Here’s what our own government’s experts of the National Institute of Drug Abuse (NIDA) believe about addiction. It’s an amazingly realistic appraisal, very different from PROP’s anti-opioid rhetoric.
Addiction is defined as
- a chronic, relapsing disorder characterized by
- compulsive drug seeking,
- continued use despite harmful consequences, and
- long-lasting changes in the brain.
How are substance use disorders categorized?
NIDA uses the term addiction to describe compulsive drug seeking despite negative consequences.
This makes a lot more sense than CDC’s conjectures.
However, addiction is not a specific diagnosis in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—a diagnostic manual for clinicians that contains descriptions and symptoms of all mental disorders classified by the American Psychiatric Association (APA).
In 2013, APA updated the DSM, replacing the categories of substance abuse and substance dependence with a single category:
substance use disorder, with three subclassifications—mild, moderate, and severe.
The symptoms associated with a substance use disorder fall into four major groupings:
- impaired control,
- social impairment,
- risky use, and
- pharmacological criteria (i.e., tolerance and withdrawal).
Pain patients will only have the pharmacological criteria, but none of the others.
The new DSM describes a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress with 10 or 11 diagnostic criteria (depending on the substance) occurring within a 12-month period.
Those who have
- two or three criteria are considered to have a “mild” disorder,
- four or five is considered “moderate,” and
- six or more symptoms, “severe.” The diagnostic criteria are as follows:
Here is NIDA’s official list:
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Craving, or a strong desire or urge to use the substance, occurs.
- Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
- Use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
- Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
- Use of the substance is recurrent in situations in which it is physically hazardous.
- Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of the substance to achieve intoxication or desired effect
- A markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for that substance (as specified in the DSM-5 for each substance).
- The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.
How does NIDA use the terms drug use, misuse, and addiction?
Drug use refers to any scope of use of illegal drugs: heroin use, cocaine use, tobacco use
Drug misuse is used to distinguish improper or unhealthy use from use of a medication as prescribed or alcohol in moderation. These include the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality,
These supposedly distinguishing characteristics of “improper or unhealthy use” are so vague as to include many of the responses to the relief of pain, which is obviously a pleasant happening.
It also includes using prescription drugs in ways other than prescribed or using someone else’s prescription.
Addiction refers to substance use disorders at the severe end of the spectrum and is characterized by a person’s inability to control the impulse to use drugs even when there are negative consequences.
This is the obvious reason that jail sentences or other punishments won’t work to reduce addiction: one of the characteristics of addiction is to keep using the drug *despite* negative consequences.
These behavioral changes are also accompanied by changes in brain function, especially in the brain’s natural inhibition and reward centers. NIDA’s use of the term addiction corresponds roughly to the DSM definition of substance use disorder.
The DSM does not use the term addiction.
Why does NIDA use the term “misuse“ instead of “abuse“?
NIDA uses the term misuse, as it is roughly equivalent to the term abuse. Substance abuse is a diagnostic term that is increasingly avoided by professionals because it can be shaming, and adds to the stigma that often keeps people from asking for help.
Substance misuse suggests use that can cause harm to the user or their friends or family.
What is the difference between physical dependence, tolerance, and addiction?
Physical dependence can occur with the regular (daily or almost daily) use of any substance, legal or illegal, even when taken as prescribed. It occurs because the body naturally adapts to regular exposure to a substance (e.g., caffeine or a prescription drug).
When that substance is taken away, (even if originally prescribed by a doctor) symptoms can emerge while the body re-adjusts to the loss of the substance. Physical dependence can lead to craving the drug to relieve the withdrawal symptoms.
Tolerance is the need to take higher doses of a drug to get the same effect. It often accompanies dependence, and it can be difficult to distinguish the two.
Addiction is a chronic disorder characterized by drug seeking and use that is compulsive, despite negative consequences.
Is drug use or misuse a voluntary behavior?
The initial decision to take drugs is generally voluntary.
And this is where pain patients feel very different: we did * not* want to take opioids, but we feel we had little choice because it was the only method with which we could control our pain at least a little.
However, with continued use, a person’s ability to exert self-control can become seriously impaired. Brain imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decision-making, learning, memory, and behavior control
Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors of a person who becomes addicted.
Can addiction be treated successfully?
Yes. Addiction is a treatable, chronic disorder that can be managed successfully.
Research shows that combining behavioral therapy with medications, if available, is the best way to ensure success for most patients. The combination of behavioral interventions and medications to treat a substance use disorder is known as medication assisted treatment (MAT).
Treatment approaches must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric, environmental, and social problems.