Thursday, November 20, 2008

Is addiction a moral weakness?

The only reason to make the distinction [between habit and addiction] is to persecute somebody’ (Szasz, 1973).
The terms addiction, abuse, dependence etc have been used in an imprecise manner by many and this has created some confusion. Lay people still use the term 'addict, addiction' as these are easily understood. But professionals, especially mental health professionals, prefer to avoid these terms for various reasons. One reason is from the angle of political correctness - these terms have pejorative connotations. The other reason is the lack of precise definition, even though these terms have been in use for quite long time. Yet another issue is the trivialized usage. This is when we refer to 'cross word puzzle addicts or exercise addict'. Using the term this way creates a wrong impression that substance use is a problem of similar nature.
Both DSM - TR and ICD - 10 (these are the classification systems used by psychiatrists for diagnosing and classifying mental disorders) use the terms 'substance use disorders' and substance induced disorders'. Substance use disorders include 'substance abuse' and 'substance dependence'. Substance induced disorders include intoxication, withdrawal and other more serious psychiatric conditions.
There are two aspects to dependence - physiological and behavioral. Physiological dependence has two aspects. One is the development of tolerance to the drug necessitating the use of increased quantity over time. The other is the development of a specific withdrawal syndrome on cessation of use.
Behavioral aspects include 1) strong desire or craving for the substance, 2) inability to control the onset, duration, termination or quantity of use, 3) spending lot of time to procure, use or get over from the effects and neglecting other avenues of pleasure due to excessive preoccupation with the substance
and 4) continued despite having adverse consequence (e.g: drinking despite having liver impairment)
It has been argued that it is better to use the term 'neuro adaptation' to the physiological phenomena of tolerance and withdrawal. Therefore, the term dependence is better reserved for the psychological and behavioral consequences.
But this is not strictly adhered to by most authorities. Thus the term 'dependence' continues to include both the physiological phenomena and the behavioral aspects.
The quote given at the beginning is not acceptable to mental health professionals. Dependence is a maladaptive state. It is a significant problem affecting millions all over the world - both the users, their families, employers and the society as a whole. A problem of such magnitude should not be trivialized by comparing with use of common things like food, music, clothes, water or oxygen.
Dependence to substances need not always be thought of from the moralistic angle. A person who is dependent on a psychoactive substance is in a pathological state. It is not like excessive time being spent on music or cross word puzzles. There are no serious physical, mental or social consequences for them. But the serious consequences of substance dependence can be proved with ample evidence. There is no need to be value neutral when one is dealing with a disease condition.
There is definite vulnerability underlying development of dependence. When such a vulnerable person is exposed to the substance, he is at risk for dependence. Social, cultural and psychological factors are also important in shaping the final picture. There may be several others who can have controlled usage. Dependence on substance is not a sign of moral weakness. It is a pathological condition which develops in persons with biological, psychological or social vulnerability, needing proper evaluation and treatment. If untreated, it will lead to serious individual and social consequences. Substance abuse in most cases, is just a prelude to development of dependence. It is always better to intervene at this stage without waiting for development of a full blown dependence syndrome or serious health consequences.

1 comment:

anushka said...

thank you for the post.happy to see you back.