Category: General

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

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Position Statement on Medical Marijuana

03/08/09 | by the professor [mail] | Categories: General, Drug-Regulation Policy

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.

Click here to listen to a podcast discussing why it's unlikely that medical marijuana will ever be approved in the United States. (length: 24 minutes)

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. :>]

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Drug Addiction as a "Disease"

02/11/09 | by the professor [mail] | Categories: General, Nomenclature

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.

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A New Addiction Science Network Resource -- Welcome to the "Blog!"

02/11/09 | by the professor [mail] | Categories: General

Welcome to the new discussion forum of the Addiction Science Network (ASNet). This 'blog' is an open, unmoderated forum for discussing drug addiction and related topics. Neither the Addiction Science Network nor any of its agents are responsible for the content of this blog. "The Professor" will on occasion add commentary or initiate a thread but generally does not moderate or direct this forum.

The discussion forum has been added as a new resource to the Addiction Science Network because of popular demand for such a mechanism to share information about the scientific study of drug addiction and the evidenced-based knowledge obtained from such analysis. It is hoped that the many requests for information that are sent to the ASNet for a personal reply are redirected to this forum for a more prompt response and for sharing with the many others who have similar interests.

To help organize the information discussed and subsequently archived here, please initiate a new thread when appropriate (e.g., changing a topic) and post replies and added commentary to an existing thread at least while the thread is still active. Because of the nature of this forum, any personal information collected for registration purposes is protected under Federal regulations including HIPPA and FERPA. Information posted by the participants in this forum, however, is public and the user is cautioned about revealing personal information in such postings (e.g., actual identify, personal address).

Good hunting, happy blogging, and cheers,

"The Professor"

UPDATE 12 September 2012

We have been forced to move to a "moderated" structure because of the heavy spam left in open, user-initiated, unmoderated posts (for an example of the potential for abuse, see the server overload we experienced when the 'gate' was left open as described in our posting Unscheduled Service Disruption to all ASNet Resources.) We will continue to permit the free, open exchange of ideas and positions on topics related to drug addiction, substance abuse, and psychopharmacology, but we now must impose a slight delay while new posts are reviewed to insure that they are legitimate posts and not spam. We still do not technically moderate the posts; we will gladly present opposing views including those which conflict with our own opinions and position statements. The "moderation" is strictly to ensure legitimate posts and prohibit spam or commercial promotions for other websites and treatment centers. Sorry for any inconvenience and please continue to leave your comments and feedback.

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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.

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