What Is Drug Addiction? Surprising Answers From A Medical Point Of View Part 3 of 3 Part Series

There is no single answer to the question of what is drug addiction. It depends who you ask. In this post, (part 3 of a series of 3), we will focus on answering the question of what is addiction from a medical point of view.

In part one we attempted to answer the question of what is addiction from the point of view of the addict. In part two we gave a neurological or brain science point of view.

In asking medical trained people for a definition of addiction and treatment, be prepared for many points of view. If you ask 100 doctors what a simple fracture of a leg looks like and what it’s treatment is, probably 100 doctors will give you the same answer on diagnosis – the x-ray shows a broke bone.. and treatment – we set it and put on a cast.

If you ask the same hundred doctors what drug addiction is be prepared for 100 different answers and 100 different opinions on treatment.

Pleas also see Part 1 Addiction from the addicted person’s point of view.

Part 2 Addiction as a brain disease.

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The AMA endorses the proposition that drug dependencies, including alcoholism, is a disease and that their treatment is a legitimate part of medical practice. “

OK, so the American Medical Association the American Society of Addiction Medicine, World Health Organization and American Psychiatric Association and a host of others agree that drug addiction and alcoholism are diseases.

This had huge implications in moving drug and alcohol addiction from the realm of a moral issue of weak willed or degenerate persons into a legitimate illness. This shift opened up the legitimacy of research and exploring treatment venues.

But it wasn’t until about 25 years ago that the Medical Association and other professionals could agree on a definition of the disease of addiction. Kind of. Sort Of.

In 1992 The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine formed a committee to study the definition and criteria for the diagnosis of alcoholism.

The goals of the committee were to create by consensus a revised definition that is (1) scientifically valid, (2) clinically useful, and (3) understandable by the general public.

I especially like #3, a definition ‘understandable by the general public’. It should be clear to the average person, right?

Here is what they came up with: the committee agreed to define alcoholism as:

A primary, chronic disease with genetic, psycho-social, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.”

Great, I’m a member of the general public, but am not so sure how clear that is, so let’s break that definition and wording down a bit into even more understandable terms.

Primary: This suggests that alcoholism, or drug use, as an addiction stands on its own and is not a symptom of another underlying disease state.  It refers to the disease as possibly being in addition to, but separate from other states which may be associated with it. It is not secondary to something else.

Disease: This means impairment or involuntary disability that is associated with a specified common set of characteristics, signs and symptoms that differentiate these individuals from the general population and which places them at a disadvantage.

Often progressive and fatal… Drug addiction is persistent over time, the physical emotional and social changes are key, and will progress as long using continues.  The negative effects of alcohol and drug use accumulate over time and can cause premature death through overdose, suicide, homicide motor vehicle accidents and traumatic events.  Medical or organic complications often involve the brain, heart, liver, and many other organs within the body. If left unchecked is has a known outcome.

Impaired control: this is the phenomenon of a person’s inability to control their use of alcohol or drugs after a certain point.  They become unable to consistently set enforceable limits on both the quantity consumed, the length of the episode, and their behavior consequences of use. A lot of this is not just psychological, but neurological.

Preoccupation: as the disease progresses, the individual often starts to divert attention and energy away from important life concerns.  The alcohol or drug use becomes the central point of focus, or central organizing a factor around which the users life starts to revolve.

Adverse Consequences:  This means negative consequences: quite plainly stated, ‘ bad stuff happens’, hitting bottom. The qualities of interpersonal relationships start to suffer.  There may be impairments and a decrease in the ability to think clearly, as well as producing altered states of mood and behavior. There may be legal, financial spiritual problems.  Physical health problems may start to manifest themselves such as withdrawal symptoms, craving, anemia, liver disease, brain disease etc.

Characterized By Denial: Denial is a unique symptom of the disease of addiction.  It is much deeper than simply responding negatively to accusations that you have a problem.  In order to stay active in their addiction, a user must create a rational framework in which it is OK or the to do so.

These mental manipulations, or psychological defense mechanisms eventually create almost a fantasy world in which it is OK for the user to continue.  Some common elements of a denial system are a minimization of how much is actually consumed, and minimizing the negative effects on themselves and people around them.

There is also a tendency to blame people, places, and things for their use, and holding the belief that they are ‘entitled’ to continue using or it is a reward for their hard work.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the American Psychiatric Association’s (APA) classification and diagnostic tool. In the United States the DSM serves as a universal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications.

Here is the official Substance Use Disorder (the current politically correct way of saying drug addiction criteria). This is a sample for opiates, but just about every drug has similar criteria.

Opioid Use Disorder Criteria:

A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe (APA, 2013). Opioid Use Disorder is specified instead of Substance Use Disorder, if opioids are the drug of abuse.

1. Taking the opioid in larger amounts and for longer than intended
2. Wanting to cut down or quit but not being able to do it
3. Spending a lot of time obtaining the opioid
4. Craving or a strong desire to use opioids
5. Repeatedly unable to carry out major obligations at work, school, or home due to opioid use
6. Continued use despite persistent or recurring social or interpersonal problems caused or made worse by opioid use
7. Stopping or reducing important social, occupational, or recreational activities due to opioid use
8. Recurrent use of opioids in physically hazardous situations
9. Consistent use of opioids despite acknowledgment of persistent or recurrent physical or psychological difficulties from using opioids
10. *Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount. (Does not apply for diminished effect when used appropriately under medical supervision)
11. *Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal (Does not apply when used appropriately under medical supervision)

Browse Our Highly Recommended Resources:

Chicken Soup for the Recovering Soul: Your Personal, Portable Support Group with StoriesThe Body Keeps the Score: Brain, Mind, and Body in the Healing of TraumaLoving Someone in Recovery: The Answers You Need When Your Partner Is RecoveringYour Best Investment: Secrets to a Healthy Body and MindHealed From Drug Addiction: Healed From Mind ErosionEmpty Spaces: One Man’s Victory Over Addiction

Summary:

We would like to note that sustaining long-term recovery is simply not about saying no to drugs (although that is the object of the exercise). It is about gaining an education of the nature of drug addiction, how it personally applies to you, and formulating strategic prevention awareness and actions.

Clich Here For: Part 1 Drug addiction from an addicts point of view

Click Here For: Part 3 Drug addiction from a neurological point of view.

Free Resources:

1. More About The Diagnostic Criteria of Addiction A little more detail.
2. Easy to Read Drug Facts A nice info page, easy to read with lots of facts by National Institute of Drug Abuse.