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Drug Rehab and Drug
Addiction
Defining Drug
Addiction
Twenty years of scientific research, coupled with
even longer clinical experience, has taught us that focusing on this physical
vs. psychological distinction is off the mark, and a distraction from the real
issue. From both clinical and policy perspectives, it does not matter much what
physical withdrawal symptoms occur. Other aspects of addiction are far more
important.
Physical dependence is not that important because, first,
even the florid withdrawal symptoms of heroin and alcohol addiction can be
managed with appropriate medications. Therefore, physical withdrawal symptoms
should not be at the core of our concerns about these substances.
Second, and more important, many of the most addicting and dangerous
drugs do not even produce very severe physical symptoms upon withdrawal. Crack
cocaine and methamphetamine are clear examples. Both are highly addicting, but
stopping their use produces very few physical withdrawal symptoms, certainly
nothing like the physical symptoms of alcohol or heroin withdrawal.
What does matter tremendously is whether or not a drug causes what we
now know to be the essence of 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.
Essence of Addiction
Drug craving and the other
compulsive behaviors are the essence of 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
"Trainspotting" showed us so well, the addicts 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.
Rethinking
Addiction
Focusing on addiction as compulsive,
uncontrollable drug use should help cIarify everyone's perception of the nature
of 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 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 them 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 drug rehab 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. |
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