Posted by Elizabeth on June 25, 2001, at 2:50:07
In reply to Addictive meds in general, posted by JCB on June 22, 2001, at 0:58:18
The term "addiction" is confusing. This is due, in part, to changing definitions. Twenty years ago, any drug that had a characteristic withdrawal syndrome was considered "addictive," and people who took such drugs (regardless of how they took them) were uniformly considered "drug addicts." It was a relatively simplistic and objective definition.
Today, "addiction" refers to the psychological disorder classified as "substance dependence" in DSM-IV. The tolerance/withdrawal syndrome is more properly identified as "pharmacologic dependence." It is not a disease, but a normal response to taking drugs for a long enough period of time. It is recognised that people who take drugs that have virtually no abuse potential (including many antidepressants) do often experience withdrawal symptoms if they discontinue the drug abruptly or miss a dose. This phenomenon, it is recognised, is not properly considered to be a drug addiction, and people who use antidepressants, anticonvulsants (including benzodiazepines), certain cardiac drugs, stimulants, glucocorticoids, opioids, etc., on a daily basis are not automatically classified as "drug addicts." It is understood that these drugs can and are used in a nonpathological way in the treatment of such conditions as depression, bipolar disorder, anxiety disorders, chronic pain, hypertension, tremor, attention deficit disorder, narcolepsy and some other sleep disorders, inflammatory conditions, autoimmune diseases, organ transplantation, etc.
The realisation that many classes of drugs thought to be virtually free of abuse potential -- such as SSRIs, tricyclics, MAOIs, centrally-acting alpha-adrenergic agonists, glucocorticoids, and anticonvulsants other than barbiturates and benzodiazepines -- can cause characteristic withdrawal syndromes and/or rebound symptoms is clinically important, because it is extremely important that these drugs be abruptly only in emergencies.
The distinction between true addiction and pharmacologic dependence is also important because "addiction" is such a loaded word today. Most people who take benzodiazepines for anxiety, stimulants for ADHD or narcolepsy, opioids for pain, etc., do *NOT* become drug addicts. Withdrawal symptoms are normal responses to discontinuation of these drugs, just as it should not surprise a pdoc (or other medical professional or counselor) if a person suffers withdrawal symptoms when he or she tries to stop taking Paxil or Effexor.
It is incorrect and misleading to label a person a "drug addict" based solely upon the manifestation of the substance-specific withdrawal syndrome upon discontinuation of the drug. Although most addicts do suffer withdrawal symptoms, there is much more to addiction than that.
Although I don't generally think that the DSM-IV definitions of mental disorders are very useful or precise, the definitions of substance dependence and substance abuse are worth careful examination -- *especially* by mental health professionals. A MHP who is unaware of the difference between true addiction and pharmacologic dependence runs the risk of placing people in "treatment" programs which will, at best, be of no benefit; indeed, the stigmatising label of "addict" may be harmful to these people in many cases.
It might be of interest that a standard medical school pharmacology textbook (Goodman & Gilman's _Pharmacological Basis of Therapeutics_) recommends doing away with the word "addiction" altogether because of its pejorative connotations and the confusion surrounding its meaning.
-elizabeth
poster:Elizabeth
thread:1356
URL: http://www.dr-bob.org/babble/20010618/msgs/67768.html