What Is Addiction? And What Are Its True Causes? – By Wolfgang Vogel – Feb 2019
Here’s another article pointing out that addiction isn’t lurking inside drugs like opioids, but rather inside the individual.
This seems so obvious because hundreds of millions of people are routinely prescribed opioids for post-surgical pain and if all or most of them became addicted, there would hardly be any non-opioid-addicted people left.
Unfortunately, most individuals know little about what addiction actually is, and even less about what causes it.
Let’s clarify some misconceptions and provide some scientific explanations.
First, what is addiction?
Addiction, or dependence, has a specific medical definition as documented in the diagnostic statistical manual, otherwise known as the DSM.
However, in general terms, it can be characterized as an uncontrollable craving for a substance or drug, even when its use can result in negative health effects, or even death. This craving is caused by an overwhelming desire to experience euphoria, or to avoid unpleasant feelings.
In contrast, the controlled use of such substances is not considered addiction.
This point is too often overlooked.
Second, what causes this uncontrollable craving, which eventually leads to addiction?
Two hypotheses exist, and the word “substance” being used refers to FDA-approved drugs (e.g. OxyContion or oxycodone) as well as non-FDA-approved substances (e.g., heroin, LSD).
The first hypothesis
blames the substance as the sole cause of the problem.
Here, use of a particular substance causes the individual to become slowly addicted to it. To cure addiction requires removing the drug from the individual, or the individual from the substance using physical restraint, or even jail.
This approach is the belief of most legislatures, law enforcement officials and the majority of the lay population.
The media is much to blame for popularizing this erroneous belief, but it’s truly sad that even some doctors seem to believe this.
It, however, has little common-sense support from those who view this dilemma with either a historical and scientific perspective.
Common sense tells us that use of a substance does not necessarily lead to its abuse. While many young people do experiment with alcohol or nicotine or other substances, most will not use them in the future at all, or in a controlled fashion where only a small minority will become addicted.
Scientific experiments and studies have demonstrated that drug exposure alone does not lead to addiction or abuse, except, again, in a minority of subjects
most deaths today from substance abuse are not caused by the legal drugs, but instead through the purchase of substances from illegal sources. It is here where the purity, dose and toxic impurities of the product are largely unknown; these substances are often highly toxic and potentially deadly.
As a nation, we have spent billions on the so-called “War on Drugs” and have jailed millions of people with drug problems over the last several decades – with no success whatsoever.
At the same time curtailing legitimate drugs has the problem of punishing the innocent, like in the case of today’s opioid drugs where physicians have become afraid to prescribe pain medications to deserving patients.
This dynamic has led to unnecessary suffering, which has even driven some to suicide in an effort to escape intolerable pain.
Unfortunately, doctors withholding pain medication from needy patients continues to be done in spite of successive and ongoing failures.
The second hypothesis
states that certain individuals are predisposed by genetic and environmental factors to seek the use of psychoactive substances – and to become addicted to them.
Here, only some individuals will develop this uncontrollable craving to obtain euphoria or to escape unpleasant feelings. The majority of the population will not.
That portends that the individual – and not the drug – is in the center of addiction.
This would explain that with exposure to a psychoactive substance, only a minority – not all – will become addicted to it.
Genetic studies already have found differences between individuals who are, or are not, addicted.
Thus, to solve the problems of addiction requires treating it as an individual and/or medical problem.
Since we do not have the tools to genetically alter an addictive personality, we still can do a lot to help these addicted individuals. Improvement of socioeconomic conditions would be a start to help reduce the risk of addictive behaviors.
At this point, it seems ridiculous to ask for the necessary social changes because we are so entrenched in a ‘business first’ society, where profit has seized the highest priority.
Dr. Wolfgang Vogel is an emeritus professor of pharmacology.