Problems of Defining Addiction, by Harvard Researcher....

Discussion in 'Fibromyalgia Main Forum' started by coyote, Feb 3, 2003.

  1. coyote

    coyote New Member

    Conceptual Confusion About the Definition of Addiction:

    Absent a clear definition of addiction, researchers will continue finding it very difficult to determine addiction prevalence rates, etiology, or the necessary and sufficient causes that stimulate recovery. Absent a working definition of addiction, clinicians will encounter diagnostic and treatment matching difficulties (e.g., Havens, 1982; Marlatt, 1988; Shaffer, 1987, 1992; Shaffer & Robbins, 1995). Satisfactory treatment outcome measures will remain elusive. Without a functional definition of addiction, social policy makers will find it difficult to establish regulatory legislation, determine treatment need, establish health care systems, and promulgate new guidelines for health care reimbursement.

    Scientists and treatment providers are not the only ones with a problem when the meaning of addiction is fuzzy. The average citizen will find that, without a clear definition of addiction, the distinctions among an array of human characteristics (e.g., interest, dedication, attention to detail, craving, obsession, compulsion and addiction) will remain blurred. Finally, the contemporary conceptual chaos surrounding addiction must be resolved to clarify the similarities and differences—if these exist—between process or activity addictions (e.g., pathological gambling, excessive sexual behavior) and psychoactive substance using addictions (e.g., heroin or alcohol) (Shaffer, 1997).
    Howard J. Shaffer, Ph.D.,C.A.S.

    I don't know what is best for anyone else, but I think there is a lot to think about.



    [This Message was Edited on 02/03/2003]
  2. Mikie

    Mikie Moderator

    People who need pain meds for chronic pain are not addicts. Anyone seeking drugs who doesn't need them is an addict, especially when that person will continue to take more and more meds and exhibit drug seeking behavior in order to obtain drugs.

    I believe that we all have addictions; it's just a matter of identifying where our addictions lie. Mine is nicotine; I can never, ever use tobacco again. It is also easy for me to use chocolate to escape life's problems. I have given it up.

    To me, being healthy is worth more than all the cigarettes and chocolate in the world. And yes, even after 20 years without a cigarette, I still get an urge to smoke from time to time.

    Love, Mikie
  3. coyote

    coyote New Member

    Madwolf,
    The article I quote was written after the WHO's definition.
    As I said before, I don't agree with your definition of addiction.
    The article I presented does not equate addiction with dependence.
    Nor do I.
    Many pain patients do end up as addicts.
    If you are treating alchoholics and they are using prescription pain killers, then their addiction is being exacerbated. Alcoholics metabolize these substances differently than others. It's not something that one can be "cured" of by agreeing to use drugs in a prescribed manner. As you said, "Addicts are born".
    I am not angry about not being able to use opiods. I am glad that I am in a position that I don't have to. I get angry when people talk down to me. There is plenty of room for different ideas, even at the top. There is no one correct, workable definition of addiction. As the author mentioned, it is an elusive thing. I assume that you keep current on the theories and treatment of addiction. I assume that you know also that denial is at the core of any addiction. Although you may keep current, you are not ain the field of addictions treatment. It might help to consult with someone in that field from time to time.

    I will repeat I NEVER SUGGESTED THAT ANYONE GO OFF THEIR MEDS. I ONLY SAID THAT IF PEOPLE ARE CONCERNED ABOUT ADDICTION, THAT THEY SHOULD TALK WITH THEIR PHYSICIAN ABOUT IT. I THINK THAT IS REASONABLE.

    Denizen,
    I make no criticism of anyone in the original post that I made. I am not saying that anyone shouldn't take the meds that they and their doctor have agreed on. I said only that people should talk with their doctors if they have questions.

    Good luck, I wish you only the best.

    Mikie,
    A generalization such as people who pain meds to treat their pain are not addicts cannot be made.
    Just recently there was a post here from a woman who posted her doctor's name and he was inundated with people looking for "certain" drugs.
    Some people (Liz Tayor) may not know they are "born addicts" when they begin treatment for pain.

    I have to wonder why my original post created such a defensive reaction from people here. Why is it such a sensitive issue? I wouldn't wish addiction on anyone.

    [This Message was Edited on 02/03/2003]
  4. layinglow

    layinglow New Member

    Here is a group of three that certainly have the credentials, and have formulated a clear definition. They include those involved in the treatment of pain, and those in the treatment addiction medication.

    The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine recognize the following definitions and recommend their use.

    Addiction
    Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

    Physical Dependence
    Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

    Tolerance
    Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

    I have added to your other post coyote--explaining that it is not defensiveness you are meeting. It is the hope that no one whether a previous substance abuser, or someone who is instilled with fear, due to an outdated myth, regarding chronic pain treatment, will ever have to live life unmedicated when they could get relief, and improved function, because they are afflicted with a lifelong, disabling illness. There are some whose days are unrelenting.

    Best wishes, LL



    [This Message was Edited on 02/03/2003]
  5. Mikie

    Mikie Moderator

    Just the fact that someone asks for pain meds for chronic pain doesn't, in itself, mean someone is an addict.

    An addict can be a person who has chronic pain.

    I am not defending pain meds. Everyone here knows that I recommend finding alternative ways to relive pain once one is getting pain meds. When one finally gets some relief from the pain, one is free to try the Guai treatment, physical therapy, Yoga, Tai Chi, or whatever will help with pain. I believe the goal should be to, at some point, be able to discontinue using pain meds. Some will be able to do this and some will not. I still believe that should be the goal.

    I agree that if anyone has concerns about addiction, she or he should feel free to discuss this conern with the doc. Unfortunately, many docs are not well informed in this area and may well decide not to prescribe for a patient who describes herself or himself as an addict.

    Love, Mikie
  6. loonie

    loonie New Member

    Hi, Coyote;
    For my two cents worth, I would like to say that the two paragraphs you quoted from Schaffer, are nothing more than a statement that the definition of addiction needs to be standardized in the medical field.

    The varied reactions you received were indicative of that pressing need, since both yourself and others were using their definition of the word addiction, making my case in point as to the value of the a medical wide definition of addiction.

    I, IMHO, tend to lean towards the WHO's definition as told by Madwolf. It seems reasonable to assume that a person who uses "drugs" for pain relief and one who uses them for so-called "recreational use" are worlds apart. Those lines can be blurred, but I would feel that to be a matter between patient and caregiver to work over.

    My family background easily uncovers hereditary and perhaps environmental "causes" in drugs used for "pleasure-seeking". My family was broken up when I was three yrears old because my mother could not put up with my father's functional alcoholism. Due to indescretions on her part I was given into the care of my relatives and came to my father and stepmother when I was six years old. I subsequently had three siblings from my father and three from my mother. My father's children all had (and have) substance abuse problems, my mother's children did not- and neither do I. So, I believe highly in the hereditary problems of "addiction", though the environmental factor could also be considered.

    One other thing. You made this statement-"Mikie,
    A generalization such as people who pain meds to treat their pain are not addicts cannot be made." Really don't understand your point here. At this point in time, I use on
    only a muscle relaxer to relieve my lumbar pain at night, as relieving it during the day could lead to overstressing my back and possibly losing the use of my legs. But if it comes to the point to where I cannot work anymore (can only do part time now) then I will consider using "drugs" to ease the pain so I can function. I hardly think this would put me over into your generalization that if one takes drugs for pain one is an addict. The generalization can be made if one states that one can overuse the pain meds in an effort to remain pain free, but once again that is a line that has to be drawn by patient and caregiver.

    Please understand that I enjoy discussing things and have no desire to try to "knock" anyone's conceptions of whatever subject comes up that I wish to "put my 2 cents worth"in on. Just like to bring a different point of view. As has been said so many times before by so many, we are all in "the same boat"-just kinda figure each one has a different colored or shaped oar, but we're all pulling together.

    Sunny Days to all, Loonie >^..^< (editd wrong-way whisker)


    [This Message was Edited on 02/04/2003]
  7. coyote

    coyote New Member

    I can't disagree with anything that anyone said here.
    Maybe we agree on more than it first appeared.