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"Addiction" is a very tricky concept... Wikipedia defines it as "compulsive engagement in rewarding stimuli, despite adverse consequences". But what if the pers

by md224 10y ago

"Addiction" is a very tricky concept... Wikipedia defines it as "compulsive engagement in rewarding stimuli, despite adverse consequences". But what if the person engaging in the behavior doesn't mind the adverse consequences? What if the only adverse consequence is a slight decrease in life expectancy? How bad do the consequences have to be before a behavior becomes pathological? The line we draw here seems rooted in personal values, not an objective standard. What if someone uses amphetamines daily and really doesn't want to give them up. Are they addicted? What if they later learn they have ADHD and they've just been self-medicating? What if they don't have ADHD but the drug just improves their life? What if their name happens to be Paul Erdős? If someone suffers depression from opiate withdrawal, we call them an addict. If someone suffers depression from going through a breakup, it's just par for the course. And yet both scenarios are withdrawal from a pleasurable stimulus. Why is one acceptable and the other not?

concinds 10y ago
> But what if the person engaging in the behavior doesn't mind the adverse consequences? Addiction is by definition not something that is indulged in voluntarily by carefully weighing the consequences. I recommend you familiarize yourself with the Jellinek Curve, which accurately describes the guilt and shame that results from addiction. > What if the only adverse consequence is a slight decrease in life expectancy? Addiction itself not only has much worse consequences than that, but you're omitting the fact that addiction is present for a reason. Addiction is self-medication of excessive pain, and that excessive pain has deep, significant adverse effects. There is a reason that addiction is often comorbid with family dysfunction; addiction is a response to pain, not just a cause of pain. "Curing" an addiction involves reducing this pain to remove the need for self-medication. > The line we draw here seems rooted in personal values, not an objective standard. We need to recognize that subjectivity when we discuss addiction. The line is very clear. If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. Treating addiction as a "subjective" thing just ignores the pain-dimension which drives people to addiction in the first place, to run away from their pain. Society's focus should be on becoming more nurturing and cohesive, which'll hopefully result in fewer people being in so much pain that they'll destroy their lives and relationships just to feel remotely human.
- md224 10y ago
  > Addiction is self-medication of excessive pain Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response. What are you going to do, just suffer it? Therapy is nice but it doesn't solve everything. Would it be better if you took the "self" out of the equation and were supervised by a professional? > If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction?
  - concinds 10y ago
    > Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response No, it's a survival mechanism. It only reduces the pain superficially and temporarily. It's like giving an adrenaline shot to Atlas instead of getting the Globe off his back. >So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction? It's all motivation. Addictions are a way to deal with deep-seated and excessive shame, guilt, fears, hopelessness, despair, and loneliness. If that's why you take a drug, you're only hurting yourself by not seeking help for the aforementioned problems. If you're taking a drug just for fun, that's fine. Note that many addicts will lie to themselves and pretend the latter applies to them.
    - md224 10y ago
      > It's all motivation. Addictions are a way to deal with deep-seated and excessive shame, guilt, fears, hopelessness, despair, and loneliness. If that's why you take a drug, you're only hurting yourself by not seeking help for the aforementioned problems. What if these emotional issues are caused by a chemical imbalance that the drug alleviates?
      - concinds 10y ago
        > What if these emotional issues are caused by a chemical imbalance that the drug alleviates? These deep emotional issues are not random brain malfunctions, but often caused by childhood trauma, or other forms of trauma. Addiction is a pathological response to pathology.
DanBC 10y ago
Addiction has a fairly well defined meaning, that doesn't apply to a bunch of stuff (sex, gambling) or to problematic but less severe than addiction stuff like harmful drinking. This is why people tend to talk about dependence instead. There are 4 aspects to dependence. 1) Tolerance 2) Pre-occupation 3) Craving 4) Continuing when you know it's harmful Here you'd have people who'd continue the activity beyond the slight decrease in life expectancy because, as you quote, there's an element of compulsivity. All addiction is harmful misuse. Not all harmful misuse is addiction.
- md224 10y ago
  Your definition of dependence seems to assume there is harm involved, but I can think of a lot of dependencies that are either beneficial or neutral. Are you referring specifically to psychological dependence, as opposed to physical dependence?
  - crawfordcomeaux 10y ago
    I think "dependence" as described above is a softer way to address addictions. I'm guessing people use it to avoid the stigma of addiction & because so many definitions of addiction (including the one in the DSM) only address drugs/alcohol. I think that's kind of what the article's looking to address is we need to broaden the definition of addiction. I don't think what he's saying is meant to be applicable to people who suffer from chronic pain from irreparable/incurable afflictions & so are physically dependent on drugs to alleviate their pain. I do think there's harm in prescribing drugs to alleviate chronic pain in sufferers whose pain was triggered by something long since treated & now persists as a learned pattern in their mind. Treating that condition with drugs instead of mental techniques to unlearn the pattern is like putting Neosporin on an open wound that won't heal shut without stitches.
duaneb 10y ago
I would not characterize breakup depression as withdrawal.
- md224 10y ago
  Okay, but why not?
matheusmoreira 10y ago
Recreational drugs affect the brain in a very different manner when compared to medication, which is designed to be safer. I have ADHD and have taken prescription amphetamines before. They're much safer drugs than a recreational stimulant. There are many reasons for this. The subjective "high" caused by a drug is determined by how fast the concentration of dopamine increases¹ in the brain. Each individual drug has a distinct mechanism of action, so they all increase dopamine concentration at different rates. The high is also linked to the route of administration of the drug; the fastest routes are intravenous administration and inhalation, followed by intranasal administration. Prescription stimulants are designed¹ to modulate neuronal circuits in a healthy manner. Recreational drugs do the opposite. They aim for a massive release of dopamine in the brain's mesolimbic reward system. All drugs that can lead to addiction have this effect. High concentrations of dopamine results in neuroadaptation² in those circuits. Their receptors are down-regulated so as to better tolerate the drug. Less receptors for the same concentration of neurotransmitter translates to a diminished response. This is why the first use of the drug provides the strongest stimulation. It also explains why addicts may continuously escalate the dose; they're attempting to get that same level of stimulation again. Neuroadaptation is also associated with withdrawal effects. After down-regulation occurs, the new amount of receptors is appropriate for higher concentrations of the neurotransmitter. After the drug wears off, concentrations are back to physiologic levels which are no longer adequate. The resulting neurotransmission deficiency results in withdrawal effects. The flow of information within the affected circuits has become dependent on the higher neurotransmitter levels³ caused by the drug. >How bad do the consequences have to be before a behavior becomes pathological? In the development of addiction, a dramatic change in behavior can be observed: addicts gradually shift from impulsive use of the drug for pleasure and reward to compulsive use in order to avoid the adverse effects associated with withdrawal. These impulsive-compulsive disorders are proposed¹ as the common neurobiological substrate of many disorders, not just addiction. They're also linked to OCD, gambling, obesity and others. ¹ Stahl's Essential Psychopharmacology. Chapter 12 and 14. http://imgur.com/a/LcgkT http://imgur.com/a/LcgkT ² https://www.ncbi.nlm.nih.gov/pubmed/18316420 https://www.ncbi.nlm.nih.gov/pubmed/18316420 ³ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/
- grkvlt 10y ago
lujim 10y ago
> If someone suffers depression from opiate withdrawal, we call them an addict. If someone suffers depression from going through a breakup, it's just par for the course. And yet both scenarios are withdrawal from a pleasurable stimulus. Why is one acceptable and the other not? If someone doesn't get food or water and is deprived of sleep for a few days they will develop the symptoms of depression. Humans need food, water, sleep, and social connections to thrive. When one of those is temporarily thwarted, mental and physical pain is a signal to take action. It's not always pleasant, but it will keep you alive and your genes in the game. This is unavoidable and often useful pain. Recreational opiate use on the other hand is an extremely dangerous short circuit of the brains pleasure centers that very often results in physical dependance, legal problems, and death. Part of maturing is understanding that you don't always have to mask pain and chase pleasure. It's ok and even healthy to feel like shit sometimes.

by md224 10y ago

concinds 10y ago

> But what if the person engaging in the behavior doesn't mind the adverse consequences? Addiction is by definition not something that is indulged in voluntarily by carefully weighing the consequences. I recommend you familiarize yourself with the Jellinek Curve, which accurately describes the guilt and shame that results from addiction. > What if the only adverse consequence is a slight decrease in life expectancy? Addiction itself not only has much worse consequences than that, but you're omitting the fact that addiction is present for a reason. Addiction is self-medication of excessive pain, and that excessive pain has deep, significant adverse effects. There is a reason that addiction is often comorbid with family dysfunction; addiction is a response to pain, not just a cause of pain. "Curing" an addiction involves reducing this pain to remove the need for self-medication. > The line we draw here seems rooted in personal values, not an objective standard. We need to recognize that subjectivity when we discuss addiction. The line is very clear. If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. Treating addiction as a "subjective" thing just ignores the pain-dimension which drives people to addiction in the first place, to run away from their pain. Society's focus should be on becoming more nurturing and cohesive, which'll hopefully result in fewer people being in so much pain that they'll destroy their lives and relationships just to feel remotely human.

md224 10y ago
> Addiction is self-medication of excessive pain Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response. What are you going to do, just suffer it? Therapy is nice but it doesn't solve everything. Would it be better if you took the "self" out of the equation and were supervised by a professional? > If you compulsively use, in a way that harms you, to relieve inner pain, it's addiction. So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction?
- concinds 10y ago
  > Well if you're going through excessive pain, self-medication sounds like a pretty reasonable response No, it's a survival mechanism. It only reduces the pain superficially and temporarily. It's like giving an adrenaline shot to Atlas instead of getting the Globe off his back. >So this requires all 3 parts though, right? If you compulsively use to relieve inner pain but without harm, that's okay, right? How much harm is allowed before it's addiction? It's all motivation. Addictions are a way to deal with deep-seated and excessive shame, guilt, fears, hopelessness, despair, and loneliness. If that's why you take a drug, you're only hurting yourself by not seeking help for the aforementioned problems. If you're taking a drug just for fun, that's fine. Note that many addicts will lie to themselves and pretend the latter applies to them.
  - md224 10y ago
    > It's all motivation. Addictions are a way to deal with deep-seated and excessive shame, guilt, fears, hopelessness, despair, and loneliness. If that's why you take a drug, you're only hurting yourself by not seeking help for the aforementioned problems. What if these emotional issues are caused by a chemical imbalance that the drug alleviates?
    - concinds 10y ago
      > What if these emotional issues are caused by a chemical imbalance that the drug alleviates? These deep emotional issues are not random brain malfunctions, but often caused by childhood trauma, or other forms of trauma. Addiction is a pathological response to pathology.

DanBC 10y ago

Addiction has a fairly well defined meaning, that doesn't apply to a bunch of stuff (sex, gambling) or to problematic but less severe than addiction stuff like harmful drinking. This is why people tend to talk about dependence instead. There are 4 aspects to dependence. 1) Tolerance 2) Pre-occupation 3) Craving 4) Continuing when you know it's harmful Here you'd have people who'd continue the activity beyond the slight decrease in life expectancy because, as you quote, there's an element of compulsivity. All addiction is harmful misuse. Not all harmful misuse is addiction.

md224 10y ago
Your definition of dependence seems to assume there is harm involved, but I can think of a lot of dependencies that are either beneficial or neutral. Are you referring specifically to psychological dependence, as opposed to physical dependence?
- crawfordcomeaux 10y ago
  I think "dependence" as described above is a softer way to address addictions. I'm guessing people use it to avoid the stigma of addiction & because so many definitions of addiction (including the one in the DSM) only address drugs/alcohol. I think that's kind of what the article's looking to address is we need to broaden the definition of addiction. I don't think what he's saying is meant to be applicable to people who suffer from chronic pain from irreparable/incurable afflictions & so are physically dependent on drugs to alleviate their pain. I do think there's harm in prescribing drugs to alleviate chronic pain in sufferers whose pain was triggered by something long since treated & now persists as a learned pattern in their mind. Treating that condition with drugs instead of mental techniques to unlearn the pattern is like putting Neosporin on an open wound that won't heal shut without stitches.

duaneb 10y ago

I would not characterize breakup depression as withdrawal.

md224 10y ago
Okay, but why not?

matheusmoreira 10y ago

Recreational drugs affect the brain in a very different manner when compared to medication, which is designed to be safer. I have ADHD and have taken prescription amphetamines before. They're much safer drugs than a recreational stimulant. There are many reasons for this. The subjective "high" caused by a drug is determined by how fast the concentration of dopamine increases¹ in the brain. Each individual drug has a distinct mechanism of action, so they all increase dopamine concentration at different rates. The high is also linked to the route of administration of the drug; the fastest routes are intravenous administration and inhalation, followed by intranasal administration. Prescription stimulants are designed¹ to modulate neuronal circuits in a healthy manner. Recreational drugs do the opposite. They aim for a massive release of dopamine in the brain's mesolimbic reward system. All drugs that can lead to addiction have this effect. High concentrations of dopamine results in neuroadaptation² in those circuits. Their receptors are down-regulated so as to better tolerate the drug. Less receptors for the same concentration of neurotransmitter translates to a diminished response. This is why the first use of the drug provides the strongest stimulation. It also explains why addicts may continuously escalate the dose; they're attempting to get that same level of stimulation again. Neuroadaptation is also associated with withdrawal effects. After down-regulation occurs, the new amount of receptors is appropriate for higher concentrations of the neurotransmitter. After the drug wears off, concentrations are back to physiologic levels which are no longer adequate. The resulting neurotransmission deficiency results in withdrawal effects. The flow of information within the affected circuits has become dependent on the higher neurotransmitter levels³ caused by the drug. >How bad do the consequences have to be before a behavior becomes pathological? In the development of addiction, a dramatic change in behavior can be observed: addicts gradually shift from impulsive use of the drug for pleasure and reward to compulsive use in order to avoid the adverse effects associated with withdrawal. These impulsive-compulsive disorders are proposed¹ as the common neurobiological substrate of many disorders, not just addiction. They're also linked to OCD, gambling, obesity and others. ¹ Stahl's Essential Psychopharmacology. Chapter 12 and 14. http://imgur.com/a/LcgkT http://imgur.com/a/LcgkT ² https://www.ncbi.nlm.nih.gov/pubmed/18316420 https://www.ncbi.nlm.nih.gov/pubmed/18316420 ³ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036556/

grkvlt 10y ago

lujim 10y ago

> If someone suffers depression from opiate withdrawal, we call them an addict. If someone suffers depression from going through a breakup, it's just par for the course. And yet both scenarios are withdrawal from a pleasurable stimulus. Why is one acceptable and the other not? If someone doesn't get food or water and is deprived of sleep for a few days they will develop the symptoms of depression. Humans need food, water, sleep, and social connections to thrive. When one of those is temporarily thwarted, mental and physical pain is a signal to take action. It's not always pleasant, but it will keep you alive and your genes in the game. This is unavoidable and often useful pain. Recreational opiate use on the other hand is an extremely dangerous short circuit of the brains pleasure centers that very often results in physical dependance, legal problems, and death. Part of maturing is understanding that you don't always have to mask pain and chase pleasure. It's ok and even healthy to feel like shit sometimes.