Addiction is a chronic disorder proposed to be precipitated by a combination of genetic, biological/pharmacological and social factors. Addiction is characterized by the repeated use of substances or behaviors despite clear evidence of morbidity secondary to such use.
There is a lack of consensus as to what may properly be termed 'addiction.' Some within the medical community maintain a rigid definition of addiction and contend that the term is only applicable to a process of escalating drug or alcohol use as a result of repeated exposure. However, addiction is often applied to compulsive behaviors other than drug use, such as overeating or gambling. These behavioral addictions, however, almost never exist without another addiction to some substance. In all cases, the term addiction describes a chronic pattern of behavior that continues and is perceived to be hard or impossible to quit at any time. It is quite common for an addict to express the desire to stop the behavior, but find himself or herself unable to cease.
Addiction is often characterized by an ongoing effort to use more (drug or behavior), tolerance, and withdrawal symptoms in the absence of the stimulus. Many drugs and behaviors that provide either pleasure or relief from pain pose a risk of addiction or dependency.
Varied forms of addiction
Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the drug is suddenly discontinued. While opioids, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, other drugs share this property that 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, the primary attribute of an addictive drug is its ability to induce euphoria while causing harm.
Some drugs 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 Effexor and Paxil, 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, and the individual. Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Studies have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of people. Because of these variations, in addition to the adoption and twin studies that have been well replicated, the medical community is satisfied that addictive disease is in part genetically moderated. Nicotine is one of the most addictive psychoactive substances: although 35 million smokers make an attempt to quit every year, less than 7% achieve even one year of abstinence.
Eating disorders are complicated pathological mental illnesses and thus are not considered addictions. More information about eating disorders can be found at http://www.edap.org or http://www.something-fishy.org
Psychological addictions are a dependency of the mind, and lead to psychological withdrawal symptoms. Addictions can theoretically form for any rewarding behavior, or as a habitual means to avoid undesired activity, but typically they only do so to a clinical level in individuals who have emotional, social, or psychological dysfunctions, taking the place of normal positive stimuli not otherwise attained
Psychological addiction, as opposed to physiological addiction, is a person's need to use a drug or engage in a behavior despite the harm caused out of desire for the effects it produces, rather than to relieve withdrawal symptoms. Instead of an actual physiological dependence on a drug, such as heroin, psychological addiction usually develops out of habits that relieve symptoms of loneliness or anxiety. As the drug is indulged, it becomes associated with the release of pleasure-inducing endorphins, and a cycle is started that is similar to physiological addiction. This cycle is often very difficult to break.
It is also considered possible to be both psychologically and physically addicted at the same time. Some doctors make little distinction between the two types of addiction, for the result -- substance abuse -- is the same. However, the cause of the addiction in either case is quite different, as is the type of treatment preferred.
Psychological addiction does not have to be limited only to substances; even various activities and behavioral patterns may be considered addictions if they are harmful, e.g. gambling, Internet use, usage of computers, sex/pornography, eating, self-harm or work.
Addiction and drug control legislation
Most countries have legislation, which brings various drugs and drug-like substances under the control of licensing systems. Typically this legislation covers any or all of the opiates, cannabinoids, cocaine, barbiturates, hallucinogens and a variety of more modern synthetic drugs, and unlicensed production, supply or possession is a criminal offense.
Usually, however, drug classification under such legislation is not related simply to addictiveness. The substances covered often have very different addictive properties. Some are highly prone to cause physical dependency, whilst others rarely cause any form of compulsive need whatsoever.
Also, although the legislation may be justifiable on moral grounds to some, it can make addiction or dependency a much more serious issue for the individual: reliable supplies of a drug become difficult to secure, and the individual becomes vulnerable to both criminal abuse and legal punishment.
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 has roots in genetic predisposition, 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.