addiction, drug or alcohol Repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means. Typically, tolerance is prominent and a withdrawal syndrome frequently occurs when substance use is interrupted. The life of the addict may be dominated by substance use to the virtual exclusion of all other activities and responsibilities. The term addiction also conveys the sense that such substance use has a detrimental effect on society, as well as on the individual; when applied to the use of alcohol, it is equivalent to alcoholism. Addiction is a term of long-standing and variable usage. It is regarded by many as a discrete disease entity, a debilitating disorder rooted in the pharmacological effects of the drug, which is remorselessly progressive. From the 1920s to the 1960s attempts were made to differentiate between addiction ; and "habituation", a less severe form of psychological adaptation. In the 1960s the World Health Organization recommended that both terms be abandoned in favour of dependence, which can exist in various degrees of severity. Addiction is not a diagnostic term in ICD-10, but continues to be very widely employed by professionals and the general public alike. See also: dependence; dependence syndrome
Approximately 90% of the patients treated in my office are addicts, and the other 10% are opiate-dependent. The opiate-dependent patients are most likely to find pain relief by means of one or more of the following during detox: rest, physical therapy, non-opiate pain management, non-invasive procedures, or surgery. Opiate-dependent patients have a comparatively easy time getting off opiates at my office, except those patients who are on chronic Suboxone maintenance for pain management. Opiate addicts, on the other hand, encounter more difficulty because they must now take responsibility for their disease of addiction, and this involves a person first admitting that they do have a problem and are willing to make permanent changes in their lives after the detox is complete. The common analogy that is often proposed is that Suboxone is to an addict as insulin is to a diabetic. This analogy is a great sales pitch for Suboxone, but it is not valid. We need to separate facts from myths. If a type 1 diabetic does not take insulin he will die. If an addict stops taking Suboxone after making a number of changes to his emotional and spiritual outlook and attitude and has a recovery program in place, then he has a good chance of being extremely healthy, happy, and productive. If an addict stops taking Suboxone and does not follow a recovery program, then there are only four likely outcomes: resuming opiate addiction, life behind bars, a ruined life, or death.
Mortality-related factors and 1-year survival in nursing home residents
While the alcoholic's dopamine high is drunk and the heroin addict's numb, the nicotine addict's dopamine high is alert. But if this amazing chemical truly is a gateway to diminished impulse control, anger, depression and destruction of brain gray matter, the full societal cost of not treating alert dopamine intoxication on a drug treatment par with other flavors of dopamine intoxication boggles the imagination.
Ensure that the appropriate tools are available to collect, monitor and evaluate data about key populations.