Definitions of Addiction

Patterns of Addiction (If you NEED HELP WITH YOUR OR A LOVED ONE's ADDICTION, please CALL toll-free (872) 666-9868 - compassionate people are waiting for your call right now ! )

Different drugs produce different patterns of addiction, with an emphasis on different components of the addiction cycle. Opioids are a classic drug of addiction, in which an evolving pattern of use includes intravenous or smoked drug taking, intense initial intoxication, the development of profound tolerance, escalation in intake, and profound dysphoria, physical discomfort, and somatic withdrawal signs during abstinence (Box 1.1). Intense preoccupation with obtaining opioids (craving) develops and often precedes the somatic signs of withdrawal. This preoccupation is linked to stimuli associated with obtaining the drug, stimuli associated with withdrawal, and internal and external states of stress. A pattern develops in which the drug must be administered to avoid the severe dysphoria and discomfort of abstinence.

Alcohol substance use disorder or alcoholism follows a somewhat different pattern of drug taking that depends on the severity of the disorder. The initial intoxication is less intense than opioids, and the pattern of drug taking often is characterized by binges of alcohol intake that can be daily episodes or prolonged days of heavy drinking. A binge is currently defined by the US National Institute on Alcohol Abuse and Alcoholism as consuming five standard drinks for males and four standard drinks for females in a two hour period, or obtaining a blood alcohol level of 0.08 gram percent. Alcoholism is characterized by a severe emotional and somatic withdrawal syndrome and intense craving for the drug that is often driven by negative emotional states but also by positive emotional states. Many individuals with alcoholism continue with such a binge/withdrawal pattern for extended periods; for others, the pattern evolves into opioid-like addiction, in which they must have alcohol available at all times to avoid the consequences of abstinence.

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BOX 1.1

Jimmy pulls out of the graveled driveway onto the smooth asphalt surface of the road. It feels so good to drive again after the long months in “rehab.” No heroin use in over 6 months. ‘‘Not bad,” he congratulates himself. But as he takes the exit to the old neighborhood, his bowels begin to growl. He breaks out in sweat, gripping the steering wheel and trying to ignore the raw, acid taste in the back of his throat. Yawning, eyes watering, he feels mounting panic, and the desire for drugs begins to burn in the pit of his stomach, “So much for good intentions,” be mutters, turning toward a familiar alley and the drug that will make everything right again.

Dennis leaves his cocaine therapy group full of energy. “I’ve got 30 days clean, and now I’m going for 90!” he yells to a buddy as they enter their cars. As he leaves the parking lot, a familiar white sedan is pulling in – Diana’s car; she probably is going to the next group session. Dennis’ heart begins to pound – gripped by a flood of memories about the car, where he and Diana had shared so much cocaine. A wave of intense feeling rushes from the tip of his toes, up to his head and back down again. Thoughts racing, desire coursing through his body, he turns away from the road home, into the night. As he approaches the familiar buying corner, he can taste the cocaine in the back of his throat. He is sweating heavily now, ears ringing. “Just a taste,” he bargains with himself, “just a taste is all I’m going to buy.”

From: Childress AR, Hole AV, Ehrman RN, Robbins SJ, McLellan AT, O’Brien CP, Cue reactivity and cue reactivity interventions in drug dependence. In: Onken LS, Blaine JD, Boren JJ (Eds.), Behavioral Treatments for Drug Abuse and Dependence (series title: NIDA Research Monograph, vol. 137), National Institute on Drug Abuse, Rockville MD, 1993, pp. 73–95.

Tobacco addiction contrasts with the above patterns. Tobacco is associated with virtually no binge-like behavior in the binge/intoxication stage of the addiction cycle. Cigarette smokers who met the criteria for substance dependence or dependence under the DSM-IV and ICD 10 criteria are likely to smoke throughout their waking hours and experience negative emotional states (dysphoria, irritability, and intense craving) during abstinence. The pattern of intake is one of highly titrated intake of the drug during waking hours.

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Psychostimulants, such as cocaine and amphetamines, show a pattern that has a greater emphasis on the binge/intoxication stage. Such binges can last hours or days, often followed by a crash that is characterized by extreme dysphoria and inactivity. Intense craving and anxiety occur later and are driven by both environmental cues that signify the availability of the drug, and internal states that are often linked to negative emotional states and stress.

Marijuana substance use disorder follows a pattern similar to opioids and tobacco, with a significant intoxication stage. As chronic use continues, subjects begin to show a pattern of chronic intoxication during waking hours. Withdrawal is characterized by dysphoria, irritability, and sleep disturbances. Although marijuana craving has been less studied to date, it is most likely linked to both cues and internal states often associated with negative emotional states and stress, similarly to other drugs of abuse.

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