Is there a difference between physical dependence and addiction?
Yes. According to the DSM, the clinical criteria for “drug dependence” (or what we refer to as addiction) include compulsive drug use despite harmful consequences; inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs—including even appropriate, medically instructed use. Thus,physical dependence in and of itself does not constitute addiction, but often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, where the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.
Can a person become addicted to psychotherapeutics that are prescribed by a doctor?
While this scenario occurs infrequently, it is possible. Because some psychotherapeutics have a risk of addiction associated with them (e.g., stimulants to treat ADHD, benzodiazepines to treat anxiety or sleep disorders, and opioids to treat pain), it is important for patients to follow their physician’s instructions faithfully and for physicians to monitor their patients carefully. To minimize these risks, a physician (or other prescribing health provider) should be aware of a patient’s prior or current substance abuse problems, as well as their family history with regard to addiction. This will help determine risk and need for monitoring.
How do other mental disorders coexisting with drug addiction affect drug addiction treatment?
Drug addiction is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness; and rates are similar for users of licit drugs—i.e., tobacco and alcohol. For these individuals, one condition becomes more difficult to treat successfully as an additional condition is intertwined. Thus, patients entering treatment either for a substance use disorder or for another mental disorder should be assessed for the co-occurrence of the other condition. Research indicates that treating both (or multiple) illnesses simultaneously in an integrated fashion is generally the best treatment approach for these patients.
Is the use of medications like methadone and buprenorphine simply replacing one drug addiction with another?
No—as used in maintenance treatment, buprenorphine and methadone are not heroin/opioid substitutes. They are prescribed or administered under monitored, controlled conditions and are safe and effective for treating opioid addiction when used as directed. They are administered orally or sublingually (i.e., under the tongue) in specified doses, and their pharmacological effects differ from those of heroin and other abused opioids.
Heroin, for example, is often injected, snorted, or smoked, causing an almost immediate “rush,” or brief period of euphoria, that wears off quickly and ends in a “crash.” The individual then experiences an intense craving to use again so as to stop the crash and reinstate the euphoria.
The cycle of euphoria, crash, and craving—sometimes repeated several times a day—is a hallmark of addiction and results in severe behavioral disruption. These characteristics result from heroin’s rapid onset and short duration of action in the brain.
In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain; as a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids. If an individual treated with these medications tries to take an opioid such as heroin, the euphoric effects are usually dampened or suppressed. Patients undergoing maintenance treatment do not experience the physiological or behavioral abnormalities from rapid fluctuations in drug levels associated with heroin use. Maintenance treatments save lives—they help to stabilize individuals, allowing treatment of their medical, psychological, and other problems so they can contribute effectively as members of families and of society.
Where do 12-step or self-help programs fit into drug addiction treatment?
Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model. Most drug addiction treatment programs encourage patients to participate in self-help group therapy during and after formal treatment. These groups can be particularly helpful during recovery, offering an added layer of community-level social support to help people achieve and maintain abstinence and other healthy lifestyle behaviors over the course of a lifetime.
Can exercise play a role in the treatment process?
Yes—exercise is increasingly becoming a component of many treatment programs and has shown efficacy, in combination with cognitive-behavioral therapy, for promoting smoking cessation. Exercise may exert beneficial effects by addressing psychosocial and physiological needs that nicotine replacement alone does not; attenuating negative affect; reducing stress; and helping prevent weight gain following cessation. Research is currently under way to determine if and how exercise programs can play a similar role in the treatment of other forms of drug abuse.
How does drug addiction treatment help reduce the spread of HIV/ AIDS, hepatitis C (HCV), and other infectious diseases?
Drug-abusing individuals, including injecting and non-injecting drug users, are at increased risk of HIV, HCV, and other infectious diseases. These diseases are transmitted by sharing contaminated drug injection equipment and by engaging in risky sexual behavior sometimes associated with drug use. Effective drug abuse treatment is HIV/HCV prevention because it reduces associated risk behaviors as well as drug abuse. Counseling that targets a range of HIV/HCV risk behaviors provides an added level of disease prevention.
Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment because the latter reduce activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity. Participation in treatment also presents opportunities for screening, counseling, and referral to additional services, including early HIV treatment and access to HAART. In fact, HIV counseling and testing are key aspects of superior drug abuse treatment programs and should be offered to all individuals entering treatment. Greater availability of inexpensive and unobtrusive rapid HIV tests should increase access to these important aspects of HIV prevention and treatment.