ADDICTION

Addiction is -- according to Wikepedia -- a chronic disorder proposed to be precipitated by a combination of genetic, biological/pharmacological and social factors. Addiction is characterized by the repeated use of substances or behaviors despite clear evidence of morbidity secondary to such use.

That's a very questionable definition when it comes down to "clear evidence of morbidity". As we know today, cannabis is not associated with any "clear evidence of morbidity" and it is questionable whether anti-depressants, methylphenidate, methamphetamine, or other drugs are associated with a "clear evidence of morbidity". If you eat meat, you could get "mad cow disease" so does that mean eating steak is an addiction?

Recently, HIV meds have been linked to liver disease and death. Does that mean taking HIV meds is an addiction? Chemical dependency and addiction appear to be placeholders for research that has not been accomplished and nothing more.

Up until about 1975, addiction was a pharmacologic term that explicitly referred to the use of a tolerance-inducing drug in high doses over a period of time to result in the need for greater dosages to produce an identical effect. During the 1960s, a lay definition of addiction developed. This definition referred to individuals who continued to use prescription medications beyond the recommended period because they developed a psychological or physical dependence.

Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). Unfortunately, terminology has become so misused by physicians themselves that it is difficult for even the shrewdest experts to identify the parameters between what constitutes dependence, addiction, abuse, misuse, and other terms that have been introduced intothe ICD 10. Pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence); psychiatrists refer to the lay definiton as being dependence; most other physicians refer to the disease as addiction interchangeable with dependence. The field of psychiatry is now considering, as they move from DSM-IV to DSM-V, transitioning from "dependence" to "addiction" as terminology for those who have become psychologically or physically maladjusted to a certain drug. Counselors now refer to all classes as abuse but also have augmented their vocabulary with use and abuse. The problem is that in a zero tolerant society which has become less precision-oriented, all terms converge to be synonymously associated.

The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological dependence (or simply addiction). Addiction is now narrowly defined as "uncontrolled, compulsive use"; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered compulsive, but to the definition of some it is not categorized as "addiction". In practice, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components.

There is also a lesser known situation called pseudo-addiction.^{[citation
needed]} A patient will exhibit drug-seeking behavior reminiscent of psychological addiction, but they tend to have genuine pain or other symptoms that have been undertreated. Unlike true psychological addiction, these behaviors tend to stop when the pain is adequately treated.

The term "dry drunk" is sometimes attached to patterns of behavior that persist after an object of dependence and/or misuse has been removed from daily living routines. This behavior is fairly common in the early stages of recovery from substance misuse.

The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal but addiction is rare.

Not all doctors agree on what addiction or dependency is, because traditionally, addiction has been defined as being possible only to a psychoactive substance (for example alcohol, tobacco, or drugs), which is ingested, crosses the blood-brain barrier, and alters the natural chemical behavior of the brain temporarily. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, cutting, and shopping / spending. However, these are things or tasks which, when used or performed, cannot cross the blood-brain barrier and hence, do not fit into the traditional view of addiction. Symptoms mimicking withdrawal may occur with abatement of such behaviors; however, it is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. In spite of traditionalist protests and warnings that overextension of definitions may cause the wrong treatment to be used (thus failing the person with the behavioral problem), popular media, and some members of the field, do represent the aforementioned behavioral examples as addictions.

In the contemporary view, the trend is to acknowledge the possibility that the hypothalmus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicals (alcohol, nicotine etc.) when addictive activities take place^{[citation
needed]}. For example, when an addicted gambler or shopper is satisfying their craving, chemicals called endorphins are produced and released within the brain, reinforcing the individual's positive associations with their behavior.

Despite the popularity of defining addiction in medical terms, recently many have proposed defining addiction in terms of Economics, such as calculating the elasticity of addictive goods and determining, to what extent, present income and consumption (economics) has on future consumption. ^[1]

In 2004, I interviewed over 1,200 people with AIDS (PWAs) from the Bay Area for a clinical trial at the Stanford Adult AIDS Clinical Trial Group (AACTG) using RNA gene therapy as a potential long-term solution in destroying the virus from the body. The criteria for candidates to be accepted included a mandatory 18-month drug-free history, where drugs referred only to illicit drugs but not prescription drugs, making absolutely no sense whatsoever since someone was accepted to the study if they were using Desoxyn but not the street version of methamphetamine, for example. Of the 1,241 candidates that I interviewed, all were referred to me by physicians from various clinics who checked off one of the two boxes on the form. The majority of physicians checked the box that stated: "Has never used illicit street drugs." The second box read: "Has not used illicit street drugs for at least 18 months. The majority of candidates came to me with the first box checked and these were validated through the third party organization who provided me with the lists in exchange for contributing to their project.

When I began the interviewing process, I started with other information first and then verified that they had not used an illicit drug within the prior 18 months. Since this was a firm requirement, they had to sign a paper stating that if any information is false, the therapy could produce serious side effects. But when it came to signing their names, they started asking me if that was really true. I told them that I really didn't know but they wouldn't print false information on the forms. The PWAs paniced, in fact of the 2,000 that I initially expected to interview, I stopped at 1,241, when they all reported using illicit drugs! However, none of them were honest with their doctors.

According to Tai Ng, the director at the third party organization that provided the names of the candidates, it is virtually impossible to find a PWA in the Bay Area who has not used illicit drugs. Furthermore, according to the statistics that he accessed from across the country, the actual numbers of people using illicit drugs in the US far exceeds the statistics. Tai noted that most individuals never reveal they use illicit drugs.

A year later, while working with Quest Diagnostics and Choicepoint in the the Los Angeles area, I discovered that MROs pass many suspected drug users through based on the answers to the questions they provide.

"Before we waste time with a confromatory test, I might ask someone who tested positive for methamphetamine if they use an inhaler," one MRO at Choicepoint who asked not to be identified confided. "If they say, 'Yes', then we accept that and pass it through. But of course if they don't know what we're talking about, I have to decline them... about 30% of those tested during the last six months came back positive for methamphetamine... only 16% were completely drug free. We bumped that number up to 63% when we interviewed them."

If that's an indicative sample of the US population, then about 84% of the population is using illicit drugs, including cannabis, at least once every two weeks. Such is a grim reminder that the American healthcare system is not responding to the needs of the public.

Trying to categorize a self-medicating public is useless. It

For a term that is used so much, there is still no clear definition of what constitutes an addiction. For example, if you are living in Las Vegas and visit the casinos on a daily basis, and match the definition of a pathelogical gambler, does that make someone addicted to gambling. President Bush claimed that Americans are "addicted to oil". Some Americans wouldn't know what oil was if they slipped on it. Everyday, people use the expression "drug addict" to describe someone they don't like. The 12-Step meetings for alcohol, narcotics, or whatever, start off with people introducing themselves by stating: "Hi I'm so-and-so, and I'm an addict". Whatever people mean when they use the term addiction, it always connotates something derogatory. You will never hear President Bush say to anyone: "Hi I'm George Walker Bush and I'm addicted to money."For a term that is used so much, there is still no clear definition of what constitutes an addiction. For example, if you are living in Las Vegas and visit the casinos on a daily basis, and match the definition of a pathelogical gambler, does that make someone addicted to gambling. President Bush claimed that Americans are "addicted to oil". Some Americans wouldn't know what oil was if they slipped on it. Everyday, people use the expression "drug addict" to describe someone they don't like. The 12-Step meetings for alcohol, narcotics, or whatever, start off with people introducing themselves by stating: "Hi I'm so-and-so, and I'm an addict". Whatever people mean when they use the term addiction, it always connotates something derogatory. You will never hear President Bush say to anyone: "Hi I'm George Walker Bush and I'm addicted to money."For a term that is used so much, there is still no clear definition of what constitutes an addiction. For example, if you are living in Las Vegas and visit the casinos on a daily basis, and match the definition of a pathelogical gambler, does that make someone addicted to gambling. President Bush claimed that Americans are "addicted to oil". Some Americans wouldn't know what oil was if they slipped on it. Everyday, people use the expression "drug addict" to describe someone they don't like. The 12-Step meetings for alcohol, narcotics, or whatever, start off with people introducing themselves by stating: "Hi I'm so-and-so, and I'm an addict". Whatever people mean when they use the term addiction, it always connotates something derogatory. You will never hear President Bush say to anyone: "Hi I'm George Walker Bush and I'm addicted to money."

Following three years of analysis, it seems that these terms, such as dependency and addiction, as well as everything that exists under substance use disorder needs to be reevaluated by clinical research experts. It seems reasonable to believe that the reason why behavior is repeated is simply because there are benefits. At this time -- June 2007 -- the archaic information provided about substance use disorder (SUD) in particular is out of synch with gambling and other behaviors that are considered harmful.

Harm Reduction examines behavior on a case by case basis. Until there is further research in this area, it is advisable that theories about SUD and personality disorders be tossed out in consideration of the actual behavior.

Thus, in conclusion, it is impossible to distinguish someone with addiction and someone who self-medicates. It is more likely that everyone self-medicates as an addiction (like chemical dependency) does not appear to exist as it is being defined a term that is too broad and too widely accepted to mean many different things. Recently, politicians have used the term addiction when referring to "oil". That could mean that the population at large is huffing gasoline rather than using it to fuel their vehicles.