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| |    Drug Abuse, Dependence, and Addiction by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Drugs are so much a part of the culture that it is easy to become confused about what might be acceptable use and what is abuse. This article offers some definitions to help you think more clearly about the whole issue of drug use and addiction. Abuse and dependence The line between drug use and drug abuse depends on the substance. Many adults drink alcohol responsibly. If the drinking begins to get out of control--drinking to the point of drunkenness, for example, or to the point of social embarrassment--the use becomes an alcohol problem, or abuse. For drugs that are clearly dangerous and illegal, any use is abuse. Tolerance to the effect of a drug means that it takes a larger dose to get the same intoxicating effect. Someone who can drink a six-pack without becoming obviously drunk has built up a tolerance for alcohol. Unfortunately, the negative physical effects (obesity, liver damage, a hangover, and so on) increase with the increasing dose--people do not become tolerant to these effects. With some drugs (MDMA, or Ecstasy, for example), tolerance is almost immediate, in the sense that most people never recapture the feeling of the original "high," even though they use greater and greater doses. Drug dependence means that a person needs to experience the high of a drug in order to feel OK. Physical dependence comes about through changes in the brain as a result of repeated drug use. Some people are able to use a drug for a long time without becoming dependent. But physical dependence can occur very quickly in people whose genetic constitution makes them especially susceptible to a particular drug. People who are drug dependent usually feel terrible when the drug wears off (withdrawal symptoms). They experience cravings for the drug, and often become obsessed with getting more of it. There is a psychological side to dependence as well. With chronic drug use, a person's whole social life and self-image begin to revolve around the drug. They find it impossible to imagine living drug-free. Any child who is dependent on drugs or alcohol is in great danger and needs to receive drug treatment. Addiction Addiction means compulsive use of a substance even though it is severely harmful. The harm can be physical, financial, social, affecting the user or her family. People who are addicted are not in control of their drug abuse, even though they may want to think that they are. Rather, the addiction controls them. Doctors talk about addiction as being a chronic, progressive, relapsing disease. Chronic means that is continues over time. Progressive means that it gets worse and worse. Relapsing means that addicted people often quit ("go into remission," in doctor parlance) but then start up again. In other words, stopping use of the drug is a part of addiction. The addicted person resolves to quit and actually stops for a while, but then relapses. With each relapse, the person loses hope and becomes more locked into the drug. The harms caused by the drug accumulate, as the person loses money, job, friends, family, and health. At some point, with luck, the addicted person decides that he has "reached the bottom" before he is utterly destroyed. Then recovery can begin. Recovery Recovery means more than just stopping the drug. It also means finding new values, new friends, and a new lifestyle to replace the drug-centered existence that the person had been living. Very few people, if any, are able to recover from addiction on their own; those who think they can usually relapse. Help can come from family, professionals (psychiatrists and addiction specialists), peer counselors, clergy, and organizations of former addicts, such as Alcoholics Anonymous (commonly referred to as AA) and Narcotics Anonymous. For more useful information check out our Tobacco, Family Relationships, and School Problems programs. Click here to join the discussion on Drugs, Alcohol, and Tobacco.
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