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What is Addiction?

Another problem word

'Addiction' is a word which is often used as a pejorative.  An addict is portrayed as someone outside the mainstream of society who, as a result, harms the wider society as well as himself.

This approach leads to the term addiction being applied in circumstances where none exists as well as people denying addiction to something such as tobacco because they don't believe they fit the stereotype of the addict often found in the media.

There are those who say the word 'addict' should be avoided because it fails to convey a useful concept. But, I believe, there is still a purpose in using the word 'addiction' even though it is difficult to fully

So what is addiction?

It is trying to be too specific about what addiction is that leads to problems. I think it is fair to say that for addiction to exist there are two requirements; the user must develop tolerance and withdrawal must produce physical symptoms.

Developing tolerance means that, over time, the effects of the same dose of the substance reduce leading the addict to increase the amount used often reaching dosages which would be fatal to a first time user.

An example of the establishment of tolerance is found in a biography of Thomas Edison. In Edison, His Life and Inventions by Frank Lewis Dyer and Thomas Commerford Martin, published in 1910, the authors provide a substantial extract from Edison’s own notes about a strange visitor to the Menlo Park, New Jersey, workshops where Edison conducted most of his work. "At Menlo Park one cold winter night there came into the laboratory a strange man in a most pitiful condition…..He said he was suffering very much, and asked if I had any morphine….. so I got the morphine sulphate. He poured out enough to kill two men….. He said he had taken it for years, and it required a big dose to have any effect. I let him go ahead. In a short while he seemed like another man and began to tell stories…… [H]e finished every combination of morphine with an acid that I had…..Then he asked if he could have strychnine. I had an ounce of the sulphate. He took enough to kill a horse, and asserted it had as good an effect as morphine. When this was gone, the only thing I had left was a chunk of crude opium…………He chewed this up and disappeared."

Some people believe there is a third indication of addiction which is the craving meaning an addict must have a fix and will do whatever is necessary to obtain one. In truth, this is really a manifestation of the onset of withdrawal. The beginnings of the physical affects of withdrawal produce a drive to avoid those affects by obtaining further supplies.

And what isn't addiction?

There is a condition which does not meet the definition of addiction but is often lumped in with it and that is dependency. Cannabis users are often described as addicts but cannabis is not addictive. It is possible, however, to become dependent on it. If someone enjoys, say, cheddar cheese they may reach the point where their day feels incomplete if they have not had any but that does not make them addicted to cheddar cheese.

The essential difference between addiction and dependence is that in the first the substance controls the subject but dependency reverses the relationship. The United Nations Office on Drugs and Crime (UNODC) has said that many dependent users of cannabis regulate their use so that it does not interfere with their work. If you've ever worked with an alcoholic you will know that the same can not be said for someone who is addicted to alcohol.

Addiction is also not a disease that can be managed but never fully cured. Though you wouldn't know it from portrayals in fiction, alcoholics can end their drinking without resorting to the mumbo-jumbo of a 12-step programme and it is absolutely untrue to say that former alcoholics cannot have even one drink without completely relapsing. A simple comparison between prevalence by age and access to treatment for the full range of psychoactive shows that most users, even those using on an almost daily basis, discontinue their use without any assistance and without relapsing.

Where's the harm?

The tendency is to believe that all addictions are harmful but that is not necessarily the case. True, addiction to tobacco is killing five million people a year but addiction to caffeine, which affects many millions of tea and coffee drinkers without them ever being aware of it, is hard to describe as 'harmful'.

There are even, some, heroin addicts who, because their personal circumstances mean that their acquisition and use of the substance does not expose them to crime or the same level of health risks as others, lead what appear to outsiders to be normal lives.

So, if our use of the word 'addiction' is flawed and even acknowledged addictive substances are not universally problematic then basing our attitude towards the psychoactive substances on the substances themselves is flawed.

There are, at last, the beginnings of a move to look at these substances from the perspective of the actual harm they cause and ways in which that harm can be minimised.

The rest of the 'Phantastica' section of The Poison Garden website is organised on the basis of looking at harms on an increasing scale.