6 criteria of addiction according to Goodman (1990)
Addiction is characterized by:
Over time, the regular drug user needs to increase their dose to enjoy the same effects. In this case, we are dealing with tolerance to the product. This increase in consumption raises the risk of harming their health.
For a long time, tolerance has been considered as a purely physiological phenomenon, a consequence of the body's adaptation to a regularly absorbed product, that is, a way for the body to increase the need for more of the product to achieve the desired effects.
It is now known that tolerance also constitutes a psycho-pharmacological reality (related to the effects exerted by substances on the psyche).
Occasionally, and for some products (e.g., marijuana), a reverse tolerance is observed. In this case, we are dealing with a situation in which the reaction to the same amount of substance appears faster, or more intensely, after repeated use.
We speak of cross-tolerance, when tolerance to one substance generalizes to others, the action of which is similar, for example, between anxiolytics and alcohol.
Dependence is defined as a state resulting from the periodic or continuous absorption of a drug. Depending on the nature of the consumed drug (medication, tobacco, alcohol, cannabis, heroin), the condition of the subject, and their tolerance towards the product, dependence can be psychological or physical.
Dependence is the ensemble of behavioral phenomena, cognitive (knowledge) phenomena, and physiological phenomena that result from the repeated consumption of a psychoactive substance, typically accompanied by:
The term drug abuse increasingly refers to consulting and controlling impulses, so it is more related to behaviors, rather than products, or in the absence of the product as in the case of pathological gambling. The term dependence, primarily, is related to the products, the notion of tolerance (the need to increase doses to obtain a constant effect) and "withdrawal" (symptoms in the case of the immediate cessation of consumption).
Drugs that cause dependence are called toxicomanogenic drugs.
Physical dependence “translates” to organic disturbances as soon as the drug is stopped being consumed: it is the state of absence, characterized by vomiting, by cramps (spasm), by great anxiety, etc.
Physical dependence appears with the withdrawal syndrome, which follows as a consequence. It results in an adaptation of the organism with a psychotropic in such a way that stopping consumption brings about psychological and physiological reactions.
The intensity of the symptoms varies according to the substances, the individual, and the consumption habits. The medical, thus neurobiological, explanation of this phenomenon talks about the time required by the organism to restore balance, as a result of the malfunctioning of some neurons (generally 7 to 10 days).
Psychological dependence "translates" to the need to consume drugs that alter mental activity. Dependence provokes a fixed and tyrannical desire to rush back to the product.
Psychological dependence is evidenced in a fixation character process that leads the consumer to the state of feeling good or better adapted to reality. It is a conditional, therefore destructive, adaptation mechanism. This dependence is based more on the characteristics of the individual (habits, affective state, lifestyle) than on the substance itself.
Psychological dependence is often defined by the English word “CRAVING” which translates to “extreme desire to consume and to feel the effects of the product”.
We call withdrawal syndrome the set of symptoms provoked by the immediate cessation of the consumption of a psychotropic substance. This symptom varies in form and intensity not only according to the substances and doses consumed, but also according to the subject and the socio-cultural context in which they are found (prison, hospital, home).
We talk about "withdrawal" when cessation or when reduction of consumption of a substance (alcohol, amphetamine, cocaine, nicotine, opiates, sedative, hypnotic or anxiolytic) brings an unadapted behavioral modification with physiological repercussions (e.g., an increase in blood pressure, an increase in respiratory rate, an increase in pulse, and an increase in body temperature) and with cognitive reactions. Most withdrawal symptoms are the opposite of those observed in the case of intoxication with the same substance.
The longer the duration of the substance's action, the greater the duration before the appearance of withdrawal symptoms and the longer the "withdrawal" can last. It is also noted that if the person consumes many substances, the interaction would complicate the "withdrawal". The most intense withdrawal symptoms usually subside a few days to a few weeks after stopping consumption. Other symptoms may last for several weeks or even months. A primary mental disorder may occur (unrelated to medication) if the symptoms persist.
The immediate cessation of the consumption of some psychotropics that are regularly consumed can be very dangerous, even deadly. Therefore, withdrawal from anxiolytics or from hypnotics should be done under the advice and supervision of a qualified person.
Social norms influence the acceptable standards regarding drug abuse. What makes a person abuse or become addicted to drugs to the point of losing their job, family, home?
Substance use disorders are related to a variety of factors:
However, it cannot be determined which of these factors is decisive.
A powerful factor thought to influence is the person's inability to cope with (or to find relief from) the emotional or physical pain they may have. Without inner strength and support for managing stress, loneliness, or depression, drugs can become the only way to cope with the situation. Unfortunately, due to the changes drugs cause in the brain, usually, trying them just once is enough to then create dependency on them.
Some other factors that increase the risk for drug abuse or dependency are:
Family history of dependency. Although the relationship between heredity and environment is still not very clear, if there is a family history of dependency, the risk of drug abuse and dependency increases.
History of mental illness. Abuse and dependency on drugs can worsen or even create new symptoms in the presence of mental illness.
Untreated physical pain. Pain relief medications, including heroin, quickly create dependency.
Pressure from others. If people around use drugs, it will be more difficult to resist the pressure to try them, especially at a young age.
Although different drugs have different effects on physical or mental health, the basic model is the same. The acquisition and use of drugs become increasingly more important than anything else in life. The physical and emotional consequences of drug abuse and addiction make functioning difficult, damaging judgment to a dangerous level.
Physical symptoms of drug abuse and addictionDrug use has a direct impact on the body and brain. Stimulants, like cocaine for example, speed up all body processes, reducing the ability to sleep. While drugs, like opiates, slow down the body's activity, slowing down breathing or blood pressure sometimes even to dangerous levels. Some physical symptoms of drug addiction include:
Cycles of increased energy, lack of fatigue, and inability to sleep;
Abnormal slowing of movement, speaking, reaction time, confusion, and disorientation (especially noticed with opiates, benzodiazepines, and barbiturates);
Cycles of excessive sleep;
Rapid weight loss or gain;
Sudden change in the way of dressing, such as the continuous wearing of long-sleeved shirts to cover injection marks;
For drugs that are snorted, chronic problems with sinusitis or nosebleeds;
For drugs that are smoked, continuous cough or bronchitis, accompanied by phlegm or blood;
Various progressive problems with teeth (especially from the use of methamphetamines). Etc.
Behavioral symptoms of drug abuse and addiction
The following behaviors are the most common, which are usually used to determine whether a person has a physical addiction to drugs.
Regular intoxication;
Lying about the extent of drug use;
Withdrawal from activities that were previously enjoyed, such as sports or hanging out with friends;
Frequent conversations about drug use;
Believing that they need to use drugs in order to feel good;
Problems with state authorities because of drugs;
Risky behavior, such as driving or engaging in unprotected sexual activities while under the influence of drugs;
Absences, problems, or exclusions from work due to drug use;
Depression;
Lack of hope;
Mental and emotional symptoms of drug abuse and addiction
Abuse and addiction also affect the mood, as they are used precisely because of the short-lived pleasure effect they provide. These effects vary with different drugs. Some mental and emotional symptoms include:
Unusually talkative, happy, and endlessly energetic cycles;
Anger, irritability, and increased agitation;
Calmness, non-responsiveness, or a confused look;
Apathy and depression;
Paranoia, delusions;
Temporary psychosis, hallucinations;
Low threshold for engaging in violent behavior.
| SUBSTANCE | PSYCHIC DEPENDENCE | PHYSICAL DEPENDENCE |
|---|---|---|
| Phencyclidine ketamine | Moderate | Weak |
| Morphine, heroin | Strong and fast in the case of intravenous use or when smoked | Very strong |
| Methadone | Less strong | Strong |
| Cannabis, tetrahydrocannabinol | Moderate, fast if smoked | Moderate |
| LSD, mescaline, psilocybin | Weak | Weak |
| Cocaine, crack | Strong and fast (especially with intravenous route and crack) | Weak |
| Amphetamine, ecstasy | Strong, less fast (except intravenous route) | Weak |
| Nicotine | Weak, fast if smoked | Weak |
| Caffeine | Weak, slow | Weak |
| Alcohol | Moderate, slow | Moderate |
| Benzodiazepines | Weak, slow | Moderate |
| Barbiturates | Weak, slow | Significant |
| Class | Substance | Withdrawal Syndrome |
|---|---|---|
| Dissociative anesthetics | Phencyclidine, ketamine | Anxiety, dysphoria |
| Analgesics | Morphine, heroin, methadone | Moderate to severe: anxiety, dysphoria, sleep disturbances, muscle cramps, diarrhea, tremors, spasms |
| Methadone | Less severe due to slower elimination | |
| Cannabinoids | Cannabis, tetrahydrocannabinol | Moderate: anxiety, dysphoria, sleep disturbances |
| Hallucinogens | LSD, mescaline, psilocybin | Rare (infrequent use - little or no physical dependence) |
| Stimulants | Cocaine and crack | Primarily psychological signs, severe depression, dysphoria, sleep and appetite disturbances |
| Amphetamines and ecstasy | As for cocaine | |
| Nicotine | Primarily physical signs, irritation, distress, depression, lack of appetite | |
| Caffeine | Primarily physical signs, irritation, depression, fatigue, headache | |
| Depressants | Alcohol | Severe: distress, depression, dysphoria, sleep disturbances, tremors and spasms, confusion, hallucinations |
| Benzodiazepines | Moderate and variable: severe anxiety, dysphoria, sleep disturbances, feelings of unreality, tremors and spasms, hallucinations | |
| Barbiturates | Severe: anxiety, dysphoria, sleep disturbances, tremors and spasms |
| Class of substance | Substance | Compensation |
|---|---|---|
| Dissociative anesthetics | Phencyclidine, ketamine | Relaxation, amnesia, perception disorders |
| Analgesics | Morphine, heroin, methadone | Euphoria, relaxation, analgesia |
| Cannabinoids | Cannabis, tetrahydrocannabinol | Euphoria, relaxation, perception disorders |
| Hallucinogens | LSD, mescaline, psilocybin | Perception disorders |
| Stimulants | Cocaine | Euphoria, stimulation |
| Amphetamines and ecstasy | Euphoria, stimulation, perception disorders | |
| Nicotine | Euphoria, concentration, relaxation | |
| Caffeine | Wakefulness, concentration | |
| Depressants | Alcohol | Euphoria, relaxation, amnesia |
| Benzodiazepines | Anxiety reduction | |
| Barbiturates | Calmness |