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FAQFrequently Asked Questions (FAQs) - and Answers

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Responses to Frequently Asked Questions (FAQs) were developed by the editorial staff of Addiction Treatment Forum and made possible by an educational grant from Mallinckrodt Pharmaceuticals, a manufacturer of methadone and naltrexone.

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Understanding Drug Addiction

addictionWhat Is Drug Addiction?

Physical Dependence. Physical dependence and addiction are not the same. Many drugs, including opioids (for example, heroin, morphine, opium), some steroids, some heart medications, and alcohol, may cause physical dependence. After someone takes the drug for a long time, the body begins to need the drug.

Suddenly stopping the drug, or taking less of it, causes unpleasant effects called withdrawal. The symptoms of withdrawal are different for each drug. They may be mild, or extremely unpleasant. With heroin, they can even be life-threatening. Taking the drug again, or a similar drug, relieves the withdrawal symptoms. Close medical supervision over a long time usually is needed for someone to stop taking a drug without having withdrawal symptoms.

Addiction (drug dependence). “Drug dependence” is the medical term for what we usually call “addiction.” Addiction means more than just physical dependence. In addition to the physical symptoms of dependence, the person has an overwhelming craving—a compulsion— to keep taking the drug for the “high” it creates. This leads to drug-seeking behavior and often to criminal activity. Eventually, nothing but getting the next dose matters much in the life of a person with a drug addiction.

Sources:

APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Gardner EJ. The neurobiology and genetics of addiction: implications of the ‘reward deficiency syndrome’ for therapeutic strategies in chemical dependency. Chap 3. In: Elster J, ed. Addiction: Entries and Exits. New York, NY: Russell Sage Foundation; 1999:57-119.

Nestler EJ, Malenka RC. The addicted brain. Scientific American. March 2004:  Also published online at: http://www.sciam.com. Accessed April 20, 2009.

Updated July 2009

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How Do Doctors Diagnose Addiction?

To decide if a person is addicted, doctors consider several factors. A key factor is the desire to obtain a “high.” Another is the craving that occurs in addiction. These factors and the changes in behavior do not occur in physical dependence.

Another factor in addiction is tolerance. Someone who needs greater amounts of a drug to reach a desired effect — (with drugs of abuse, the “high”) — has developed tolerance to that drug. So has someone who continues to take the same amount of the drug, but reaches a lesser “high.” But some people become addicted to a drug without developing tolerance.

A doctor may suspect that a patient has become addicted to a prescription drug. Some signs: Is the patient using more of the drug than is necessary? Or, is the patient taking the drug longer than needed? In other words, is the drug not being used as prescribed?

Doctors also look for withdrawal symptoms. But these can occur with either physical dependence or addiction.

Sources:

APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Jaffe JH. Current concepts on addiction. Addictive States. In: O’Brien CP, Jaffe JH. Addictive States. New York, NY: Raven Press;1992:1-21.

Updated July 2009

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What Are The Results Of Addiction?

People who are addicted to a drug may really want to cut down on or control their drug abuse. They may try, but may not be able to.

Addictive drugs, like heroin, cause changes in the brain’s chemistry. The person begins to need the drug for the brain to function properly. When that drug is not present, the person goes into “withdrawal” which can be prolonged and painful. To avoid that, the addicted person constantly thinks about getting the next “fix.”

When people are addicted to a drug, the drug tends to take over their lives. Getting and using the drug fills their days. Forgetting family, friends, and work, they continue to use the drug, even knowing that it is destroying their lives.

Sources:

Erickson CK, Wilcox RE. Neurobiological causes of addiction. J Soc Work Pract Addictions. 2001;1(3):7-22.

Gardner EJ. The neurobiology and genetics of addiction: implications of the ‘reward deficiency syndrome’ for therapeutic strategies in chemical dependency. Chap 3. In: Elster J, ed. Addiction: Entries and Exits. New York, NY: Russell Sage Foundation; 1999:57-119..

Leshner AI. Understanding drug addiction: Insights from the research. In: Graham AW, et al (eds). Principles of Addiction Medicine. 3rd ed. Chevy Chase, MD: American Society of Addiction Medicine; 2003:47-56.

Updated July 2009

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brain

Is Addiction A Brain Disease?

Studies show that addiction is a chronic brain disease. People may stop using an addictive drug for a while, but often start again. Using certain medications, illicit drugs, or alcohol over and over changes the way the brain functions. Advanced ways of looking at how the brain works reveal the effects of the changes.

The brain has areas called reward centers. These centers make the person feel good after certain things happen in their lives. Substances that are addictive act on, and take over, these centers. From then on, almost all of the person’s time and energy may be spent getting more of the addictive substance.

Some people say that addiction is a choice. But it is a choice only when the person makes that first choice – the first decision to use the addictive substance.

Many experts don’t know about the evidence showing that addiction is a chronic disease. This is true even of some workers in the addiction-treatment field. Some other experts are aware of the evidence, but ignore it. They still say that addiction is a choice, not a chronic brain disease. To them, this means that people who develop addictions are weak-willed, irresponsible, and morally corrupt.

But addiction disorder is a chronic disease. This means it can be treated with medication, like other chronic diseases. In the same way that a diabetic patient takes insulin every day, an addicted person can be treated with medication.

Methadone has been used for over 45 years to treat heroin addiction. It has helped many millions of people. Methadone usually is given as a single, daily dose, by mouth. It does not cure addiction, just as insulin does not cure diabetes. But methadone satisfies the brain’s reward centers, so that the person no longer needs the drug of addiction. It means that the person can return to a more normal family life, rejoin the work force, and benefit from counseling—becoming a contributing member of society again.

Sources:

Andreasen NC. Linking mind and brain in the study of mental illnesses: a project for scientific psychopathology. Science. 1997;275:1586-1593.

 Dolan RJ. Emotion, cognition, and behavior. Science. 2002;298:1191-1194.

Updated July 2009

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