Hardly a day goes by without a report in the press about some new addiction.
One gets the impression that life is awash in threats of addiction. People tend to equate the word “addiction” with “abuse.” Ironically, “addiction” is a subject of abuse.
The American Society of Addiction Medicine defines addiction as a
- “chronic disease of brain reward, motivation, memory and related circuitry…characterized by
- the inability to consistently abstain,
- impairment in behavioral control,
- craving” that continues despite resulting destruction of relationships, economic conditions, and health
This is why punishment doesn’t work to prevent (or even mitigate) addiction: the definition specifies that it continues *despite* negative consequences. Using the punishment of jail time doled out by law enforcement is thus completely ineffective in discouraging addiction.
In fact, once a person has an arrest record they will have even more trouble successfully integrating into society and thus be even more prone to the “nothing to lose” cycle of addiction until they overdose.
A major feature is compulsiveness.
Addiction has a biopsychosocial basis with a genetic predisposition and involves neurotransmitters and interactions within reward centers of the brain.
This compulsiveness is why alcoholics or other drug addicts will return to their substance of abuse even after they have been “detoxed” and despite the fact that they know it will further damage their lives.
Addiction is not the same as dependence. Yet politicians and many in the media use the two words interchangeably.
I’ve come across doctors who even believe this nonsense. That level of ignorance about the medicine they’re prescribing borders on malpractice.
Physical dependence represents an adaptation to the drug such that abrupt cessation or tapering off too rapidly can precipitate a withdrawal syndrome, which in some cases can be life-threatening.
Physical dependence is seen with many categories of drugs besides drugs that are commonly abused. For example, it is seen with many antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), and with beta blockers like atenolol and propranolol, which are used to treat a variety of conditions including hypertension and migraines.
Once a patient is properly tapered off of the drug on which they have become physically dependent, they do not feel a craving or compulsion to return to the drug.
There’s the difference: no compulsion.
I supposed some would confuse the compulsion for the pain relief opioids provide with the simple compulsion to alter consciousness, as any other biological organism would seek relief or escape from pain.
Some also confuse tolerance with addiction. Similar to dependency, tolerance is another example of physical adaptation.
The Media’s Role in the Opioid Crisis
Writing in the Columbia Journalism Review, science journalist Maia Szalavitz ably details how journalists perpetuate this lack of understanding and fuel misguided opioid policies.
Many in the media share responsibility for the mistaken belief that prescription opioids rapidly and readily addict patients—despite the fact that Drs. Nora Volkow and Thomas McLellan of the National Institute on Drug Abuse point out addiction is very uncommon, “even among those with preexisting vulnerabilities.”
Cochrane systematic studies of chronic pain patients 2010 and 2012 found addiction rates in the 1 percent range, and a report on over 568,000 patients in the Aetna database who were prescribed opioids for acute postoperative pain between 2008 and 2016 found a total “misuse” rate of 0.6 percent.
Equating dependency with addiction caused lawmakers to impose opioid prescription limits that are not evidence-based and is making patients suffer needlessly after being tapered too abruptly or cut off entirely from their pain medicine.
There have been enough reports of suicides that the U.S. Senate is poised to vote on opioid legislation that “would require HHS and the Department of Justice to conduct a study on the effect that federal and state opioid prescribing limits have had on patients—and specifically whether such limits are associated with higher suicide rate.”
It’s outrageous that they’ve made such huge changes to the medical treatment of pain without any analysis or even monitoring of outcomes over the years they’ve been doing this.
And complaints about the lack of evidence behind present prescribing policy led Food and Drug Administration Commissioner Scott Gottlieb to announce plans last month for the FDA to develop its own set of evidence-based guidelines.
Before people see more of their rights infringed or are otherwise harmed by unintended consequences, it would do us all a great deal of good to be more accurate and precise in our terminology. It would also help if lawmakers learned more about the matters on which they create policy.