Physical and Psychological Dependence

12 Key excerpts on "Physical and Psychological Dependence"

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  eBook - ePub

  Adult Psychological Problems

  An Introduction

  • Lorna Champion, Michael Power(Authors)
  • 2014(Publication Date)
  • Taylor & Francis

    (Publisher)

  Although media coverage often leads us to think of drug addiction as a modern-day phenomenon, excessive drug use has occurred at most periods in history and in most cultures. In Victorian England, for instance, not only was alcoholism rife in the inner-city slums, but opiates were used heavily in the form of laudanum, sold commercially for the relief of minor aches and pains. Prior to the 18th century, heavy drug use was usually considered a vice, and it was only towards the end of the 19th century that medical explanations conceptualising “inebriety” as a disease began to gain a significant foothold. These early medical models focused primarily on the phenomenon of physical dependence, identifying the onset of withdrawal symptoms as the main impediment to abstinence. This meant that substances such as alcohol and opiates, which have particularly florid withdrawal syndromes, became prototypical of addictive drugs, whereas others such as nicotine, which either do not induce physical dependence or where the withdrawal symptoms are very subtle, were for a long time not considered to be addictive at all. To quote Rolleston (1926), a highly influential authority on drugs at the time, “To regard tobacco as a drug of addiction is all very well in a humorous sense, but it is hardly accurate.”

  Increasingly, however, it has become recognised that people can develop psychological as well as physical dependence on drugs, experiencing a strong and apparently irresistible urge or “craving” for the substance in question even when they are not in the grip of withdrawal symptoms. Indeed, in 1964 the World Health Organisation (WHO, 1964) gave greater weight to the psychological than to the physical symptoms, defining drug dependence as follows:

  A state, psychic and sometimes also physical resulting from the interaction between a living organism and a drug, characterized by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present.

  There have been numerous hypotheses regarding the underlying causes of psychological dependence, with varying implications for treatment. On the one hand it has often been suggested that certain personality traits may be associated with proneness to addiction; as yet there is little convincing evidence that this is so. Other theories focus on particular drug effects that the individual experiences, and conceptualise psychological dependence as an inability to cope with the void that cessation of drug use would leave. Whereas psychoanalytic models may postulate that the drug serves crucial symbolic functions, cognitive-behavioural formulations emphasise very practical needs such as dealing with stress, or acceptance within a particular sub-culture. This theoretical framework will be discussed at greater length later.

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  Addiction Neuroethics

  The Promises and Perils of Neuroscience Research on Addiction

  • Adrian Carter, Wayne Hall(Authors)
  • 2011(Publication Date)
  • Cambridge University Press

    (Publisher)

  Psychological dependence encompasses the variety of psychological changes that drive drug use or makes one feel that they need to use drugs. It is sometimes seen as synonymous with addiction. As a result, the term ‘addiction’ was dropped from most diagnostic criteria and the term depend- ence used in its stead (e.g. Diagnostic and Statistical Manual for Mental Disorders, 3rd edition, revised (DSM-III-R)). This decision has recently been contested by some addiction researchers who propose that ‘addiction’ be reintroduced into the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-V) (O’Brien, et al., 2006). Addiction is also used to refer to the use of drugs in a way that repeatedly causes significant harms to the individual independently of symptoms of physical or psychological depend- ence. Therefore, some clinical diagnostic classifications refer instead to substance use disorder (American Psychiatric Association, 2000). Addiction is therefore a broad term used to describe a continuous disorder with varying degrees of severity and length of drug habit, patterns of drug use, degree of control over drug use, and amount of harm caused to self and others. We follow Courtwright (1982) in using ‘addiction’ to refer to a heterogeneous collection of patterns of problematic drug use that may or may not involve physical dependence and may cause varying levels of harm to the user and others. 20 Addiction Neuroethics 2.2.1. Folk understanding of addiction Folk or common-sense understanding of addiction can be surprisingly com- plex and may vary considerably according to the context in which it is understood and the type of persons involved. For example, an unsympathetic view is often held towards addicted persons from a lower socio-economic background whose addiction causes significant harm to others, particularly their children or dependents.

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  Drug Addiction & Rehabilitation

  • (Author)
  • 2014(Publication Date)
  • Learning Press

    (Publisher)

  The Expert Committee recommends substitution of the term drug dependence for the terms drug addiction and drug habituation. The committee did not clearly define dependence, but did go on to clarify that there was a distinction between physical and psychological (psychic) dependence. It said that drug abuse was a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis. Psychic dependence was defined as a state in which there is a feeling of satisfaction and psychic drive that requires periodic or continuous administration of the drug to produce pleasure or to avoid discomfort and all drugs were said to be capable of producing this state: There is scarcely any agent which can be taken into the body to which some individuals will not get a reaction satisfactory or pleasurable to them, persuading them to continue its use even to the point of abuse – that is, to excessive or persistent use beyond medical need. The 1957 and 1964 definitions of addiction, dependence and abuse persist to the present day in medical literature. It should be noted that at this time (2006) the Diagnostic Statistical Manual (DSM-IV-TR) now spells out specific criteria for defining abuse and dependence. (DSM-IV-TR) uses the term substance dependence instead of addiction ; a maladaptive pattern of substance abuse, leading to clinically significant impairment or distress, as manifested by three (or more) specified criteria, occurring at any time in the same 12-month period. This definition is also applicable on drugs with smaller or nonexistent physical signs of withdrawal, e.g., cannabis.

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  Drug Addiction, Rehabilitation and Policies

  • (Author)
  • 2014(Publication Date)
  • College Publishing House

    (Publisher)

  The Expert Committee recommends substitution of the term drug dependence for the terms drug addiction and drug habituation. The committee did not clearly define dependence, but did go on to clarify that there was a distinction between physical and psychological (psychic) dependence. It said that drug abuse was a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis. Psychic dependence was defined as a state in which there is a feeling of satisfaction and psychic drive that requires periodic or continuous administration of the drug to produce pleasure or to avoid discomfort and all drugs were said to be capable of producing this state: There is scarcely any agent which can be taken into the body to which some individuals will not get a reaction satisfactory or pleasurable to them, persuading them to continue its use even to the point of abuse – that is, to excessive or persistent use beyond medical need. The 1957 and 1964 definitions of addiction, dependence and abuse persist to the present day in medical literature. It should be noted that at this time (2006) the Diagnostic Statistical Manual (DSM-IV-TR) now spells out specific criteria for defining abuse and dependence. (DSM-IV-TR) uses the term substance dependence instead of addiction; a maladaptive pattern of substance abuse, leading to clinically significant impairment or distress, as manifested by three (or more) specified criteria, occurring at any time in the same 12-month period. This definition is also applicable on drugs with smaller or nonexistent physical signs of withdrawal, e.g., cannabis.

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  Drugs of Abuse and Addiction

  Neurobehavioral Toxicology

  • Raymond Niesink, R.M.A. Jaspers, L.M.W. Kornet, J.M. van Ree, Raymond Niesink, R.M.A. Jaspers, L.M.W. Kornet, J.M. van Ree(Authors)
  • 1998(Publication Date)
  • CRC Press

    (Publisher)

  This definition combined what would later be thought of as Physical and Psychological Dependence. Only in the late 1970s did the concept of alcohol related problems emerge. This was a reminder of the earlier period of public health association with drug and alcohol use and indeed in the 1980s following the HIV epidemic drug and alcohol policies have again entered the public health domain. Definitions of dependence have been formulated using criteria which facilitate experimental research. Emphasis is given to the observable behavior of the substance user and how it is learned, modified, and reinforced. An example is the definition of substance use used by Pomerleau and Pomerleau35. They define addiction as repeated use of a substance and/ or a compelling involvement in a behavior that directly and indirectly modifies the internal mi-lieu in such a way that produces immediate reinforcement but with harmful long term effects. This definition incorporates both the pharmacological and social learning factors. Dependence implies that there is a degree of neuroadaptation which in the absence of drug consumption will result in receptor readaptation; this gives rise to a physical withdrawal in the case of opiates but not so with stimulants. Sociologists have also contributed to the debate on alcohol and drug use. Consumption may be considered deviant if it exceeds the established norm of 12 Chapter 1 Aspects of drug use and drug dependence the community. Other sociological perspectives would argue that dependence symptoms such as loss of control are social constructions that facilitate the categorization and management of such individuals in a more humane way' 1 • Psychiatry as a whole has gone through a revolution in the past 3 decades. The antipsychiatry movement of the 1960s and 1970s highlighted the dearth of empiricism in the classification of mental illness.

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  Psychology for Nurses and Health Professionals

  • Richard Gross, Nancy Kinnison(Authors)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  Brian has tried to stop drinking but said he’s now given up ‘giving up’. Physiological versus psychological dependence As Box 12.2 shows, physiological dependence is related to withdrawal and/or tolerance (which relates to the traditional concept of addiction ), while psy-chological dependence is not. However, being deprived of a substance that is highly pleasurable can induce anxiety. Since the symptoms of anxiety (rapid pulse, profuse sweating, shaking, and so on) overlap with withdrawal symp-toms, people may mistakenly believe that they are physiologically dependent. Psychological dependence is, though, part of the overall dependence syndrome (see Figure 12.2). Whether Brian’s ‘shakes’ are the result of psychological or physiological dependence they must be equally distressing. Figure 12.1 George Best, gifted footballer and famous alcoholic. Classifying drugs 281 A good example of the difference between the two types of dependence is imipramine, used to treat depression. When it is stopped after prolonged use, there may be nausea, muscle aches, anxiety and difficulty in sleep-ing, but there was never a compulsion to resume taking it (Lowe, 1995). However, Lowe claims that ‘psychological’ dependence has little scientific meaning beyond the notion that drug taking becomes part of one’s habitual behaviour. Giving it up is very difficult, because the person has become habituated to it: Habituation is the repeated use of a drug because the user finds that use increases pleasurable feelings or reduces feelings of anxiety, fear or stress. Habituation becomes problematic when the person becomes so consumed by the need for the drug-altered state of consciousness that all his or her energies are directed to compulsive drug-seeking behaviour … (Lowe, 1995). Physiologically addictive drugs, such as heroin and alcohol, typically cause habituation as well .

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  Handbook of Substance Abuse

  • (Author)
  • 2014(Publication Date)
  • Library Press

    (Publisher)

  In 1964, a new WHO committee found these definitions to be inadequate, and suggested using the blanket term drug dependence: The definition of addiction gained some acceptance, but confusion in the use of the terms addiction and habituation and misuse of the former continued. Further, the list of drugs abused increased in number and diversity. These difficulties have become increasingly apparent and various attempts have been made to find a term that could be applied to drug abuse generally. The component in common appears to be dependence, whether psychic or physical or both. Hence, use of the term drug dependence, with a modifying phase linking it to a particular drug type in order to differentiate one class of drugs from another, had been given most careful consideration. The Expert Committee recommends substitution of the term drug dependence for the terms drug addiction and drug habituation. The committee did not clearly define dependence, but did go on to clarify that there was a distinction between physical and psychological (psychic) dependence. It said that drug abuse was a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis. Psychic dependence was defined as a state in which there is a feeling of satisfaction and psychic drive that requires periodic or continuous administration of the drug to produce pleasure or to avoid discomfort and all drugs were said to be capable of producing this state: There is scarcely any agent which can be taken into the body to which some individuals will not get a reaction satisfactory or pleasurable to them, persuading them to continue its ________________________ WORLD TECHNOLOGIES ________________________ use even to the point of abuse – that is, to excessive or persistent use beyond medical need. The 1957 and 1964 definitions of addiction, dependence and abuse persist to the present day in medical literature.

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  The SAGE Handbook of Drug & Alcohol Studies

  Social Science Approaches

  • Torsten Kolind, Betsy Thom, Geoffrey Hunt, Torsten Kolind, Betsy Thom, Geoffrey Hunt, Author(Authors)
  • 2016(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  4 Psychological Explanations of Addiction

  Robert Hill and Jennifer Harris

  Introduction

  Terms such as ‘addiction’, ‘dependence’ and ‘excessive appetites’ are used to describe an individual’s overwhelming, intense desire to engage in a particular behaviour, despite the negative consequences of doing so. Addiction is typically thought of as relating to psychoactive substances but encompasses other behaviours that can become compulsive such as eating, gambling, sexual activity, exercising and shopping. While these behaviours are thought to share similar psychological processes, psychoactive substances exert an additional unique neurobiological impact on the brain, psyche and body. With repeated use, the body and mind can adapt to the substance so that, if prevented from taking the substance, they can enter a withdrawal state. This triggers the urge to use in order to gain relief and regain equilibrium. Tolerance develops so that the individual experiences the need for increasingly frequent doses of the substance to maintain biological, neurological and psychological homeostasis. Alongside the typical cycle of craving, substance-seeking and use, relief and withdrawal, there is a concomitant narrowing of interests, social contact and lifestyle in order to focus on the substance. It may seem perplexing that the behaviour continues despite the dwindling positive effects of substance use over time, together with the considerable negative impact on physical and mental health, social, financial and legal aspects of life. Moreover, substance dependence has historically been viewed in terms of a chronic relapsing condition with periods of remission and relapse. The two major psychiatric diagnostic systems, the World Health Organisation's International Classification of Mental and Behavioural Disorders (ICD-10; WHO, 1992) and the American Diagnostic and Statistical Manual of Mental Disorders, Version 5 (DSM-5; APA, 2014), clearly describe the above physiological, behavioural, cognitive and social features of excessive and dependent substance use.

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  Substance Abuse as Symptom

  A Psychoanalytic Critique of Treatment Approaches and the Cultural Beliefs That Sustain Them

  • Louis S. Berger(Author)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Thus, dependence or addiction encompasses a comprehensive range of subjects: bodily changes (“adjustments”), physical withdrawal symptoms and mechanisms, inferences about pain and discomfort, psychological phenomena including craving and emotional and mental preoccupation with subjective effects of an external agent. Criticizing the received view, then, is a massive undertaking. Fortunately, one author has devoted an entire book to just such a criticism (Peele, 1985). I will list the topics he addresses and add a few supplementary comments.

  One class of criticisms concerns the difficulties entailed in the very concept of addiction or dependence (I will not follow the strict distinction proposed by Cox et al.), difficulties that arise especially when one assumes that it is legitimate to separate dependence into physical and psychological components:

  The concepts of psychological dependence and pharmacological dependence represent distinctions made for purposes of convenience to describe states that vary from situation to situation and within individuals. In some circumstances, psychological and pharmacological dependence seem to be highly correlated; under other conditions, one or the other may predominate. Glib delineations of different “kinds” of addicts are at best premature and at worst erroneous. (Pomerleau & Pomerleau, 1988, pp. 119-120)

  Peele (1988) introduces a basic but subtle critical epistemological point when he calls attention to the observational basis of these distinctions. He points out that what certain pharmacologists and other researchers

  are clinging to by retaining the category of physical dependence is the idea that there is a purely physiological process associated with specific drugs that will describe the behavior that results from their use. It is as though they were saying: “Yes, we understand that what has been referred to as addiction is a complex syndrome into which more enters than just the effects of a given drug. What we want to isolate, however, is the addiction-like state that stems from these drug effects if we could somehow remove extraneous psychological and social considerations.” This is impossible because what are being identified as pharmacological characteristics exist only in the drug user’s sensations and interactions with his environment. Dependence is, after all, a characteristic of people and not of drugs. (Peele, 1985, p. 23)

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  Therapist's Guide to Substance Abuse Intervention

  • Sharon L. Johnson(Author)
  • 2003(Publication Date)
  • Academic Press

    (Publisher)

  physical health (e.g., alcohol: withdrawal, liver damage, gastritis, pancreatitis, heart problems, anemia, neurological disorders) b. psychological functioning (cognitive impairment, mood changes with associated behavioral changes) c. interpersonal functioning (relationship problems, social problems, child abuse–neglect) d. occupational functioning (school–job problems) e. legal problems (DUI, bad checks, ignoring responsibilities) f. financial problems g. spiritual problems 7. Denial of the significance of all of the aforementioned events and issues. 8. Losses. CAUSAL FACTORS OF SUBSTANCE ABUSE AND DEPENDENCE Another way of viewing the development of abuse and dependence is to consider the causal factors that contribute to an individual’s abuse of substances and the pattern of substance abuse (Crabbe et al ., 1985; Mc Carthy, 1985; Washton, 1995). 1. Availability of substances: Substances being readily accessible is a necessary condition for substance abuse; however, it is not a factor, in and of itself, that results in an individual using substances. 2. Onset of action: Substances that act quickly to mask symptoms and alter mood are more prone to abuse. Additionally, the benefit being sought by using a specific substance plays a role in the choice of the substance used. 3. Biological predisposition: There appears to be some genetic predisposition to alcoholism. There may be numerous biological factors involved in the development of substance dependence. 4. Childhood experiences and environment: Learning theory states that behaviors are handed down from one generation to another. The issue of “identification” may be at work when children unconsciously adopt behaviors or learn through modeling the various characteristics of their caretakers and other role models while growing up. Other factors playing a role under the rubric of experiences would be neglect and various forms of abuse and the impact on coping, etc.

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  Drug Abuse in the Modern World

  A Perspective for the Eighties

  • Gabriel G. Nahas, Henry Clay Frick, Gabriel G. Nahas, Henry Clay Frick(Authors)
  • 2013(Publication Date)
  • Pergamon

    (Publisher)

  1. mood alteration (sedation, euphoria, stimulation) (primary reason of intake) 2. neuropsychotoxicity (adverse effects on awareness^sensory perception, psychomotor performance) impairment of information processing 3. induction of reinforcement k. tolerance 5. withdrawal symptoms 6. increased evidence of mental illness after prolonged use In addition, these drugs may have physical effects. 1. lethal overdose 2. increased incidence of somatic illness CONCLUSION The simplified concepts of psychic and physical dependence do not account for the effects of addictive drugs (or dependence producing drugs) which all act as primary reinforcers, inducing a compulsive pattern of use. We have, therefore, proposed to classify addictive drugs on the basis of their effects on the endogenous reinforcement system of the brain, These effects are mediated through the alteration of brain neurotransmitters and structural functions of limbic system and cerebral cortex. Drugs of abuse produce profound alterations in brain homeostasis: they disrupt the many biochemical regulations and feed back controls which are essential for the proper processing and integration of the signals constantly reaching t he b ra i n ce 1 1 s. A better knowledge of the mechanism of action of these drugs on brain processes, has already helped the scientist to understand some of the neurochemical regula-tions which underly normal thinking and behavior. Speaking of brain homeostasis, I am reminded of Claude Bernard's conclusion of his fundamental physiologic observations, La constance du milieu intérieur est la condition de la vie libre, The constancy of the internal environment is the very condition for a free life. It is evident that addictive drugs impairs this constancy. (32) REFERENCES 1. Heath, R. G. Definition of the septal region in Studies in Schizophrenia Harvard University Press, Cambridge, 195^ 2. Levine, P. P. Pharmacology-Drug actions and reactions Little Brown δ Co., Boston, 1573 ~~~ ~ 3.

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  Co-Dependency

  Issues in Treatment and Recovery

  • Bruce Carruth, Warner Mendenhall(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  Co-dependence: Our Most Common Addiction – Some Physical, Mental, Emotional and Spiritual Perspectives Charles L. Whitfield, MD  

  Co-dependence is a disease of lost selfhood. I define it as any suffering and/or dysfunction that is associated with or results from focusing on the needs and behavior of others . Co-dependents become so focused upon or pre-occupied with important and even less important people in their lives that they neglect their true self–who they really are. As Schaef21 says, it leads to a process of “nonliving,” which is progressive.

  I list below seven recent definitions of co-dependence and synthesize what these have in common in my overall definition above.

  SOME DEFINITIONS OF CO-DEPENDENCE

  (1) … an exaggerated dependent pattern of learned behaviors, beliefs and feelings that make life painful. It is a dependence on people and things outside the self, along with neglect of the self to the point of having little self identity.

  (Smalley, S: cited in Wegscheider-Cruse, 1985)

  (2) … preoccupation and extreme dependence (emotionally, socially, and sometimes physically) on a person or object. Eventually, this dependence on another person becomes a pathological condition that affects the co-dependent in all other relationships. This may include … all persons who (1) are in a love or marriage relationship with an alcoholic; (2) have one or more alcoholic parents or grandparents; or (3) grew up in an emotionally repressive family…. It is a primary disease and a disease within every member of an alcoholic family.

  (Wegscheider-Cruse, 1985)

  (3)… ill health, maladaptive or problematic behavior that is associated with living with, working with or otherwise being close to a person with alcoholism (other chemical dependence or other chronic impairment). It affects not only individuals, but families, communities, businesses, and other institutions, and even whole societies.

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