Describe addiction.
Addiction is a chronic or recurrent condition proposed to be precipitated by one or more of the following: genetic, biological/pharmacological and social factors. Addiction is characterized by the compulsive use of substances or engagement of behaviors despite clear evidence to the user of negative consequences.
Akrasia
Alcoholism
Alcohol-related traffic crashes
Alcohol tolerance
Alcoholics Anonymous
Codependence
Computer addiction
Disease model of addiction
Drug addiction
Drug injection
Free will
Higher order desire
Junkie
Life-process model of addiction
Love-hate relationship
Moderation Management
Narcotics Anonymous
Problem gambling
Sexual addiction
Decades ago addiction was a pharmacologic term that clearly referred to the use of a tolerance-inducing drug in sufficient quantity as to cause tolerance (the requirement that greater dosages of a given drug be used to produce an identical effect as time passes). With that definition, humans (and indeed all mammals) can become addicted to various drugs quickly. Almost at the same time, a lay definition of addiction developed. This definition referred to individuals who continued to use a given drug despite their own best interest. This latter definition is now thought of as a disease state by the medical community.
Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). Unfortunately, terminology has become quite complicated in the field. To wit, pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence); psychiatrists refer to the disease state as dependence; most other physicians refer to the disease as addiction. The field of psychiatry is now considering, as they move from DSM-IV to DSM-V, transitioning from "dependence" to "addiction" as terminology for the disease state.
The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological dependence (or simply addiction). Addiction is now narrowly defined as "uncontrolled, compulsive use"; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered compulsive, but to the definition of some it is not categorized as "addiction". In practice, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components.
There is also a lesser known situation called pseudo-addiction. A patient will exhibit drug-seeking behavior reminiscent of psychological addiction, but they tend to have genuine pain or other symptoms that have been undertreated. Unlike true psychological addiction, these behaviors tend to stop when the pain is adequately treated.
The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal. While opiates are essential in the treatment of acute pain, the benefit of this class of medication in chronic pain is not well proven. Clearly, there are those who would not function well without opiate treatment; on the other hand, many states are noting significant increases in non-intentional deaths related to opiate use. High-quality, long-term studies are needed to better deliniate the risks and benefits of chronic opiate use.
Not all doctors agree on what addiction or dependency is, because traditionally, addiction has been defined as being possible only to a psychoactive substance (for example alcohol, tobacco and other drugs) which ingested cross the blood-brain barrier, altering the natural chemical behavior of the brain temporarily. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, cutting, and shopping / spending. However, these are things or tasks which, when used or performed, cannot cross the blood-brain barrier and hence, do not fit into the traditional view of addiction. Symptoms mimicking withdrawal may occur with abatement of such behaviors; however, it is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. In spite of traditionalist protests and warnings that overextension of definitions may cause the wrong treatment to be used (thus failing the person with the behavioral problem), popular media, and some members of the field, do represent the aforementioned behavioral examples as addictions.
In the contemporary view, the trend is to acknowledge the possibility that the hypothalmus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicals (alcohol, nicotine etc.) when addictive activities take place[citation needed]. For example, when an addicted gambler or shopper is satisfying their craving, chemicals called endorphins are produced and released within the brain, reinforcing the individual's positive associations with their behavior.
Despite the popularity of defining addiction in medical terms, recently many have proposed defining addiction in terms of Economics, such as calculating the elasticity of addictive goods and determining, to what extent, present income and consumption (economics) has on future consumption.
Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance or behavior is suddenly discontinued. While opioids, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, other categories of substances share this property and are not considered addictive: cortisone, beta-blockers and most antidepressants are examples. So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the primary attribute of an addictive substance is usually its ability to induce pleasure[citation needed] and its facility in becoming routinely used. A notable exception to this is nicotine. Users report that a cigarette can be pleasurable, but there is a medical consensus[citation needed] that the user is likely fulfilling his/her physical addiction and, therefore, is achieving pleasurable feelings relative to his/her previous state of physical withdrawal. Further, the physical dependency of the nicotine addict on the substance itself becomes an overwhelming factor in the continuation of most users' addictions. Although 35 million smokers make an attempt to quit every year, fewer than 7% achieve even one year of abstinence (from the NIDA research report on nicotine addiction).
Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.
The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Studies[citation needed] have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. The vast majority of medical professionals and scientists agree that if one uses strong opioids on a regular basis for even just a short period of time, one will most likely become physically dependent[citation needed]. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine.
Eating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this article. Eating disorders, which some argue are not addictions at all, are driven by a multitude of factors, most of which are highly different than the factors behind addictions described in this article.
Psychological dependency is a dependency of the mind, and leads to psychological withdrawal symptoms (such as cravings, irritability, insomnia, depression, anorexia etc). Addiction can in theory be derived from any rewarding behavior, and is believed to be strongly associated with the dopaminergic system of the brain's reward system (as in the case of cocaine and amphetamines). Some claim that it is a habitual means to avoid undesired activity, but typically it is only so to a clinical level in individuals who have emotional, social, or psychological dysfunctions, replacing normal positive stimuli not otherwise attained (see Rat Park).
It is considered possible to be both psychologically and physically dependent at the same time. Some doctors make little distinction between the two types of addiction, since the result, substance abuse, is the same. However, the cause and characteristics of each of the two types of addiction is quite different, as is the type of treatment preferred.
Psychological dependence does not have to be limited only to substances; even activities and behavioral patterns can be considered addictions, if they are harmful, e.g. gambling, Internet use, usage of computers, sex / pornography, eating, self-harm or work.
Methods of care
Early editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) described addiction as a physical dependency to a substance that resulted in withdrawal symptoms in its absence. Recent editions, including DSM-IV, have moved toward a diagnostic instrument that classifies such conditions as dependency, rather than addiction. The American Society of Addiction Medicine recommends treatment for people with chemical dependency based on patient placement criteria (currently listed in PPC-2), which attempt to match levels of care according to clinical assessments in six areas, including:
Acute intoxication and/or withdrawal potential
Biomedical conditions or complications
Emotional/behavioral conditions or complications
Treatment acceptance/resistance
Relapse potential
Recovery environment
Some medical systems, including those of at least 15 states of the United States, refer to an Addiction Severity Index to assess the severity of problems related to substance use. The index assesses problems in six areas: medical, employment/support, alcohol and other drug use, legal, family/social, and psychiatric.
While addiction or dependency is related to seemingly uncontrollable urges, and arguably could have roots in genetic predispositions, treatment of dependency is conducted by a wide range of medical and allied professionals, including Addiction Medicine specialists, psychiatrists, and appropriately trained nurses, social workers, and counselors. Early treatment of acute withdrawal often includes medical detoxification, which can include doses of anxiolytics or narcotics to reduce symptoms of withdrawal. An experimental drug, ibogaine, is also proposed to treat withdrawal and craving. Alternatives to medical detoxification include acupuncture detoxification. In chronic opiate addiction, a surrogate drug such as methadone is sometimes offered as a form of opiate replacement therapy. But treatment approaches universal focus on the individual's ultimate choice to pursue an alternate course of action.
Therapists often classify patients with chemical dependencies as either interested or not interested in changing. Treatments usually involve planning for specific ways to avoid the addictive stimulus, and therapeutic interventions intended to help a client learn healthier ways to find satisfaction. Clinical leaders in recent years have attempted to tailor intervention approaches to specific influences that effect addictive behavior, using therapeutic interviews in an effort to discover factors that led a person to embrace unhealthy, addictive sources of pleasure or relief from pain.
When you are addicted, for example, to the use of alcohol, drugs, smoking, sex or gambling, you are (physically or mentally) dependent on this use or behaviour. You get withdrawal and/or tolerance symptoms when you don't use the substance. Tolerance means that one needs higher quantities of a substance over time to reach the desired effects.
Withdrawal symptoms are unpleasant physical reactions that occur when the use of the substances is decreased or discontinued. These symptoms range from nausea, muscle aches and fever to concentration problems, insomnia, anxiety and unpleasant dreams. But, also people who do not experience tolerance and/or withdrawal symptoms can be dependent on the substance. They repeatedly and with no success try to reduce or control the use of the substance, or they use it longer or more than they had intended. Obtaining the substance, using it and recovering from the effects of the substance takes a lot of time. They neglect important activities like work, school or social contacts, or completely stop these activities. One characteristic of dependence is not being able to control the use of the substance or to stop using it. There is a certain pressure, an almost irresistible need to use the substance.
To be able to determine if somebody is addicted, the person must meet certain conditions that have been determined by the World Health Organisation (WHO), amongst others.
The following are conditions for dependence; you only have to comply with a few to be considered dependent:
Tolerance (need more to still feel the effects).
Psychological dependence (desire, varying from very little to very severe).
Withdrawal symptoms (get all kinds of physical reactions after you stop).
Use the substance or carry out certain behavior to reduce the withdrawal symptoms.
Failed attempts to control the use or the behaviour.
Spend a great deal of time on the use or the behavior or on recovery of the use or the behaviour.
Damaging effects due to the use on the addicts themselves and people in their environment (problems at work or school, arguments with people around the person, illnesses, dedicate less time to hobbies).
Use more frequently and in higher doses than planned.
Continue to use even if you know it is damaging for you.
Addiction is a chronic or recurrent condition proposed to be precipitated by one or more of the following: genetic, biological/pharmacological and social factors. Addiction is characterized by the compulsive use of substances or engagement of behaviors despite clear evidence to the user of negative consequences.
Akrasia
Alcoholism
Alcohol-related traffic crashes
Alcohol tolerance
Alcoholics Anonymous
Codependence
Computer addiction
Disease model of addiction
Drug addiction
Drug injection
Free will
Higher order desire
Junkie
Life-process model of addiction
Love-hate relationship
Moderation Management
Narcotics Anonymous
Problem gambling
Sexual addiction
Decades ago addiction was a pharmacologic term that clearly referred to the use of a tolerance-inducing drug in sufficient quantity as to cause tolerance (the requirement that greater dosages of a given drug be used to produce an identical effect as time passes). With that definition, humans (and indeed all mammals) can become addicted to various drugs quickly. Almost at the same time, a lay definition of addiction developed. This definition referred to individuals who continued to use a given drug despite their own best interest. This latter definition is now thought of as a disease state by the medical community.
Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). Unfortunately, terminology has become quite complicated in the field. To wit, pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence); psychiatrists refer to the disease state as dependence; most other physicians refer to the disease as addiction. The field of psychiatry is now considering, as they move from DSM-IV to DSM-V, transitioning from "dependence" to "addiction" as terminology for the disease state.
The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological dependence (or simply addiction). Addiction is now narrowly defined as "uncontrolled, compulsive use"; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered compulsive, but to the definition of some it is not categorized as "addiction". In practice, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components.
There is also a lesser known situation called pseudo-addiction. A patient will exhibit drug-seeking behavior reminiscent of psychological addiction, but they tend to have genuine pain or other symptoms that have been undertreated. Unlike true psychological addiction, these behaviors tend to stop when the pain is adequately treated.
The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal. While opiates are essential in the treatment of acute pain, the benefit of this class of medication in chronic pain is not well proven. Clearly, there are those who would not function well without opiate treatment; on the other hand, many states are noting significant increases in non-intentional deaths related to opiate use. High-quality, long-term studies are needed to better deliniate the risks and benefits of chronic opiate use.
Not all doctors agree on what addiction or dependency is, because traditionally, addiction has been defined as being possible only to a psychoactive substance (for example alcohol, tobacco and other drugs) which ingested cross the blood-brain barrier, altering the natural chemical behavior of the brain temporarily. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, cutting, and shopping / spending. However, these are things or tasks which, when used or performed, cannot cross the blood-brain barrier and hence, do not fit into the traditional view of addiction. Symptoms mimicking withdrawal may occur with abatement of such behaviors; however, it is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. In spite of traditionalist protests and warnings that overextension of definitions may cause the wrong treatment to be used (thus failing the person with the behavioral problem), popular media, and some members of the field, do represent the aforementioned behavioral examples as addictions.
In the contemporary view, the trend is to acknowledge the possibility that the hypothalmus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicals (alcohol, nicotine etc.) when addictive activities take place[citation needed]. For example, when an addicted gambler or shopper is satisfying their craving, chemicals called endorphins are produced and released within the brain, reinforcing the individual's positive associations with their behavior.
Despite the popularity of defining addiction in medical terms, recently many have proposed defining addiction in terms of Economics, such as calculating the elasticity of addictive goods and determining, to what extent, present income and consumption (economics) has on future consumption.
Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance or behavior is suddenly discontinued. While opioids, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, other categories of substances share this property and are not considered addictive: cortisone, beta-blockers and most antidepressants are examples. So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the primary attribute of an addictive substance is usually its ability to induce pleasure[citation needed] and its facility in becoming routinely used. A notable exception to this is nicotine. Users report that a cigarette can be pleasurable, but there is a medical consensus[citation needed] that the user is likely fulfilling his/her physical addiction and, therefore, is achieving pleasurable feelings relative to his/her previous state of physical withdrawal. Further, the physical dependency of the nicotine addict on the substance itself becomes an overwhelming factor in the continuation of most users' addictions. Although 35 million smokers make an attempt to quit every year, fewer than 7% achieve even one year of abstinence (from the NIDA research report on nicotine addiction).
Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.
The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Studies[citation needed] have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. The vast majority of medical professionals and scientists agree that if one uses strong opioids on a regular basis for even just a short period of time, one will most likely become physically dependent[citation needed]. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine.
Eating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this article. Eating disorders, which some argue are not addictions at all, are driven by a multitude of factors, most of which are highly different than the factors behind addictions described in this article.
Psychological dependency is a dependency of the mind, and leads to psychological withdrawal symptoms (such as cravings, irritability, insomnia, depression, anorexia etc). Addiction can in theory be derived from any rewarding behavior, and is believed to be strongly associated with the dopaminergic system of the brain's reward system (as in the case of cocaine and amphetamines). Some claim that it is a habitual means to avoid undesired activity, but typically it is only so to a clinical level in individuals who have emotional, social, or psychological dysfunctions, replacing normal positive stimuli not otherwise attained (see Rat Park).
It is considered possible to be both psychologically and physically dependent at the same time. Some doctors make little distinction between the two types of addiction, since the result, substance abuse, is the same. However, the cause and characteristics of each of the two types of addiction is quite different, as is the type of treatment preferred.
Psychological dependence does not have to be limited only to substances; even activities and behavioral patterns can be considered addictions, if they are harmful, e.g. gambling, Internet use, usage of computers, sex / pornography, eating, self-harm or work.
Methods of care
Early editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) described addiction as a physical dependency to a substance that resulted in withdrawal symptoms in its absence. Recent editions, including DSM-IV, have moved toward a diagnostic instrument that classifies such conditions as dependency, rather than addiction. The American Society of Addiction Medicine recommends treatment for people with chemical dependency based on patient placement criteria (currently listed in PPC-2), which attempt to match levels of care according to clinical assessments in six areas, including:
Acute intoxication and/or withdrawal potential
Biomedical conditions or complications
Emotional/behavioral conditions or complications
Treatment acceptance/resistance
Relapse potential
Recovery environment
Some medical systems, including those of at least 15 states of the United States, refer to an Addiction Severity Index to assess the severity of problems related to substance use. The index assesses problems in six areas: medical, employment/support, alcohol and other drug use, legal, family/social, and psychiatric.
While addiction or dependency is related to seemingly uncontrollable urges, and arguably could have roots in genetic predispositions, treatment of dependency is conducted by a wide range of medical and allied professionals, including Addiction Medicine specialists, psychiatrists, and appropriately trained nurses, social workers, and counselors. Early treatment of acute withdrawal often includes medical detoxification, which can include doses of anxiolytics or narcotics to reduce symptoms of withdrawal. An experimental drug, ibogaine, is also proposed to treat withdrawal and craving. Alternatives to medical detoxification include acupuncture detoxification. In chronic opiate addiction, a surrogate drug such as methadone is sometimes offered as a form of opiate replacement therapy. But treatment approaches universal focus on the individual's ultimate choice to pursue an alternate course of action.
Therapists often classify patients with chemical dependencies as either interested or not interested in changing. Treatments usually involve planning for specific ways to avoid the addictive stimulus, and therapeutic interventions intended to help a client learn healthier ways to find satisfaction. Clinical leaders in recent years have attempted to tailor intervention approaches to specific influences that effect addictive behavior, using therapeutic interviews in an effort to discover factors that led a person to embrace unhealthy, addictive sources of pleasure or relief from pain.
When you are addicted, for example, to the use of alcohol, drugs, smoking, sex or gambling, you are (physically or mentally) dependent on this use or behaviour. You get withdrawal and/or tolerance symptoms when you don't use the substance. Tolerance means that one needs higher quantities of a substance over time to reach the desired effects.
Withdrawal symptoms are unpleasant physical reactions that occur when the use of the substances is decreased or discontinued. These symptoms range from nausea, muscle aches and fever to concentration problems, insomnia, anxiety and unpleasant dreams. But, also people who do not experience tolerance and/or withdrawal symptoms can be dependent on the substance. They repeatedly and with no success try to reduce or control the use of the substance, or they use it longer or more than they had intended. Obtaining the substance, using it and recovering from the effects of the substance takes a lot of time. They neglect important activities like work, school or social contacts, or completely stop these activities. One characteristic of dependence is not being able to control the use of the substance or to stop using it. There is a certain pressure, an almost irresistible need to use the substance.
To be able to determine if somebody is addicted, the person must meet certain conditions that have been determined by the World Health Organisation (WHO), amongst others.
The following are conditions for dependence; you only have to comply with a few to be considered dependent:
Tolerance (need more to still feel the effects).
Psychological dependence (desire, varying from very little to very severe).
Withdrawal symptoms (get all kinds of physical reactions after you stop).
Use the substance or carry out certain behavior to reduce the withdrawal symptoms.
Failed attempts to control the use or the behaviour.
Spend a great deal of time on the use or the behavior or on recovery of the use or the behaviour.
Damaging effects due to the use on the addicts themselves and people in their environment (problems at work or school, arguments with people around the person, illnesses, dedicate less time to hobbies).
Use more frequently and in higher doses than planned.
Continue to use even if you know it is damaging for you.
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