Talk:Substance dependence

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Add to Page[edit]

Substance dependence and Substance are a clearly defined in the DSM IV however, addiction is not a term commonly used within the framework of diagnoising an individual nor in measuring the severity of an individuals condition. Addiction could be charactorized by either of these sub catergories. Substance dependence or Substance abuse. While there is disagreement on which of these catorgoies is addiction, it is widely excepted in the recovery community that either may describe an "ADDICT" Habit, dependence, and addiction, are three very real things, that can occur simultaneously, but indeed they are different. Lumping them together merely muddies the perception of each of the conditions. The World Health Organization started this foolish endeavor, to make the term 'addiction' meet what the layman's term meant. The short story, we lost real medical definition, so we could have talk shows about people being 'addicted' to anything they wished to produce. There is *dire* need for the distinction between them. And, the public needs made aware of this.

75.33.52.79 (talk)

"Addict" is more of a term for those whom are addicted, or those who crave a drug, and will seek drugs, (drug seeking behavior), when they do not have any more to take, the same as any other addictive disease, and they could be said to have an addictive personality. However, some whom are on medications to stop long term chronic pain, etc, do not crave the drug, even while having withdrawal symptoms if the drug is stopped, and only take the drug to feel normal, and live without constant pain. There should always be a difference shown, even though there are still some hard-line physicians whom say everyone are addicts, when that is not so, as pain specialists/rehab physicians say differently. In other words, one can be substance dependent, (including the long term use of steroids), and not be an addict, but still need to be weaned off a medication if it is no longer needed. Ref: American Pain Foundation, American Chronic Pain Association, and The National Pain Foundation.Craxd (talk) 20:25, 28 January 2013 (UTC)

Citations[edit]

Several theories of drug addiction exist, some of the main ones are genetic predisposition, the self medication theory, and factors involved with social/economic development.

Epidemiological studies estimate that genetic factors account for 40-60% of the risk factors for alcoholism. Similar rates of heritability for other types of drug addiction have been indicated by other studies (Kendler, 1994). Knestler hypothesized in 1964 that a gene or group of genes might contribute to predisposition to addiction in several ways. For example, altered levels of a normal protein due to environmental factors could then change the structure or functioning of specific brain circuits during development. These altered brain circuits could change the susceptibility of an individual to an initial drug use experience. In support of this hypothesis, animal studies have shown that environmental factors such as stress can affect an animal's genotype (Knestler, 1996). The self-medication hypotheses espoused by both psychoanalysts and biological researchers, predicts that certain individuals abuse drugs in an attempt to self-medicate their unique and seemingly intolerable states of mind (Khantzian, 1985). The self medication theory has a long history. Freud in 1884, first raised this concept in noting the anti-depressing properties of cocaine. Stress has long been recognized as a major contributor for drug cravings and relapse and is therefore supportive of the self-medication theory. In line with this theory, a person's use of a particular drug of choice is not an accident, but rather it is chosen for its pharmacological affect in relieving stressful symptoms or unwanted feelings. Research has shown that people who survive disasters are prone to stress related disorders such as Post Trauma Stress Disorder (PTSD) and depression. People who experience major trauma in their life experiences may self-medicate with drugs or alcohol to relieve the symptoms of PTSD and depression (Vlahov, 2002).jnewguy

Kendler, K.S., et al., (1994). A twin family study of alcoholism in women. In: Am J. Psychiatry 151, (pp707-715).

Khantzian, E.J. (1985). The Self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. In: Am. L. Psychiatry 142: (pp. 1259-1264).

Knestler, E.J., Berhow, M.T. & Brodkin, E.S. (1996). Molecular mechanisms of drug addiction: adaptations in signal transduction pathways. In: Mol. Psychiatry 1, (pp. 190-199).

Vlahov, D., et al. (2002). Increased use of cigarettes, alcohol, and marijuana among Manhattan,

New York, residents after the September 11 terrorist attacks. American Journal of

Epidemiology 155(11): 988-996, (2002).

Is the editor posting these citations suggesting we add them? the text was copypasted so would have to be rewritten to avoid copyright violation, i believe.66.80.6.163 (talk) 16:46, 16 February 2011 (UTC)

Remove Nils Bejerot/Public Health[edit]

There is no reason to have such a long discussion of the theories of Nils Bejerot (he was influential in his time within Sweden, but not much elsewhere, and his theories are not well-regarded today). All this information is already on the Nils Bejerot page, and Bejerot is already mentioned earlier on the Substance dependence page. As the entire "Public Health" section is currently entirely about Bejerot, I propose to remove the entire Public Health section. Likiva (talk) 09:10, 29 April 2010 (UTC)

Bejerots have been portrayed as a propagandist giving the Swedish police munition in its lobbying campaigns for harsher drug policies (see "Zero Tolerance Wins the Argument?" by Lenke and Olsson in "European drug policies and enforcement" for an example) and it is a shame that he is quoted as an authority on wikipedia. I concur with the previous speaker. Remove the section. Steinberger (talk) 19:33, 29 April 2010 (UTC)
I brought the issue up in August last year. I think those opposed to removal have had ample opportunity to come up with a reason. Deleted. --GSchjetne (talk) 01:46, 12 July 2010 (UTC)

"List of countries by drugs consumption"[edit]

Should be created a list of countries by drugs consumption.--Nekrox (talk) 09:23, 11 January 2011 (UTC)

what's this rubbish!!!!!!!!!!! —Preceding unsigned comment added by 203.176.151.253 (talk) 08:14, 21 January 2011 (UTC)

References[edit]

what is with the long chinese character Digital object identifier? does that need to be visible?(mercurywoodrose)66.80.6.163 (talk) 16:49, 16 February 2011 (UTC)

Substance addictiveness chart[edit]

I believe that this chart is highly suspect. For Tobacco, it has 2.3, 2.6, and 3.0 as pleasure, psychological addictiveness, and physiological addictiveness respectively, but then the mean for those three is listed as 2.23! I went and looked at the source, and found that the physiological addictiveness for tobacco is cited as a mere 1.8! This seems to imply that people smoke for the pleasure, not because it's a habit they can't kick, which has been my impression from personal experience. I just wanted to point this out, as it seems to throw the validity of the whole study under question(Other studies I've seen rank nicotine as being almost as physiologically addictive(or more) as heroin). — Preceding unsigned comment added by 68.212.245.182 (talk) 16:26, 5 June 2011 (UTC)

I agree. It is also strange that they say Cannabis and LSD are physically addictive. They ascribe low numbers, suggesting that they cause minimal physiological dependence, but I have never heard of one person who is physically addicted to LSD or cannabis. I doubt it is even possible. What does it mean to say that LSD is a .3 on the scale if it doesnt happen at all. — Preceding unsigned comment added by 71.204.24.212 (talk) 15:59, 14 June 2012 (UTC)

It is incorrect to say that LSD and cannabis and not associated with physiological dependence. Physiological dependence is defined by the presence of tolerance and/or withdrawal. Both tolerance and withdrawal have been documented with cannabis dependent individuals. Tolerance also rapidly develops with LSD; however, there is not a withdrawal syndrome for LSD. — Preceding unsigned comment added by Kelseybananas (talkcontribs) 16:16, 19 July 2013 (UTC)

A common class of drugs that has been left out of this list is the steroids group. Corticosteroids like prednisolone, (Prednisone), taken for a week can cause withdrawal symptoms if stopped abruptly. There are several groups of steroids, and about all can cause severe reactions if suddenly stopped after they have been administered for a while, thus the patient must be weaned from the drug. There is no difference from these withdrawal symptoms than there are with narcotics, except that the symptoms may differ.Craxd (talk) 20:51, 28 January 2013 (UTC)

‘Substance’ use[edit]

The article’s use of ‘substance’ strikes me as bizarre
Does it represent denial that ethanol and nicotine are drugs?
Or generally muddled thinking about drugs by supposed authorities?
Or am I substance dependent, within the meaning intended by the article, because air and water are substances?
Laurel Bush (talk) 15:31, 16 August 2011 (UTC)

drug use make people think indepentenly and makes them what you say ' clam '.
'Substance' is the medical term. Paint thinner is a substance, but one would hardly consider it a drug. -Highspam (talk) 19:09, 8 February 2012 (UTC)
What evidence is there, that medical professionals use terms like substance abuse or substance dependence instead of drug abuse and drug addiction? If that is really how the speak and write, we should include some information about word usage. If not, we should move the article (back?) to Drug addiction. --Uncle Ed (talk) 15:23, 2 April 2013 (UTC)

Lead[edit]

I just added the "lead" clean-up template. Seems to me that the lead needs to be rewritten in the "Substance dependence is" format rather than just diving in to the DSMMD's non-use of the term "addiction". Unfortunately, I am a complete layman in this area, so cannot do it myself. – ukexpat (talk) 15:13, 17 August 2011 (UTC)

WP:NOADS[edit]

Esctacy/MDMA as sever addiction potential>[edit]

It seems there is some bias in the addictive potential section, with the opening paragraph stating that MDMA has can result in severe addiction but it the table below, it is claimed to be less addictive than the famously non-addictive cannabis. — Preceding unsigned comment added by 129.12.237.254 (talk) 19:48, 11 May 2013 (UTC)

Work of Carl Hart[edit]

I smell the work of carl hart has been greatly under emphasized when it comes to the evidence for chemical dependency. — Preceding unsigned comment added by Xyn1 (talkcontribs) 23:18, 7 November 2013 (UTC)


If you link the relevant research reviews that include the research you're talking about, those reviews satisfy MEDRS, and the content isn't WP:FRINGE, then it will probably be added. If it fails one or more of those policies, it may only be added to a limited extent, or not at all. Seppi333 (talk) 23:30, 7 November 2013 (UTC)

I've removed this along with a lot of other non-medical sources. Seppi333 (Insert ) 13:09, 9 January 2014 (UTC)

"Defining terms" section[edit]

I came here via this WP:MED notification with regard to this article. Looking in the edit history of this article, I saw this removal; in my opinion, most of that material should be in this article, but should be summarized better and should go in the History section...per Wikipedia:MEDMOS#Sections. The current matter on definitions with regard to this topic, however, should have a Definitions section...which is done for other medical articles where the definition aspect is needed to better understand the subject. Flyer22 (talk) 06:00, 11 January 2014 (UTC)

I agree that it'd be useful to have a definition section; most of the content in that section was on past definitions, which would be more suitable for a history section. That's really the only reason I cut a lot of it out. Seppi333 (Insert ) 06:25, 11 January 2014 (UTC)
Edit: There was 1 paragraph stating a definition given by a single researcher that needed to come out though. Seppi333 (Insert ) 06:28, 11 January 2014 (UTC)

There appear to be a bunch of circular references of terms that do no not have the same meaning. Tolerance, dependance and addiction are not the same thing. Tolerance is strictly pharmacological. Dependance can be both pharmacological and psychological. Addiction is behavior. Cancer patients on fentanyl patches will become opioid tolerant. They may experience anxiety and withdrawal if not medicated correctly ibluding the treatment of both chronic and breakthrough pain. They are not, however, "addicted." Addiction is continuing an often uncontrollable destructive behavior despite adverse affects. Lumping addiction in with dependance is medically inaccurate. It's important for people seeking to understand palliative care to know the difference. --DHeyward (talk) 13:01, 4 February 2014 (UTC)

Article size[edit]

This article is way too large (82k). Let's break it up into separate articles or in a different way, reduce the size. --WikiTryHardDieHard (talk) 15:59, 8 May 2014 (UTC)

Agree, it could use some paring down. Also it touches on 12 step programs but not some of the new non 12 step recommendations that have a higher success rate. That seems to be very conspicuously lacking on wikipedia as a whole-- References to that type treatment and commentary about it and given the prevalence of it, it would seem to be something we should be doing, or am I just missing it in the mix? Ladymacbeth9 (talk) 20:45, 1 June 2014 (UTC)

FOSB etc.[edit]

While the FOSB stuff looks plausible, I think it's radically oversimplifying things to state that it is the mechanism of addiction, as if the matter was settled beyond doubt, and these massive text dumps go way beyond what's needed. At the moment, I think it can best be regarded as a hypothesis.

The current text dump and huge transcluded table, is way too large for the context, discounts all the other theories, and, I believe, doesn't meet the requitements of the WP:NPOV policy to balance and attribute statements. It's also been inserted into at least two other articles: sexual addiction and addiction.

What would make more sense, and would meet the WP:NPOV requirement, would be a statement on the lines of "Several researchers, most notably Dr. X and Professor Y, have put forward the hypothesis that ...", to then describe the theory briefly, and then point the reader at the FOSB article for more detail. -- The Anome (talk) 23:45, 9 September 2014 (UTC)

@The Anome: I didn't notice this earlier. I've corrected the poor summary in the lead you pointed out. If you know of any competing theories in molecular biology, I'd be okay with with making the changes you're proposing. Seppi333 (Insert  | Maintained) 03:26, 10 September 2014 (UTC)