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Salient: Victoria University of Wellington Students' Newspaper. Vol. 32, No. 10. 1969.

Dependence Not "Addiction"

Dependence Not "Addiction"

'Drug addiction', with its lurid connotations and loose, non-medical use, has been rejected as a term with which to describe drug habits. The World Health Organisation has developed over recent years the notion of 'drug dependence' in an attempt to find "a term that will cover all kinds of drug abuse", that is, "excessive or persistent use beyond medical need." (Bull Who. 1965.) "Drug dependence is a state of physic or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continuous basis. The characteristics of such a state will vary with the agent involved, and these characteristics must always be made clear by designating the particular type of drug dependence in each specific case; for example, drug dependence of morphine type, of barbiturate type, of amphetamine type etc. The specification of the type of dependence is essential and should form an integral part of the new terminology, since it is neither possible nor even desirable to delineate or define the term drug dependence independently of the agent involved .... It must be emphasised that drug dependence is a general term that has been selected for its applicability to all types of drug abuse and thus carries no connotations of the degree of risk to public health or need for any or a particular type of drug control."

Psychic dependence is "a particular state of mind ... [where] there is a feeling of satisfaction and a psychic drive that require periodic or continuous administration of the drug to produce pleasure or to avoid discomfort". Physical dependence is "an adaptive state that manifests itself by intense physical disturbances when the administration of the drug is suspended or when its action is affected by the administration of a specific antagonist. These disturbances, i.e. the withdrawal of abstinence syndromes ... are characteristic for each drug type." Drugs may also induce tolerance, which is "an adaptive state characterised by diminished response to the same quantity of drug or by the fact that a larger dose is required to produce the same degree of pharmacodynamic effect."

Some drugs which lead to psychic dependence also lead to physical dependence and/or tolerance. Psychic dependence, physical dependence and tolerance all develop with continued use of drugs such as morphine, heroin, alcohol and barbiturates, (all depressants). Psychic dependence and tolerance develop with use of amphetamines and LSD. (stimulants), although with the latter, tolerance disappears as rapidly as it develops—in a few days. Marihuana and cocaine (stimulants), are associated with psychic dependence only, cocaine use typically leading to greater dependence. Fatigue or mild depression may follow a drug experience without being associated with any 'abstinence syndrome' proper.

'Drug dependence' thus takes some account of the range of different drug reactions and it has no connotations of risk or control. However, it is important to note that the definition of 'drug dependence' given by Who is not a simple medical one. Various value judgements are implicit. Most obviously, Who still insists on talking about drug "abuse" (i.e. non-medical or non-scientific use), and does not consider for example, recreational use as something separate. That is except, somewhat inconsistently, in the characterisation of drug dependence of the alcohol type. They state that this "may be said to exist when the consumption of alcohol by an individual exceeds the limits that are accepted by his culture, if he consumes alcohol at times that are deemed inappropriate within that culture, or if his intake of alcohol becomes so great as to injure his health or impair his social relationships." Psychic dependence is said to occur, however, "in the mildest grade [where] alcohol is missed or desired if not available at meals or at social functions", which, of course, can occur well within cultural norms. Or perhaps Who is suggesting that psychic dependence in the case of alcohol does not constitute a 'drug dependence of the alcohol type'.

'Tolerance' and 'physical dependence' are relatively unproblematical: they can be shown to exist more or less unambiguously by a series of experiments, either with animals or with humans.

'Psychic dependence' is not so simple. It is generally agreed that it may be present in varying degrees. It is recognised that it is a very common, widespread phenomenon. One may be psychically dependent on TV watching, eating cornflakes (or just eating), cunnilinctus, playing rugby, listening to the Beatles or to Baroque music, protesting, reading, wearing trousers, cigarette smoking, church going, etc. None of these dependency activities are regarded as particularly reprehensible within cultural limits, and the participants are not generally subject to prosecution. Many activities may form the basis of a 'compulsion', and it is often rather difficult to decide whether one exists. Personal values may become involved very quickly in deciding in any individual case.

In other words, as indicated above, the mere fact of psychic dependence has no implications for risk or control. It merely refers to the fact that there is a greater likelihood of a person repeating an action if previously it has resulted in a pleasurable experience or in the removal of discomfort.