- Addiction vs Dependence
- Am I addicted or just dependent on opioids?
- Diagnosis of Addiction
- Causes of Addiction
- Risk Factors for Addiction
- Consequences of Addiction
- Are you an Addict?
- Addiction Treatment Options
Addiction or compulsive drug use despite harmful is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal).
Physical dependence can happen with the chronic use of many drugs including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it may accompany addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.
Although sometimes used interchangeably, the terms addiction; and dependence; are clinically thought of as two separate things. The National Institutes of Health says drug addiction is present when a person compulsively uses a drug despite negative and dangerous consequences and effects. A physical drug dependence means a person needs the substance to function and can have intense cravings, according to the organization.
Dependence does not always entail addiction. For example, some blood pressure medications can cause physical dependence but don’t lead to addiction, and drugs like cocaine can be addicting without physical dependence. Withdrawing from cocaine can produce depression and other psychological changes, but don’t leave users with physical problems such as chills and other flu-like symptoms.
The American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine, in a collaborative effort, have adopted the following definitions: Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Addiction is a chronic disorder with a strong potential for relapse. This means users who are trying to get clean fall back into old patterns of drug use and abuse. Because opiates are so potent, they have a particularly high relapse rate. Strong cravings and other withdrawal symptoms can trigger relapse, even after a period of abstinence.
Many patients with a history of increasing and relapsing opioid use wonder if their trouble with the medications can be over once the "withdrawals" are gone. While this may be true for those patients that took opioids in a very controlled way purely for pain, it is not usually true for those who took opioids to obtain any euphorogenic effects, get high, or deal with emotional problems such as anxiety. The reason is that the latter patients have a compulsive need to use the opioids for their psychological effects, i.e. addiction to opioids. Many such patients may attend detox programs that address the brief physical withrawal effects, but then quickly relapse to use after the detox in search for the euphoria, relaxation or "high" that the opioids offered. This is a very important distinction as it can change the best treatment mode for the patients. For patients that have an addiction to opioids, detox programs are generally unsuccessful; these patients are served better in a maintenance program with methadone or suboxone.
Opiates are powerful painkillers that cause sedation and euphoria and are commonly abused. These include OxyContin, morphine, codeine, Fentanyl, Dilaudid, Lorcet, Lortab, heroin and Stadol. Opiate addiction is caused by persistent use of opiates and is thought to be a disorder of the central nervous system. Once addicted, many opiate users feel completely powerless and continue to use despite potentially dangerous or life-threatening consequences. Unlike some drugs, which can elicit one or the other, opiates can cause both addiction and physical dependence.
In many cases, it is a family member or very good friend who raises concern about the patient’s behavior (rather than the patient himself/herself doing so). The first port of call is usually a GP (general practitioner, primary care physician, family doctor). The doctor will ask several questions, including how often the substance is consumed, whether the substance use has been criticized by other people, and whether the patient feels he/she may have a problem. If the doctor suspects there is an addiction problem, the patient will be referred to a specialist. In cases of nicotine addiction, establishing whether or not there is an addiction is done at the GP-patient level. With more powerful substances there is usually an evaluation by a specialized addiction counselor, psychologist or psychiatrist.
Urine test - this may be ordered to determine whether the substance is still in the body (whether the substance has been taken recently).
Though Addiction is not the same dependence, DSM criteria for substance dependence can guide the diagnosis - a patient diagnosed with substance dependence (an addiction) must meet criteria laid out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), a manual published by the American Psychiatric Association. The criteria for drug dependence that causes significant problems must include three of the following:
- Tolerance - the substance has less effect on the patient because their body has developed
tolerance. They need more and more of it to get the same pleasure.
- There are physical/psychological withdrawal symptoms, or the patient takes the substance to
avoid experiencing withdrawal, or the patient takes a similar substance to avoid experiencing
- The patient frequently takes higher-than-intended doses of the substance.
- The patient often tries to quit or cut down.
- More and more time is spent getting hold of the substance, using it, or recovering from its
- The patient’s drug use causes him/her to give up social, occupational or recreational
- Even though patients know it causes psychological/physical problems, they continue taking it.
This is a question researchers have grappled with for some time. As yet there's no definitive answer and no one has discovered one single cause. Obviously, if people didn't drink alcohol, use drugs, gamble or indulge in other potentially destructive behaviours, they wouldn't become addicted. However, there are some people who can indulge without becoming addicted. So why do some develop problems and not others ?
How does addiction start?
People try drugs or other potentially addictive behaviour because they are seeking some sort of reward or benefit. Those who take drugs, for instance, do so because of the physical effects they hope to experience. Drugs have a marked effect on the body and mind. If there were no effect, people would be unlikely to repeat the experience. No one sets out just to become addicted. Crucially, substances and certain behaviours change the way we feel. If they make us feel better, relax us, make us feel powerful, excite us, let us escape and so on, we tend to go back to them.
Sometimes the attraction also comes from the feeling that the behaviour identifies us as one of a certain social group - people may try drugs because they think it will gain them acceptance in a desirable gang or that they become one of the rebels or cool people. However, in some people, those experiences uncover a powerful attraction. What can start out as casual experimentation, normal social behaviour or even a doctor's prescription, can lead to repeating the behaviour more frequently and with greater quantities. The more you do, the more likely you're to do more. Following the psychological shift to dependence (meaning you can't do without the substance or activity), the brain's chemistry may start to adapt, demanding ever more of what it's grown used to and fiercely resisting the discomfort of withdrawal. The behaviour takes on a self-perpetuating life of its own as the body becomes physically dependent on it.
People of any age, sex or economic status can become addicted to a drug. However, certain factors can affect the likelihood of your developing an addiction:
- Family history of addiction. Drug addiction is more common in some families and likely
involves the effects of many genes. If you have a blood relative, such as a parent or sibling,
with alcohol or drug problems, you're at greater risk of developing a drug addiction.
- Being male. Men are twice as likely to have problems with drugs.
- Having another psychological problem. If you have a psychological problem, such as
depression, attention-deficit/hyperactivity disorder or post-traumatic stress disorder, you're
more likely to become dependent on drugs.
- Peer pressure. Particularly for young people, peer pressure is a strong factor in starting to
use and abuse drugs.
- Lack of family involvement. A lack of attachment with your parents may increase the risk of
addiction, as can a lack of parental supervision.
- Anxiety, depression and loneliness. Using drugs can become a way of coping with these
painful psychological feelings.
- Taking a highly addictive drug. Some drugs, such as heroin and cocaine, cause addiction
faster than do others.
Dependence on drugs can create a number of life-changing complications. They can include:
- Health problems. Drug addiction can lead to a range of both short- and long-term mental
and physical health problems. These depend on what drug is taken.
- Unconsciousness, coma and sudden death. Taking some drugs can be particularly risky,
especially if you take high doses or combine them with other drugs or alcohol.
- Getting a communicable disease. People who are addicted to a drug are more likely to get
an infectious disease, such as HIV, either through unsafe sex or by sharing needles.
- Accidents. If you're addicted to a drug, you're more likely to drive or do other dangerous
activities while intoxicated.
- Suicide. People who are addicted to drugs commit suicide more often than do people who
- Family problems. Behavioral changes may cause marital or family strife and custody issues.
- Work issues. Work performance may decline, and you may be absent from work more often.
- Problems at school. Academic performance and motivation to excel in school may suffer.
- Legal issues. These can stem from stealing to support your drug addiction, driving while
under the influence of drugs or alcohol, and disputes over child custody.
- Financial problems. Spending money to support your habit takes away money from your
other needs, could put you into debt, and could lead you into illegal or unethical behaviors.
When we think of the word “addict,” images of syringes and hard-core drug use often come to mind. But addiction as an obsessive and compulsive tendency to either ingest a substance or engage in a behavior may not be so black and white.
We’ve all heard of “workaholics,” or of people who are “addicted” to Starbucks or going to the gym or teenagers who are “addicted” to video games. Maybe you’ve even felt that you were a chocolate “addict” when your spoon hit the bottom of that Ben and Jerry’s Super Fudge Chunk on a midnight refrigerator raid.
But does liking chocolate too much or going to the gym too often make you an “addict”? Is that really addiction? Or, for that matter, does having a couple of drinks every night make you an alcoholic?
There is research indicating that certain aspects of an individual's personality and temperament may put them at higher risk for addiction.
Regardless of how addiction may manifest itself in a person’s life, there are several common red flags.
The first major sign (and a diagnostic clinical criterion) is whether or not the behavior or the use of the substance is having a negative effect on your life. So if you’re asking yourself “am I an addict?” you need to honestly also ask yourself if your job, relationship or any other aspects of your personal or professional life are suffering because of the behavior in question.
Deceit can also be a red flag. Are you lying about or hiding the drinking, drugging or problem behavior? That can be a very telling sign that there is an addiction issue.
Another tell-tale sign that we hear many addicts talk about is describing addiction as going from a “want” to a “need”; in other words, the ingestion of the substance or the engagement in the problem behavior no longer feels like a voluntarily choice (want) but, rather, has morphed into an uncontrollable compulsion (need) (i.e. I must—eat this Ben and Jerry’s or I must have this drink in order to feel okay).
Here are some other behaviors that can be helpful indicators in assessing drug and alcohol dependence or addictive behaviors:
- Increased tolerance
- The substance or behavior is done more over a longer period than intended.
- Unsuccessful efforts to cut down or control the substance or behavior.
- A significantly large chunk of a person’s time is devoted to the addictive behavior or to
obtaining the substance, using the substance, or recovering from its effects.
It’s also important to understand that addiction is less about the addictive substance or problem behavior and more about the way that a person is wired that makes them more prone to seek a substance or to engage in the problem behavior. Thus if you’re asking the question “Am I an addict?” the real question may be “do I have an addictive personality?”
There is research indicating that certain aspects of an individual's personality and temperament may potentially put them at a higher risk for addiction. For example, research has shown that people who get frustrated easily, are pessimistic, as well as those who are less resilient have higher rates of addiction.
The same is true for those who have psychiatric disorders or for people who have suffered sexual abuse. According to the National Institute of Mental Health, patients with mental health problems are nearly three times as likely to have an addictive disorder as those without.
Regarding the link between sexual abuse and addiction, here are some statistics from the Mental Health Association of New York State: teenagers with a drug and alcohol problem are 18-21 times more likely to have been sexually abused than those without a drug or alcohol problem; 75% of women in treatment programs report having been sexually abused.
And speaking of families, according to SAMHSA (The Substance Abuse and Mental Health Services Administration), children of addicts are 2 to 4 times more likely to become addicts (whether that’s a result of a genetic predisposition or, instead, a byproduct of parents modeling addictive behaviors for their children is a matter of debate within the addiction field).
All this research clearly demonstrates that things like temperament, mental health, biology and environment all play a role in what I like to call the “Perfect Storm of Addiction.” But it’s also important to point out that all of these variables merely indicate that a person might be more susceptible to developing an addiction issue—not that they will necessarily develop a problem.
So are you an addict? It’s important to know that even if you are—there is help.
If any of the aforementioned warning signs seem like they might apply to you, you should meet with a mental health professional to get from complete assessment. Potentially that professional can also point you in the right direction for treatment if you do indeed have a problem.
The first step for the addicted person is to acknowledge that there is a substance dependency problem (addiction problem). The next step is to get help. In most of the world there are several support groups and professional services available.
Treatment options for addiction depend on several factors, including what type of substance it is and how it affects the patients. Typically, treatment includes a combination of inpatient and outpatient programs, counseling (psychotherapy), self-help groups, pairing with individual sponsors, and medication.
Treatment programs - these typically focus on getting sober and preventing relapses. Individual, group and/or family sessions may form part of the program. Depending on the level of addiction, patient behaviors, and type of substance this may be in outpatient or residential settings.
Psychotherapy - there may be one-to-one (one-on-one) or family sessions with a specialist.
Help with coping with cravings, avoiding the substance, and dealing with possible relapses are key to effective addiction programs. If the patient’s family can become involved there is a better probability of positive outcomes.
Self-help groups - these may help the patient meet other people with the same problem, which often boosts motivation. Self-help groups can be a useful source of education and information too. Examples include Alcoholics Anonymous and Narcotics Anonymous. For those dependent on nicotine, ask your doctor or nurse for information on local self-help groups.
Help with withdrawal symptoms – the main aim is usually to get the addictive substance out of the patient’s body as quickly as possible. Sometimes the addict is given gradually reduced dosages (tapering). In some cases a substitute substance is given. Depending on what the person is addicted to, as well as some other factors, the doctor may recommend treatment either as an outpatient or inpatient.
The doctor or addiction expert may recommend either an outpatient or inpatient residential treatment center. Withdrawal treatment options vary and depend mainly on what substance the individual is addicted to:
- Addiction to depressants - these may include dependence on barbiturates or
benzodiazepines. During withdrawal the patient may experience anxiety, insomnia, sweating
and restlessness. In rare cases there may be whole-body tremors, seizures, hallucinations,
hypertension (high blood pressure), accelerated heart rate and fever. In severe cases there
may be delirium, which according to the Mayo Clinic, USA, could be life-threatening.
- Addiction to stimulants - these may include cocaine and other amphetamines. During
withdrawal the patient may experience tiredness, depression, anxiety, moodiness, low
enthusiasm, sleep disturbances, and low concentration. Treatment focuses on providing
support, unless the depression is severe, in which case a medication may be prescribed.
- Addiciton to opioids – Opioids are a class of drugs that are commonly prescribed for their
analgesic, or pain-killing, properties. They include substances such as morphine, codeine,
oxycodone, and methadone. Opioids may be more easily recognized by drug names such as
Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet, and Lomotil.
During withdrawal there may be sweating, anxiety and stuffy nose – symptoms tend to be
mild. In rare cases there may be serious sleeping problems, tachycardia, hypertension and
diarrhea. The doctor may prescribe methadone, or buprenorphine for cravings (alternative