Free The Anatomy of Addiction by MD Akikur Mohammad Page B

compulsively use even though it may not make them feel good.
    It is important to appreciate that addiction is not solely—and mostly isn’t—a function of choice. Addiction is not a desired condition. Remember what Joanne told us earlier in the chapter? She wanted to stop. She was aware that she should stop. She had every incentive to stop for the sake of her family and her career. But she could not stop—at least not until she was successfully treated. Simply put, people may choose to get high or drunk but no one chooses to be a junkie or an alcoholic.
    Abuse vs. Addiction
    The terms abuse and addiction have been defined and redefined over the years. The 1957 World Health Organization Expert Committee on Addiction-Producing Drugs defined addiction as:
    A state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical dependence on the effects of the drug; and (iv) detrimental effects on the individual and on society.
    In 1964, a new World Health Organization (WHO) committee found this definition to be inadequate and suggested using the blanket term
drug dependence
instead of drug addiction.
    In 2001, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine jointly issued the following definition:
    Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
    Their definition, went on to say, physical dependence
    is a state of being that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Tolerance is the body’s physical adaptation to a drug: greater amounts of the drug are required over time to achieve the initial effect as the body . . . adapts to the intake.
    The
Diagnostic and Statistical Manual of Mental Disorders
doesn’t use the word
addiction
at all. Instead it has a section about substance dependence:
    When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse, are considered Substance Use Disorders.
    The National Institute on Drug Abuse suggests the following definition:
    Addiction is a complex but treatable condition. It is characterized by compulsive drug craving, seeking, and use that persist even in the face of severe adverseconsequences. For most people, addiction becomes chronic, with relapses possible even after long periods of abstinence. As a chronic, recurring illness, addiction may require continued treatments to increase the intervals between relapses and diminish their intensity. Through treatment tailored to individual needs, people with drug addiction can recover and lead fulfilling lives.
    In 2011, the American Society of Addiction Medicine (ASAM) released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling, or sex. (The ASAM provides the public and medical professionals with valuable information, guidance, and research on addiction.) This was the first time the ASAM took an official position that addiction is not solely related to problematic substance use. Here is a