Addiction defined

A state of chronic deviation of a regulatory system from its normal (homeostatic) operating level is defined as an allostatic state. In the context of drug addiction this term has been introduced by George Koob and Michel Le Moal and represents a chronic deviation of reward set point by dysregulation of reward circuits and brain stress systems that provide a negative motivational state that drives addictive behavior. 

Drug addiction is defined as a syndrome in which drug use (e.g., psychostimulants, opiates, alcohol) pervades all life activities of the user. Life becomes governed by the drug and the addicted patient can lose social compatibility (e.g., loss of partner and friends, loss of job, crime). Behavioral characteristics of this syndrome are compulsive drug use, craving, and chronic relapses that can occur even after years of abstinence. 

Individuals with a pattern of chronic use of commonly abused substances should be assessed to determine if they meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for substance dependence (addiction).8 Criteria are not defined for each separate abused substance rather, a pattern of behavior common to the abuse or dependence of all drugs of abuse is established. 

As a researcher and therapist, I also do not like the use of colloquial terms such as addict or junkie. These terms, although potentially helpful for some who find recovery in self-help programs, are not useful for everyone with a drug problem, and can be demeaning to some. In fact, some of my clients have been put off by such labels in treatment, and found them stigmatizing, and therefore potentially harmful. Besides, such terms are highly pejorative and uncomplimentary descriptions of behavior and are not diagnostically accurate terms (i.e., are not defined in the DSM-IV). I choose not to use these terms with my own clients for these reasons. 

Mack, J. E. (2002). Addictions Individual and societal. Paper presented at the 25 Years of Addiction Treatment Conference, February 2, Boston, MA. Cited in Shaffer, H. J., Albanese, M. J. (2005). Addiction s defining characteristics. In R. H. Coombs (Ed.), Addiction Counseling Review. Mahwah, NJ Lahaska Press. 

All volumes in this series define addiction as an attachment to, or dependence upon, any substance, thing, person or idea so single-minded and intense that virtually all other realities are ignored or given second place — and consequences, even lethal ones, are disregarded (Mack, 2002). 

There is a misconception that drugs and medicines are quite different. The term drug carries with it the connotation of addiction, abuse and crime, but, in fact, medicines are just a subset of drugs. Drugs are defined as substances that can alter the biochemical processes in the body and medicines are those drugs that have a beneficial effect. 

In DSM-IV parlance, psychiatric illnesses that result from substance use are called substance-related disorders. Within this broad spectrum are two distinct categories substance use disorders and snbstance-induced disorders. The substance use disorders consist of abusive patterns of nse that produce a myriad of problems in relationships, employment, medical or physical well-being, and legal matters. There is no predefined amount or frequency of substance use that defines these disorders instead, they are diagnosed when the consequences of substance use include an adverse impact on other areas of life. As noted earlier, in some instances, substance nse disorders lead to physical dependence that is manifested by tolerance and the potential for withdrawal symptoms. When anyone talks about addiction, it is typically snbstance nse disorders to which they refer. 

In the United States today, the legal standard by which "good and "bad" drugs are now measured is the Controlled Substances Act of 1970. This act divides all known drugs into one of five classes, known as schedules. The primary criterion by which a compound is placed into one or another schedule is its potential for abuse, that is, its potential for addictive or otherwise harmful nonmedical applications. The Controlled Substances Act provides detailed descriptions of, restrictions on, and penalties for the use of chemical compounds in each of the five schedules. These schedules are defined as follows ... 

The pharmacologic studies indicated that intrinsic pharmacokinetics of 5-FU hinder their ability to reproduce the conditions required for radiosensitization. Indeed, the short half-life of the drug (from hepatic removal) preclude anything other than addictive effects when bolus drug is added to any variety of radiation fractionation scheme. These two sets of requirements together demonstrated that a continuous infusion (in which drug is made present for at least 24 h after each radiation fraction) would be optimal. In summary, 5-FU is a potent radiosensitizer under the following defined circumstances. 

Addiction is a different story. Part of the argument depends on how one defines addiction, but several lines of... 

Putting relapse on the map was an important move forward at a time when little attention was paid to the problems of maintaining changed behaviours, when a dose of detoxification treatment followed by more or less intensive, but still loosely defined, counselling or group therapy was deemed to be the treatment for addiction problems. 

A common vocabulary has not been established in the field of prescription drug abuse. Because much of the survey data collected in this area refer to nonmedical use of prescription drugs, this definition of abuse, rather than that of the Diagnostic and Statistical Manual of Mental Disorders (DSM), is used. Also, because physical dependence to prescription medications can develop during medically supervised appropriate use, the term addiction is used to reflect dependence as defined by the DSM. 

The World Health Organization expresses this view in its 1969 definition of "dependence (a term that replaced the use of "addiction" in its earlier declarations). Dependence is defined as... 

Fischer distinguishes incontinence from incapacity by defining guidance control in terms of weak responsiveness In contrast to the compulsive agent, the weak-willed agent is sensitive to at least some sufficient reasons to do otherwise. But, I doubt that any clearly intentional behavior fails to meet this condition. Certainly, the paradigm cases of severe and desperate addictions are not literally irresistible in this sense. Few if any addicts are beyond the reach of one counterincentive or another. 9... 

I have, among other things, been presenting some grounds for dissatisfaction with talk about motivational compulsion, understood on the model of irresistible desire. Although addiction is commonly described (if not always strictly defined) in these terms, we need not be skeptical about the concept itself. For the crucial notion here, 1 suggest, is the idea of an acquired appetite. It is this notion that explains the stereotypical or... 

Portenoy and Payne (1997) insist upon a distinction between physical dependence and addiction. What they mean by physical dependence is roughly what 1 mean, but they define addiction as a condition in which one is unable to abstain "Use of the term addiction to describe patients who are merely physically dependent reinforces the stigma associated with opioid therapy and should be abandoned. If the clinician wishes to describe a patient who is believed to have the capacity for abstinence, the term physical dependency must be used (564). Since my second level of dependency, which I consider to be addiction proper, need not involve this inability, Portenoy and Payne are marking a different distinction. 

To understand this view, it is necessary to understand an interest as a mental representation of a utility. Interests have different properties, among them a "characteristic period of dominance a length of time when an interest s discount curve rises above those of its competitors. The period will depend on the kinds of rewards the interest has arisen to exploit and on the intrinsic limitations of their particular modes of exploitation. This period, in turn, will have major effects on what behaviors particular interests typically favor" (Ainslie 1992,96). In this perspective, he defines addictions as behavior caused by interests that dominate other interests in periods ranging from hours to days and states that addictions have a "clear phase of conscious though temporary preference, followed by an equally clear period of regret" (Ibid., 97). Other types of interest have other periods of dominance. The period of domination for pains is fractions of seconds, that for itches seconds to minutes, and that for sellouts months to years. 

Consequently, when faced with a consumption choice of the same type as Becker and Murphy s rational consumer, hyperbolic discounters with willpower will act in a similar way. In particular, the asymmetry between stopping and starting, which is the defining characteristic of Becker and Murphy s rational addict, is reproduced in the hyperbolic case. 

To capture people s beliefs about how they will behave in the future, we define a strategy a to be a function that specifies what people would do in all situations. In other words, for all and t, a(k, t) is the action people would pursue in period t when their addiction level is k. For example, if o(0, t) = 0 and a(l, f) = 1, then people would refrain in period t if unhooked, and people would hit in period t if hooked. 

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