Addiction vs dependence | National Institute on Drug Abuse

10: Addiction vs dependence | National Institute on Drug Abuse (NIDA) – Nov 2019

We have an entire government institute that is dedicated to handling drug abuse issues. NIDA is not connected to the DEA in any manner and has much experience and knowledge about addiction, but their expertise is being ignored.

Here, the true experts on addiction give a lengthy explanation of how the brain region leading to addiction is entirely separate from the region that controls dependence and tolerance.

This is a slide show with diagrams to illustrate the points they make. Click on the link of each section to see the slides.

different parts of the brain are responsible for the addiction and dependence to heroin and opioids.

Review the areas in the brain underlying the addiction to morphine (reward pathway) and those underlying the dependence to morphine (thalamus and brainstem). 

Thus, it is possible to be dependent on morphine, without being addicted to morphine.  

(Although, if one is addicted, they are most likely dependent as well.) This is especially true for people being treated chronically with morphine for pain, for example associated with terminal cancer. 

They may be dependent--if the drug is stopped, they suffer a withdrawal syndrome. But most such patients are not compulsive users of the morphine, and they are not addicted.

However, a proportion of people treated with morphine in the hospital for pain control after surgery may become addicted.

2: Localization of opioid binding sites within the brain and spinal cord | National Institute on Drug Abuse (NIDA)

morphine binds to opioid receptors that are concentrated in areas within the reward pathway (including the VTA, nucleus accumbens and cortex). 

Morphine also binds to areas involved in the pain pathway (including the thalamus, brainstem and spinal cord).

Binding of morphine to areas in the pain pathway leads to analgesia.

7: Brain regions mediating the development of morphine tolerance | National Institute on Drug Abuse (NIDA)

The development of tolerance to the analgesic effects of morphine involves different areas of the brain separate from those in the reward pathway.

Point to the two areas involved here, the thalamus, and the spinal cord (green dots).

Both of these areas are important in sending pain messages and are responsible for the analgesic effects of morphine. The parts of the reward pathway involved in heroin or morphine addiction are shown for comparison.

8: Definition of dependence | National Institute on Drug Abuse (NIDA)

Dependence develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug. 

When the drug is withdrawn, several physiologic reactions occur.

These can be mild (e.g. for caffeine) or even life threatening (e.g. for alcohol).  This is known as the withdrawal syndrome. In the case of heroin, withdrawal can be very serious, and the user will seek and take the drug again to avoid the withdrawal syndrome.

9: Brain regions mediating the development of morphine dependence | National Institute on Drug Abuse (NIDA)

The development of dependence to morphine also involves specific areas of the brain, separate from the reward pathway

In this case, point to the thalamus and the brainstem (green dots). The parts of the reward pathway involved in heroin (morphine) addiction are shown for comparison.  Many of the withdrawal symptoms from heroin or morphine are generated when the opioid receptors in the thalamus and brainstem are deprived of the drug.

7 thoughts on “Addiction vs dependence | National Institute on Drug Abuse

  1. Kathy C

    There you go with all that science stuff again. Conflating addiction and dependence, gets attentions and it is a really good marketing device. They had to stigmatize pain patients , and undermine physicians, in our profit driven healthcare system.

    Yesterday I did a little research on the NIH and NCAAM, and it occurred to me that after 27 years of collecting “data” on alternative practices, they have not uncovered any breakthroughs. The alternative medicine industry was against formalizing standards in research or in herbal remedies. They did that because it was not profitable, they do not want scientific standards. Another thing I noticed is that there is even less research recently into the adverse events. No one did any research into the real costs. In the US healthcare is a “choice” not a human right. I wonder how many people “choose” to use alternative medicine, and believe they don’t need insurance.

    Liked by 1 person

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    1. Zyp Czyk Post author

      That made me laugh out loud!

      Although I think “real” doctors wouldn’t be limiting pain relief and it’s the ignorant politicians and administrators and bureaucrats that are vying for some sort of prize for being the “toughest on the opioid crisis”, trying to make a name for themselves as badass drug warriors. They’re not going to let a few whiny people suffering bone-crushing pain deter them from their cause.

      But unlike in the movie (The Bird Cage) in our case the inmates are sadistic power-hungry sociopaths who have no compunctions about judging our pain to be mainly psychological.

      Of course, their *own* pain would be devastatingly real. We can only hope they receive a prompt lesson in reality the next time they break their bodies or suffer some lingering condition of unrelieved agony. I’m very curious to find out how they’ll react then, when they get tortured by the very rules they themselves passed.

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  2. Kathy C

    Thanks Zyp! Dr Novella is one of the few skeptics out there. Since there is no advertising, marketing or public relations money for factual skepticism, we are continually exposed to this nonsense. The majority of health related information online is merely marketing. There is virtually no examination or even discussion of how this is ruining our health, spreading misinformation and costing vulnerable patients billions of dollars.

    The FTC and other agencies used to regulate this, but they no longer act to protect the public. These industries have even taken over academia. https://medicine.unm.edu/education/integrative/index.html This is some really clever and deceptive marketing, but after all of these years, and their “research” there is no evidence that there are better outcomes. This marketing draws in people who are afraid of surgery or “conventional medicine.” One in the system they can waste months or years on “alternative medicine” if they can afford it. Once they run the patients insurance they can steer the desperate ones towards more intrusive (and profitable) pain treatments like steroid injections, implants, surgery and pain pumps.

    There are two levels of care, one for those with Medicare, and then the better reimbursing insurance the wealthy have. In New Mexico there is a serious shortage of physicians, and years of fighting the so called opioid epidemic, have ensured that few patients are treated with opiates, or even get their pain diagnosed. Patients here have very limited options, and this clinic can pick and choose their patients. There is zero evidence that any of this CAM works, but it is profitable.

    This kind of deceptive marketing has not been studied, and it is ruining our healthcare system. In NM only 44% of the state got a flu vaccine, due to the alternative medicine’s deceptive marketing. Clinical directors are forced to hire people to work in healthcare setting who “question” vaccines. We live in a nation of alternate facts, where anything that is profitable, like spreading healthcare misinformation of marketing purposes is encouraged. Heaven forbid we have a severe outbreak of the flu or the Measles, since the facts are no longer applied. This should be a serious public health concern, yet no one is researching any of that.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      It’s so sad that Steve Jobs, with all his brilliance, fell for the lure of “alternative medicine” – but I’m not sure any kind of medical treatment could have saved him from pancreatic cancer – that one is a sure killer.

      On the other hand…

      I had a friend who lived with terminal metatastic kidney cancer for 20 years by using all kinds of bizarre alternative treatments, one after another as his body adjusted to each one and started growing tumors again. He did have the biggest ones surgically removed, but never did chemo or radiation. Scans would show new tumors, he’d try some new whacko alternative treatment, and then later scans would show them gone.

      But after so many years of almost constant effort, he eventually just got tired of fighting so hard. Once he stopped resisting, he died in less than a month.

      The doctors could not explain why he didn’t die in the first few years. I suspect it’s because he never went to any “practitioners”, but always did the nutritional and electrical treatments himself. That means he was using his mind, like those expert yogis who can survive all kinds of weird tortures (not something you can do at home after 20 meditation classes).

      The mind is the wild card in all this and most of us haven’t a clue how to harness its powers. I consider myself lucky to have learned to prevent my mind just from making things worse, like anxiety.

      But I didn’t learn it by taking a few classes on “mindfulness” – it was an act of utter desperation when my anxiety was driving me to the edge of suicide. I suffered multiple years of intense mental anguish before I was able to get a handle on it. I wouldn’t recommend that route for anyone!

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  3. Pingback: Difference Between Drug Addiction and Dependence | EDS and Chronic Pain News & Info

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