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Decades ago addiction was a pharmacologic term that clearly referred to the use of a tolerance-inducing drug in sufficient quantity as to cause tolerancethe requirement that greater dosages of a given drug be used to produce an identical effect as time passesWith that definitionhumansand indeed all mammalscan become addicted to various drugs quicklyAlmost at the same timea lay definition of addiction developedThis definition referred to individuals who continued to use a given drug despite their own best interestThis latter definition is now thought of as a disease state by the medical communityPhysical dependenceabuse ofand withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental DisordersDSM-IV TRUnfortunatelyterminology has become quite complicated in the fieldTo witpharmacologists continue to speak of addiction from a physiologic standpointsome call this a physical dependencepsychiatrists refer to the disease state as dependencemost other physicians refer to the disease as addictionThe field of psychiatry is now consideringas they move from DSM-IV to DSM-Vtransitioning fromdependencetoaddictionas terminology for the disease stateThe medical community now makes a careful theoretical distinction between physical dependencecharacterized by symptoms of withdrawaland psychological dependenceor simply addictionAddiction is now narrowly defined asuncontrolledcompulsive useif there is no harm being suffered byor damage done tothe patient or another partythen clinically it may be considered compulsivebut to the definition of some it is not categorized asaddictionIn practicethe two kinds of addiction are not always easy to distinguishAddictions often have both physical and psychological componentsThere is also a lesser known situation called pseudo-addictionA patient will exhibit drug-seeking behavior reminiscent of psychological addictionbut they tend to have genuine pain or other symptoms that have been undertreatedUnlike true psychological addictionthese behaviors tend to stop when the pain is adequately treatedThe obsolete term physical addiction is deprecatedbecause of its connotationsIn modern pain management with opioids physical dependence is nearly universalWhile opiates are essential in the treatment of acute painthe benefit of this class of medication in chronic pain is not well provenClearlythere are those who would not function well without opiate treatmenton the other handmany states are noting significant increases in non-intentional deaths related to opiate useHigh-qualitylong-term studies are needed to better delineate the risks and benefits of chronic opiate useNot all doctors agree on what addiction or dependency isbecause traditionallyaddiction has been defined as being possible only to a psychoactive substancefor example alcoholtobacco and other drugswhich ingested cross the blood-brain barrieraltering the natural chemical behavior of the brain temporarilyMany peopleboth psychology professionals and laypersonsnow feel that there should be accommodation made to include psychological dependency on such things as gamblingfoodsexpornographycomputersworkexercisecuttingand shoppingspendingHoweverthese are things or tasks whichwhen used or performedcannot cross the blood-brain barrier and hencedo not fit into the traditional view of addictionSymptoms mimicking withdrawal may occur with abatement of such behaviorshoweverit is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addictionbut rather of a behavioral disorderIn spite of traditionalist protests and warnings that overextension of definitions may cause the wrong treatment to be usedthus failing the person with the behavioral problempopular mediaand some members of the fielddo represent the aforementioned behavioral examples as addictionsIn the contemporary viewthe trend is to acknowledge the possibility that the hypothalmus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicalsalcoholnicotine etcwhen addictive activities take placecitation neededFor examplewhen an addicted gambler or shopper is satisfying their cravingchemicals called endorphins are produced and released within the brainreinforcing the individual’s positive associations with their behaviorDespite the popularity of defining addiction in medical termsrecently many have proposed defining addiction in terms of Economicssuch as calculating the elasticity of addictive goods and determiningto what extentpresent income and consumptioneconomicshas on future consumptionVaried forms of addiction Physical dependency Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance or behavior is suddenly discontinuedWhile opioidsbenzodiazepinesbarbituratesalcohol and nicotine are all well known for their ability to induce physical dependenceother categories of substances share this property and are not considered addictivecortisonebeta-blockers and most antidepressants are examplesSowhile physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addictionthe initial primary attribute of an addictive substance is usually its ability to induce pleasurealthough with continued use the goal is not so much to induce pleasure as it is to relieve the anxiety caused by the absence of a given addictive substancecausing it to become used compulsivelyA notable exception to this is nicotineUsers report that a cigarette can be pleasurablebut there is a medical consensuscitation neededthat the user is likely fulfilling his/her physical addiction andthereforeis achieving pleasurable feelings relative to his/her previous state of physical withdrawalFurtherthe physical dependency of the nicotine addict on the substance itself becomes an overwhelming factor in the continuation of most usersaddictionsAlthough 35 million smokers make an attempt to quit every yearfewer than 7achieve even one year of abstinencefrom the NIDA research report on nicotine addictioncitation neededSome substances induce physical dependence or physiological tolerancebut not addictionfor example many laxativeswhich are not psychoactivenasal decongestantswhich can cause rebound congestion if used for more than a few days in a rowand some antidepressantsmost notably venlafaxineparoxetine and sertralineas they have quite short half-livesso stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressantsMany non-addictive prescription drugs should not be suddenly stoppedso a doctor should be consulted before abruptly discontinuing themThe speed with which a given individual becomes addicted to various substances varies with the substancethe frequency of usethe means of ingestionthe intensity of pleasure or euphoriaand the individual’s genetic and psychological susceptibilitySome alcoholics report they exhibited alcoholic tendencies from the moment of first intoxicationwhile most people can drink socially without ever becoming addictedStudies have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of peoplealthough this may be due to a variety of other factorsas opioid use heavily stimulates pleasure-inducing neurotransmitters in the brainThe vast majority of medical professionals and scientists agree that if one uses strong opioids on a regular basis for even just a short period of timeone will most likely become physically dependentcitation neededNonethelessbecause of these variationsin addition to the adoption and twin studies that have been well replicatedmuch of the medical community is satisfied that addiction is in part genetically moderatedThat isone’s genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routineEating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this articleEating disorderswhich some argue are not addictions at allare driven by a multitude of factorsmost of which are highly different than the factors behind addictions described in this article.

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