| The entire concept of addiction has suffered greatly | | | | along which one slides back and forth over time, |
| from a misconception on the part of most people. | | | | moving from user to addict, then back to occasional |
| The confusion comes about in part because of a | | | | user, then back to addict. Extensive research studies |
| distinction between whether specific drugs are | | | | support the view that, once addicted, the individual |
| "physically" or "psychologically" addicting. Historically | | | | has moved into a different state of being. Very few |
| the distinction revolved around whether or not | | | | people appear able to successfully return to |
| physical withdrawal symptoms occur when an | | | | occasional use after having been truly |
| individual discontinues using a drug; what we in the | | | | addicted.Unfortunately, we do not yet have a clear |
| field now call "physical dependence". However, years | | | | biological or behavioral marker of that transition from |
| of research has demonstrated to us that focusing on | | | | voluntary drug use to addiction. However, evidence is |
| this physical versus psychological distinction is a | | | | rapidly developing that point to an array of cellular |
| distraction from the real issues at hand.Strictly from a | | | | and molecular changes in specific brain circuits. |
| clinical perspective, it actually does not matter very | | | | Moreover, many of these brain changes are common |
| much what physical withdrawal symptoms occur. | | | | to all chemical addictions and some also are typical of |
| Physical dependence is not that important, because | | | | other compulsive behaviors such as compulsive |
| even the dramatic withdrawal symptoms of heroin | | | | overeating.The complexity of this brain disease is not |
| and alcohol addiction can now be easily managed with | | | | atypical, because virtually no brain diseases are simply |
| appropriate medications. Even more important, many | | | | biological in nature. All, including stroke, Alzheimer's |
| of the most dangerous and addicting drugs, including | | | | disease, schizophrenia, and clinical depression, include |
| methamphetamine and crack cocaine, do not produce | | | | some behavioral and social aspects. What may make |
| very severe physical dependence symptoms upon | | | | drug addiction seem unique among brain diseases, is |
| withdrawal. What really matters most is whether or | | | | that it does begin with a clearly voluntary behavior - |
| not a drug causes what we now know to be | | | | the initial decision to use drugs or drink alcohol. |
| addiction. More specifically, the compulsive craving and | | | | Moreover, not everyone who ever uses drugs goes |
| use, despite all of the negative consequences.This is | | | | on to become addicted. Individuals differ substantially |
| the crux of how the Institute of Medicine, the | | | | in how easily and quickly they become addicted and |
| American Psychiatric Association, and the American | | | | in their preferences for particular substances. |
| Medical Association define addiction and how we all | | | | Consistent with the bio-behavioral nature of addiction, |
| should use the term. It is really only this compulsive | | | | these individual differences result from a combination |
| quality of addiction that matters in the long run to | | | | of environmental and biological, particularly genetic, |
| the addict and to his or her family. Thus, the majority | | | | factors. In fact, estimates are that between 50 and |
| of the biomedical community now considers addiction, | | | | 70 percent of the variability to becoming addicted |
| in its essence, to be a brain disease - a condition | | | | can be accounted for by genetic factors. Although |
| caused by persistent changes in brain structure and | | | | genetic characteristics may predispose individuals to |
| function. The changes in brain function results in | | | | be more or less susceptible to becoming addicted, |
| compulsive craving that overwhelms all other | | | | genes do not doom one to become an addict. Over |
| motivations and is the root cause of the massive | | | | time the addict loses substantial control over his or |
| health and social problems associated with drug | | | | her initially voluntary behavior, and it becomes |
| addiction. A definition of drug addiction that is | | | | compulsive. For many people these behaviors are |
| commonly referred to is "a brain disease expressed in | | | | truly uncontrollable, just like the behavioral expression |
| the form of compulsive behavior". It is important to | | | | of any other brain disease. Schizophrenics cannot |
| correct the common misimpression that drug use, | | | | control their hallucinations and delusions. |
| abuse and addiction are points on a single continuum | | | | |