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Re: "addiction" and "drug problem"

Posted by Elizabeth on December 21, 1998, at 23:02:07

In reply to "addiction" and "drug problem", posted by anon on December 17, 1998, at 11:26:15

> What do these words mean exactly? I've heard varying definitions. In one book on psychiatric drugs, the author says that if you've ever in your life taken a prescription drug without a prescription from your doctor, you have a "drug problem." Problem for whom? The DEA, maybe. And "addiction." Are you addicted to a substance if you can stop with no physical withdrawal? And why is "self-medication," in all circumstances, even if done in an educated manner, always "wrong?"

Hi everyone. Interesting discussion.

I don't think that "addiction" has much real meaning anymore - it's just become a loaded term. Certainly one does not make a diagnosis of "addiction." Perhaps it would be more accurate of me to say that addiction has a different meaning for everyone. Certainly that author you mentioned was just citing his own opinion of what constitutes a "drug problem."

That said, while I don't agree with everything therein, I think DSM-IV did a pretty good job (all things considered) at trying to characterize what makes up what it calls "substance dependence." (Although I'm not a big fan of the "at least 3 of the following:" approach!). The symptoms listed are: tolerance; withdrawal (must be a substance-specific withdrawal syndrome, not just general dysphoria); using more of the substance than you had intended to; wanting to cut down or quit but not being able to; putting a lot of time into getting, using, and recovering from the substance (they don't mention money or effort, though); giving up other activities for drug use; and continuing to use despite health problems that are caused or exacerbated by the drug use.

I think this is pretty in line with my own list of "signs that someone may be dependent on drugs" - they use a whole lot at once; they keep using more and more; they get sick or depressed when they aren't using; using becomes an increasingly important part of their life; they keep using despite the dangers; and so on. Something that hasn't been captured well is the concept of "cravings" which I think is central to what we consider to be "addiction." Possibly making the implicit assumption that a person who is dependent on drugs is "in denial," DSM-IV limits its definition mainly to signs (things that are visible to the observer) rather than symptoms (internal experiences of the patient).

Note that since at least 3 of these must occur within the same 12-month period, this excludes "physiological addiction" whose only symptoms are tolerance and/or withdrawal. It is being recognized more and more that addiction is not so much about these, although they can be signs that something is wrong (I am especially thinking of stimulants, opiates too although it's hard to avoid these problems if you use opiates long-term at all (such as for chronic pain)).




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