Dr

Evolving research is demonstrating that "addicts" (people who are dependent according to DSM criteria) are not bad people who need to get good, crazy people who need to get sane, or stupid people who need education. "Addicts" have a brain disease that goes beyond their use of drugs.

Science is doing its best to develop ways to diagnose those people who willfully make bad choices about their use of drugs, and those who are born with or develop pathological dependence (addiction) on drugs. Most people can use cocaine or heroin for awhile and stop using when they decide to stop. Others ("addicts") cannot stop without medical and structured therapy.

Actually, caffeine probably is not addicting, according to DSM criteria. While people have marked withdrawal symptoms from using too much caffeine, withdrawal alone is not sufficient to diagnose dependence ("addiction"). Also, caffeine does not have a significant effect on the "addiction pathway" (medial forebrain bundle) of the brain.

A person addicted to (dependent on) alcohol is called an "alcoholic". If this "myth" were true, then most college students would be alcoholics, or alcohol addicted. In fact, most college students abuse alcohol, while some show dependence on alcohol at some point in their drinking careers.

Alcohol has a lethal dose of around 24 ounces (1.5 pints) of distilled spirits for a 70-kg (150-lb) male, when the beverage is drunk rapidly (within one hour or less). The mechanism of death is respiratory depression (cessation of breathing due to toxic effects of alcohol or aspiration of, drowning on, one†s own vomit).

Club drugs include ecstasy, GHB, ketamine, rohypnol, methamphetamine, and LSD. We don†t have much solid research on club drugs, but most have been around for 10-20 years or more. Emergency room reports indicate they are very dangerous, especially when mixed with alcohol. Because they are not from new drug classes, we can predict their effects rather well. However, we have little evidence about their "addictability".

While there are more "crack" addicts observed on the streets, this is probably because crack is cheaper and easier to obtain than cocaine powder. But there is no pharmacological reason why the form of a drug or the route of administration should change the addiction liability of a drug. In fact, science is beginning to realize that the drug is not the cause of "addiction"; rather, the susceptibility of the person to the drug determines how much "addiction" (dependence) develops.

Euphoria is "a sense of well-being". Cocaine produces tremendous euphoria, whereas nicotine produces mild euphoria. Yet most experts agree that nicotine and cocaine are equally "addicting". Euphoria is the reason why people use drugs ("to get high"). Dependence ("addiction") occurs in some, but not all, people who experience euphoria. People who experience dependence have a brain disease.

This is an old belief, probably based upon wanting to blame addicts for using drugs to excess. This myth is reinforced by the observation that most "treatments" (including Twelve Steps) for alcoholism and addiction are behavioral (talk) therapies.

Science is demonstrating that addicts have a brain disease that causes them to have "impaired control" over their use of drugs. If we want to punish people for using drugs, we should punish those who are willfully abusing (DSM diagnosis) drugs.

Throughout history, medical diseases have always been treated before scientists learned the causes of the diseases. Through research, causes can be found, and better treatments (more effective for more sufferers, at reduced cost) can be developed. (If we had continued to develop treatment for polio instead of trying to find the cause, today we would have computerized iron lungs!)

The key word here is "simply". A.A. doesn†t work for everyone (even for many people who truly want to stop drinking). For most people, A.A. is a gut-wrenching, lifelong working of the twelve steps. Scientists theorize that people who "get better" in A.A. are somehow learning how to overcome (or compensate for) their brain disease.

An interesting scientific question is: If drugs cause addiction, then why doesn†t everyone who uses drugs too much, too often, become dependent ("addicted")? Scientists are looking into the genetic and other unknown factors that cause some people to become dependent while sparing others of this brain pathology.

While methadone is a drug that produces dependence, methadone has been shown to reduce the craving for the dangerous illegal drug heroin. By placing an "addict" into a controlled methadone program, clinicians can monitor the progress of the addict, encourage abstinence from heroin, help the addict find a job, and gradually reduce the methadone dose. Some people, however, choose to take methadone in place of heroin, which is less dangerous than injecting heroin "on the street".

While LSD causes hallucinations, these are temporary and somewhat different than the hallucinations of schizophrenia. Long ago, clinicians gave LSD to human volunteers to produce psychotic symptoms, so they could test potential new anti-psychotic drugs on the volunteers. LSD in normal people, however, does not cause "madness".

This is an old theory, which was very attractive in the early 1970s. It suggested that alcoholics, when they drink, form opiate-like THIQs (abbreviation for several artificially-formed chemicals) in the brain, to which they become dependent. Later research was not able to consistently find THIQs in the tissues of alcoholics compared to those of non-alcoholics. Thus, the "THIQ theory" is no longer popular among most scientists.

Actually, fetal alcohol syndrome babies are a major problem. While there are babies born of mothers who use cocaine or crack during pregnancy, most of these women also use other drugs and have other prenatal problems. "Crack baby" is a pejorative, media-generated term that is not scientific. Such babies, when they are born, are more accurately described as "babies in distress".

Actually, addicts are medically detoxified, when appropriate, in hospitals all the time. But can they be medically treated after detox? New pharmacotherapies (medicines) are being developed to help patients who have already become abstinent to curb their craving for addicting drugs. These medications reduce the chances of relapse and enhance the effectiveness of existing behavioral (talk) therapies (including Twelve Steps). Such drugs include naltrexone (ReVia) and bupropion (Zyban).

It is logical to consider that every drug is not equally addicting. Addiction potential is related to many factors, including the susceptibility of the individual to dependence production, and the ability of the drug to act at the "addiction site" (the brain's pleasure center). Obviously, all drugs are not the same in their site of action in the brain.

DSM Criteria for Drug Abuse and Dependence
Drug Abuse
A. A maladaptive pattern of drug use leading to impairment or distress, presenting as one or more of the following in a 12-month period:
     1. recurrent use leading to failure to fulfill major obligations
     2. recurrent use which is physically hazardous
     3. recurrent drug-related legal problems
     4. continued use despite social or interpersonal problems
B. The symptoms have never met the criteria for substance dependence.

Drug Dependence
A. A maladaptive pattern of drug use, leading to impairment or distress, presenting as three or more of the following in a 12-month period:

Adapted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 1994, published by the American Psychiatric Association, Washington, D.C. Also available in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), 2000.