Drug Addiction
Drug addiction is a complex disease. It is characterized by compulsive, uncontrollable craving and use that persists even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. The words drug addiction call up many different images and strong emotions. Any discussion about psychoactive drugs, particularly drugs like nicotine and marijuana, inevitably moves to the question is it really addicting? The conversation then shifts to the so-called types of drug addiction - whether the drug is "physically" or "psychologically" addicting. This issue revolves around whether or not dramatic physical withdrawal symptoms occur when an individual stops taking the drug, what we in the field call "physical dependence." The assumption that follows then is that the more dramatic the physical withdrawal symptoms, the more serious or dangerous the drug must be. Indeed, people always seem relieved to hear that a substance just produces psychological addiction, or has only minimal physical withdrawal symptoms. Then they discount its dangers. They are wrong. Marijuana is a case in point here, and I will come back to it shortly.
What matter is whether or not a drug causes what we now know to be the essence of drug addiction: uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences? This is the crux of how many professional organizations all define addiction, and how we all should use the term. It is really only this expression of addiction — uncontrollable, compulsive craving, seeking and use of drugs — that matters to the addict and to his or her family, and that should matter to society as a whole. These are the elements responsible for the massive health and social problems caused by drug addiction.
Drug craving and the other compulsive behaviors are the essence of drug addiction. They are extremely difficult to control, much more difficult than any physical dependence. They are the principal target symptoms for most drug treatment programs. For an addict, there is no motivation more powerful than drug craving. As the movie "Trains potting" showed us so well, the addict’s entire life becomes centered on getting and using the drug. Virtually nothing seems to outweigh drug craving as a motivator. People have committed all kinds of crimes and even abandoned their children just to get drugs.
Focusing on drug addiction as compulsive, uncontrollable drug use should help clarify everyone's perception of the nature of drug addiction and of potentially addicting drugs. For the addict and the clinician, this more accurate definition forces the focus of treatment away from simply managing physical withdrawal symptoms and toward dealing with the more meaningful and powerful, concept of uncontrollable drug seeking use. The task of treatment is to regain control over drug craving, seeking and use. Rethinking drug addiction also affects which drugs we worry about and the nature of our concerns. The message from modern science is that in deciding which drugs are addicting and require what kind of societal attention, we should focus primarily on whether taking those causes uncontrollable drug seeking and use. One important example is the use of opiates, like morphine, to treat cancer pain. In most circumstances, opiates are addicting. However, when administered for pain, although morphine treatment can produce physical dependence - which now can be easily managed after stopping use - it typically does not cause compulsive, uncontrollable morphine seeking and use, addiction as defined here. This is why so many cancer physicians find it acceptable to prescribe opiates for cancer pain. An opposite example is marijuana, and whether it is addicting. There are some signs of physical dependence or withdrawal in heavy users, and withdrawal has been demonstrated in studies on animals. But what matters much more is that every year more than 100,000 people, most of them adolescents, seek treatment for their inability to control their marijuana use. They suffer from compulsive, uncontrollable marijuana craving, seeking and use. That makes it addicting, certainly for a large number of people.
Reprinted from the National Institute on Drug Abuse (NIDA)
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