Proper addiction

Ibogaine has demonstrated toxic effects, which could potentially limit its usefulness in treating addiction. However, the proper dosage of alternative iboga alkaloids may avert this problem. The median lethal dose of ibogaine is 82 mg/kg in the guinea pig and 327 mg/kg in the rat (Dhahir 1971 Delourme-Houde 1946). Use of ibogaine for addiction treatment has been associated with two deaths overseas. 

Does applying the illness model to addiction provide a crutch for the addict In a word, no. When properly implemented, this model, in fact, readily explains the addict s vulnerability to abusing substances, predicts the course of illness should treatment either be sought out or not, and helps to guide rational therapy decisions that will increase the probability of keeping the illness in remission. 

It is proper to distinguish between habituation and addiction. The former is a biochemical-physiological process, whereas the latter has very considerable psychological and socioeconomic components as well. 

Opioids are analgesic, or pain-relieving, medications. Studies have shown that properly managed medical use (taken exactly as prescribed) of opioid analgesics is safe, can manage pain effectively, and rarely causes addiction. 

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. 

This is the goal of methadone maintenance programs. Apparently, when properly administered, these have had considerable worldwide success in countering the adverse effects of heroin addiction. Nevertheless, as a matter of public policy, they have been controversial in the United States partly because they are thought merely to replace one addiction with another (Lowinson et al. 1997 Kreek and Reisinger 1997). 

Or at least with continence, which Aristotle distinguishes from virtue proper (Nicomachean Ethics, 1152). If addictive cravings are inherently sources of temptation, then addiction is incompatible with the virtue of temperance, as Aristotle conceives it That would sharply distinguish addictive appetites from natural ones, for the virtuous woman or man will, in Aristotle s picture, have and enjoy the natural appetites. My claim is that a virtuous person could have the same relation to his or her acquired appetites. 

Theories of addiction have traditionally not analyzed very carefully the basic problems of choice that addicted people are faced with. Addicts are conceived as consumption robots, helpless victims of their environment or their vices. Under these circumstances, "addiction" is not much more than a label, a ghost in the machine, called upon to explain norm-violating, self-destructive consumption behavior. Unfortunately, the proof of addiction is the very same behavior, and the explanation therefore becomes circular. A proper understanding of addiction requires a theory of how people conceive their world, how they evaluate different options, and how they make their choices. Among other things, we need to understand the role of ambivalence and inconsistencies in their deliberations. In this chapter, I discuss and compare two attempts in this direction. 

There are on record a few authenticated cases of congenital morphinism, that is, morphinism in the newborn of addicted mothers convulsions are a prominent feature. Unless the syndrome is promptly recognized and properly treated, the infant may succumb. 

Codeine plays a relatively minor role in the overall picture of opioid prescription drug abuse. Evidence indicates that proper prescribing of codeine for legitimate medical concerns does not greatly increase the risk of addiction and abuse. Those in the medical community agree that more education is needed on both sides to help prevent the potential for abuse and addiction, so that patients tmly in need are not denied access to codeine based on misperceptions and fear. The benefits for individuals and society are great when chronic pain is treated safely and effectively. 

These are the objective signs of withdrawal distress which can be measured the subjective indications are equally severe and the illness reaches its peak within 48-72 h after the last dose of the opioid, gradually subsiding thereafter for the next 5-10 days. The withdrawal syndrome proper is self-limiting and most addicts will survive it with no medical assistance whatever (this is known as kicking the habit, cold turkey ). Abrupt withdrawal is inhumane, but with the use of such drugs as methadone, it is possible to reduce the distress of withdrawal very considerably. ... 

The word safe must never be used to describe a medicinal product without proper qualification. It must not be stated that a product has no side effects, toxic hazards or risks of addiction or dependency. 

---