertion to be particularly irresponsible and call upon these government agencies to soften their rhetoric regarding marijuana and to recognize its actual status as a ‘soft drug’),

(3.) supports the decriminalization of marijuana and applauds progressive state legislative bodies such as that seen in our home state of New York who have already de facto decriminalized marijuana, and

(4.) while not advocating the recreational use of marijuana presently withholds opinion on this popular activity.

However, ASNet does not endorse the legalization of marijuana for the reasons outlined in Bozarth (2009).

For more information, check our webpage on medical marijuana.

[Note: The comments regarding the “nicotine addiction” hypothesis were included in the current policy statement only because this view is a matter of public record (e.g., 1994 FDA testimony transcribed in the Federal Record) that could be used to undermine the current advocacy of medical marijuana through ad hominid attack (e.g., “of course they don’t think marijuana is addictive, they don’t think nicotine is addictive either”). That’s right! But ASNet is not currently prepared to debate this second topic further than the public comments already posted on the subject. We feel that opening one ‘can of worms’ at a time is sufficient controversy and distraction from our overall mission. ]

Does considering drug addiction as a "disease" help or hinder a better understanding about the nature, cause, and treatment of this 'disorder?'

Please see the Comments from "The Professor" for the ASNet perspective on considering "Addiction" as a disease.

[adsense:]