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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by anon on December 17, 1998, at 11:26:15
What do these words mean exactly? I've heard varying definitions. In one book on psychiatric drugs, the author says that if you've ever in your life taken a prescription drug without a prescription from your doctor, you have a "drug problem." Problem for whom? The DEA, maybe. And "addiction." Are you addicted to a substance if you can stop with no physical withdrawal? And why is "self-medication," in all circumstances, even if done in an educated manner, always "wrong?"
I'm just raising these topics for discussion; there should be philosophical debate.
Posted by Nona on December 17, 1998, at 15:10:25
In reply to "addiction" and "drug problem", posted by anon on December 17, 1998, at 11:26:15
You are asking for discussion on contraversial and comprehensive issue.
Talking drugs: They may help, hurt or do nothing to different
people, regardless of MD's opinion, depending how much one takes,
what reason...
> What do these words mean exactly? I've heard varying definitions. In one book on psychiatric drugs, the author says that if you've ever in your life taken a prescription drug without a prescription from your doctor, you have a "drug problem." Problem for whom? The DEA, maybe. And "addiction." Are you addicted to a substance if you can stop with no physical withdrawal? And why is "self-medication," in all circumstances, even if done in an educated manner, always "wrong?"
> I'm just raising these topics for discussion; there should be philosophical debate.
Posted by alan on December 17, 1998, at 18:27:30
In reply to Re: "addiction" and "drug problem", posted by Nona on December 17, 1998, at 15:10:25
A few ideas.
First 'addiction' is useed to talk about qiute a few rather diverse phenomena; ther may well not be any one feature common to all (and only) the sorts of things we call 'addictions'. We may havw what the philosopher Wittgenstein called a 'family resemblance term' where we lump a whole set of phenomena together because of various chains of similarities in various directions even tho no one thing is common to all of them. Simplistically, a and b may have F in common, b and c have G in common, but a and c have nothing in common; but because of that we call all of a, b, and c by some common name. Of course, that only begins and does not end any explication of the common term applied to a, b, and c: what are the similarities and differences, and why do wee lump thos three things together, seeing them as one kind of thing?
Now for 'addiction'. There are several things lumped together by that term: a withdrawal syndrome, tolerance of higher dosages, occasional use of very high dosages, frequency of use, obsessive thoughts of the substance (not caused merely by worries about being 'addicted', getting drugs without prescription, using a drug for 'fun'
once or several or many times (moderate alcahol use does not count, the drug has seious adverse effects but has not been prescribed (antihistamines), frequently using the drug even tho you think you sshould not (note here that there is talk of 'food addicts' and 'sex addicts' and 'exercise addict' who overtrain--a frequent problem for athletic coaches), craving. And all I've no doubt left out.
Now for a very important point: "addiction' is an evaluative term, like 'disease', in the sense that it is pretty central to the concept that addictions are BAD. Indeed, this has brought on a kind of hysteria that politicians exploit. Thus doctors fear causing anything that may get called an addiction by precribing crtain substances in certain dosages to certain patients even when it may do the patient more good than harm. One doctor once sent a very sick cancer patient to an abuse treatment center for her addiction to pain killers; she soon left for hospital when the cancer flared up. If what I have read is correct, many alcahol abusers benefit from benzos while many docs will never ever prescribe them to suitable such patients. I think there is a tendancy to think 'withdrawal syndrome, ergo addiction, ergo bad. (Of course it may be bad in some cases; but that requires knowing the patient.
Well, maybe this can start the sort of discussion you wanted. Needless to say, (something we say only when it is needed) none of this is to imply that there are some devastating addictive phenomena to be avoided, studied, and treated.
Posted by alan on December 18, 1998, at 0:34:22
In reply to Re: "addiction" and "drug problem", posted by alan on December 17, 1998, at 18:27:30
In my above post, please add the obviously neended "not" to my last sentence. Please excuse my failure to edit out typos and speelling erors; my machine often goes off by itself, so I always fear losing what I've typed and post to quickly.
Posted by anon on December 18, 1998, at 9:47:05
In reply to Re: "addiction" and "drug problem", posted by alan on December 17, 1998, at 18:27:30
> A few ideas.
> First 'addiction' is useed to talk about qiute a few rather diverse phenomena; ther may well not be any one feature common to all (and only) the sorts of things we call 'addictions'. We may havw what the philosopher Wittgenstein called a 'family resemblance term' where we lump a whole set of phenomena together because of various chains of similarities in various directions even tho no one thing is common to all of them. Simplistically, a and b may have F in common, b and c have G in common, but a and c have nothing in common; but because of that we call all of a, b, and c by some common name. Of course, that only begins and does not end any explication of the common term applied to a, b, and c: what are the similarities and differences, and why do wee lump thos three things together, seeing them as one kind of thing?
> Now for 'addiction'. There are several things lumped together by that term: a withdrawal syndrome, tolerance of higher dosages, occasional use of very high dosages, frequency of use, obsessive thoughts of the substance (not caused merely by worries about being 'addicted', getting drugs without prescription, using a drug for 'fun'
> once or several or many times (moderate alcahol use does not count, the drug has seious adverse effects but has not been prescribed (antihistamines), frequently using the drug even tho you think you sshould not (note here that there is talk of 'food addicts' and 'sex addicts' and 'exercise addict' who overtrain--a frequent problem for athletic coaches), craving. And all I've no doubt left out.
> Now for a very important point: "addiction' is an evaluative term, like 'disease', in the sense that it is pretty central to the concept that addictions are BAD. Indeed, this has brought on a kind of hysteria that politicians exploit. Thus doctors fear causing anything that may get called an addiction by precribing crtain substances in certain dosages to certain patients even when it may do the patient more good than harm. One doctor once sent a very sick cancer patient to an abuse treatment center for her addiction to pain killers; she soon left for hospital when the cancer flared up. If what I have read is correct, many alcahol abusers benefit from benzos while many docs will never ever prescribe them to suitable such patients. I think there is a tendancy to think 'withdrawal syndrome, ergo addiction, ergo bad. (Of course it may be bad in some cases; but that requires knowing the patient.
> Well, maybe this can start the sort of discussion you wanted. Needless to say, (something we say only when it is needed) none of this is to imply that there are some devastating addictive phenomena to be avoided, studied, and treated.A great way to start this discussion. I will have to think more before I post a response; I just wanted to post this immediately. I suppose these terms are understood differently by different people in different contexts, and therefore should not be thrown around as if they signify a phenomenon exactly and and unambiguously. Thus absolute statements such as "if you have ever in your life taken a prescription drug without a prescription from your doctor, you have a drug problem" are merely opinions, similiar to opionions one one expound when asked to define such notions as "love" or "hate." More from me later.
Posted by alan on December 18, 1998, at 11:31:03
In reply to Thank you for getting this started, posted by anon on December 18, 1998, at 9:47:05
> > A few ideas.
> > First 'addiction' is useed to talk about qiute a few rather diverse phenomena; ther may well not be any one feature common to all (and only) the sorts of things we call 'addictions'. We may havw what the philosopher Wittgenstein called a 'family resemblance term' where we lump a whole set of phenomena together because of various chains of similarities in various directions even tho no one thing is common to all of them. Simplistically, a and b may have F in common, b and c have G in common, but a and c have nothing in common; but because of that we call all of a, b, and c by some common name. Of course, that only begins and does not end any explication of the common term applied to a, b, and c: what are the similarities and differences, and why do wee lump thos three things together, seeing them as one kind of thing?
> > Now for 'addiction'. There are several things lumped together by that term: a withdrawal syndrome, tolerance of higher dosages, occasional use of very high dosages, frequency of use, obsessive thoughts of the substance (not caused merely by worries about being 'addicted', getting drugs without prescription, using a drug for 'fun'
> > once or several or many times (moderate alcahol use does not count, the drug has seious adverse effects but has not been prescribed (antihistamines), frequently using the drug even tho you think you sshould not (note here that there is talk of 'food addicts' and 'sex addicts' and 'exercise addict' who overtrain--a frequent problem for athletic coaches), craving. And all I've no doubt left out.
> > Now for a very important point: "addiction' is an evaluative term, like 'disease', in the sense that it is pretty central to the concept that addictions are BAD. Indeed, this has brought on a kind of hysteria that politicians exploit. Thus doctors fear causing anything that may get called an addiction by precribing crtain substances in certain dosages to certain patients even when it may do the patient more good than harm. One doctor once sent a very sick cancer patient to an abuse treatment center for her addiction to pain killers; she soon left for hospital when the cancer flared up. If what I have read is correct, many alcahol abusers benefit from benzos while many docs will never ever prescribe them to suitable such patients. I think there is a tendancy to think 'withdrawal syndrome, ergo addiction, ergo bad. (Of course it may be bad in some cases; but that requires knowing the patient.
> > Well, maybe this can start the sort of discussion you wanted. Needless to say, (something we say only when it is needed) none of this is to imply that there are some devastating addictive phenomena to be avoided, studied, and treated.
> A great way to start this discussion. I will have to think more before I post a response; I just wanted to post this immediately. I suppose these terms are understood differently by different people in different contexts, and therefore should not be thrown around as if they signify a phenomenon exactly and and unambiguously. Thus absolute statements such as "if you have ever in your life taken a prescription drug without a prescription from your doctor, you have a drug problem" are merely opinions, similiar to opionions one one expound when asked to define such notions as "love" or "hate." More from me later.
>1. Does anyone know if I can easily erase a message I'm responding to on webtv without doing it sort of letter by letter?
2. The "absolute statement" you quoted--at least taken out of context--does not deserve serious consideration. We could all think of obvious counterexaamples. Waking in middle of night with terrible toothache or malaria near someone with something that might have something helpful, and taking it does not mean you have a 'drug problem', altho it may be a bad idea in some cases due to sensitivities and interactions.
3. Some opinions are much better than others; in the last analysis, 'opinions' are all we have. And we pay doctor's to get the best opinions we can.
4. It is at least possible that we all mean the same when using a term to refer to a phenomenon we know little about and about whose referent (what the term names) we have different opinions. In some contexts this can be important, so I just mention it now.
5. On some topics, such as drugs (homosexuality, effects of divorce on childen) a doctors opinion may be biased by religious, moral, and political convictions that overide scintific concerns, especially when the science is weak. Moreover, many clinicians are not terribly imbued with any scientific spirit, but hink they are--I think that especially applies to some of the older ones.
6. I thank you for your thank you and thank you for posing a very interesting question.
Posted by Victor on December 19, 1998, at 18:25:49
In reply to Re: Thank you for getting this started, posted by alan on December 18, 1998, at 11:31:03
> > A great way to start this discussion. I will have to think
>
> >1. Does anyone know if I can easily erase a message I'm responding to on webtv without doing it sort of letter by letter?
I read somewhere ( I can feel the flames already for that statement)
that addiction is two, possibly threefold. An emotional
craving continues for your "drug of choice" long after
the physical withdrawl symptoms subside.
Tell me where your money goes, where your thoughts go,
where your time goes. The answer might surprise you.
I said possibly threefold because anything that has
gotten that kind of attention from me will also bankrupt
my spirit.
Posted by alan on December 21, 1998, at 0:21:29
In reply to Re: Thank you for getting this started, posted by Victor on December 19, 1998, at 18:25:49
> > > A great way to start this discussion. I will have to think
> >
> > >1. Does anyone know if I can easily erase a message I'm responding to on webtv without doing it sort of letter by letter?
>
> I read somewhere ( I can feel the flames already for that statement)
> that addiction is two, possibly threefold. An emotional
> craving continues for your "drug of choice" long after
> the physical withdrawl symptoms subside.
> Tell me where your money goes, where your thoughts go,
> where your time goes. The answer might surprise you.
> I said possibly threefold because anything that has
> gotten that kind of attention from me will also bankrupt
> my spirit.I was talking about 'family resemblance" terms. You have cerainly expanded the family. All of your points are important. But, there are said to be addictions without a 'drug of choice' such as sex and gambling addictions; there is no non-metaohorical withdrawal from them, and the withdrawal from marijuana is generally said to not, not be serious, or not be at all like the withdrawal from ,say opiates or alcohol; personally, I tend to feel very little craving for alcohol after withdrawal from some binge, unless or until I am in a major depression or some life crisis--I may be unusual in that; the money, thought, and time devoted to something one is addictd to may be largely a function of how hard and expensive it is to get--there are places where people think little of what I would think of as addictive drugs, maybe because their use is so widespread and cheap. maybe this includes a certain pattern of wine drinking common in France (common, not COMMON) where people drink all day in small amounts without getting drunk, but go into withdrawal without it; in some of these cases, it seemsed to me that some addicted individuals were not dispirited--some were looked upom as sort of holy men, especially good at getting visions!
Another point: a 'family resemblance" term might point to a sydrome or set therof and eventually unambiguously name a disease or diseases.
Thankks again for your post. I hope others will join in.
Posted by Elizabeth on December 21, 1998, at 23:02:07
In reply to "addiction" and "drug problem", posted by anon on December 17, 1998, at 11:26:15
> What do these words mean exactly? I've heard varying definitions. In one book on psychiatric drugs, the author says that if you've ever in your life taken a prescription drug without a prescription from your doctor, you have a "drug problem." Problem for whom? The DEA, maybe. And "addiction." Are you addicted to a substance if you can stop with no physical withdrawal? And why is "self-medication," in all circumstances, even if done in an educated manner, always "wrong?"
Hi everyone. Interesting discussion.
I don't think that "addiction" has much real meaning anymore - it's just become a loaded term. Certainly one does not make a diagnosis of "addiction." Perhaps it would be more accurate of me to say that addiction has a different meaning for everyone. Certainly that author you mentioned was just citing his own opinion of what constitutes a "drug problem."
That said, while I don't agree with everything therein, I think DSM-IV did a pretty good job (all things considered) at trying to characterize what makes up what it calls "substance dependence." (Although I'm not a big fan of the "at least 3 of the following:" approach!). The symptoms listed are: tolerance; withdrawal (must be a substance-specific withdrawal syndrome, not just general dysphoria); using more of the substance than you had intended to; wanting to cut down or quit but not being able to; putting a lot of time into getting, using, and recovering from the substance (they don't mention money or effort, though); giving up other activities for drug use; and continuing to use despite health problems that are caused or exacerbated by the drug use.
I think this is pretty in line with my own list of "signs that someone may be dependent on drugs" - they use a whole lot at once; they keep using more and more; they get sick or depressed when they aren't using; using becomes an increasingly important part of their life; they keep using despite the dangers; and so on. Something that hasn't been captured well is the concept of "cravings" which I think is central to what we consider to be "addiction." Possibly making the implicit assumption that a person who is dependent on drugs is "in denial," DSM-IV limits its definition mainly to signs (things that are visible to the observer) rather than symptoms (internal experiences of the patient).
Note that since at least 3 of these must occur within the same 12-month period, this excludes "physiological addiction" whose only symptoms are tolerance and/or withdrawal. It is being recognized more and more that addiction is not so much about these, although they can be signs that something is wrong (I am especially thinking of stimulants, opiates too although it's hard to avoid these problems if you use opiates long-term at all (such as for chronic pain)).
Posted by James Dean on April 26, 1999, at 10:58:30
In reply to Re: "addiction" and "drug problem", posted by alan on December 17, 1998, at 18:27:30
Through my time on the internet i've never seen such as many sick sites as how to make bombs. I think this is very immature thing to do and i think that these people should be shot or hung.
I think that these such sites should be banned.Yours Faithfully
James Dean...................................
Posted by Bruce G. Stewart on May 13, 1999, at 14:02:46
In reply to "addiction" and "drug problem", posted by anon on December 17, 1998, at 11:26:15
I am a recovering addict (drug of choice="what 'cha got"). Actually, at the end of my active addiction (clean date=21JUL96) I was and IV methamphetamine/cocaine addict. I find your comments interesting, and they provoke many personal thoughts about the perception that people have about addiction. I would like to point out a webpage that provides information based pm addiction research at the University of Buffalo. Based on my own experiences, I find that they "hit the nail on the head." Here it is: http://wings.buffalo.edu/aru/ARUprimer.htm Thanks for letting me share here.
Posted by Bruce G. Stewart on May 13, 1999, at 14:10:12
In reply to Re: "addiction" and "drug problem", posted by Bruce G. Stewart on May 13, 1999, at 14:02:46
I forgot to mention that I am also bipolar. My advice to others on the question of choosing a doctor is to please make sure she/he has a very thorough knowledge of addiction. Some doctors, even psychiatrists, absolutely do not. After nearly three years in the recovery community, I have seen doctors prescribe totally inappropriate meds to addicts many times. Some of these addicts are no longer with us.
Posted by anne on May 13, 1999, at 23:46:14
In reply to Re: "addiction" and "drug problem", posted by Bruce G. Stewart on May 13, 1999, at 14:02:46
Bruce,
A thought provoking post. I read the web site you listed and understand stimulants such as amphetamines would be inappropriate choices to treat those with previous addiction problems, but what other drugs are problematic? What about benzos for instance or drugs that potentially interact with the dopamine system? I took Sinemet for a while (dopamine that can cross the blood brain barrier) and it was the most mood altering drug I have ever taken. It would *hit* within an hour of taking it in the morning and I felt pretty wonderful until it wore off a few hours later. Subsequent dosages during the day didn't have the same effect.
Any comments about specific drugs appreciated.
Posted by alan on May 23, 1999, at 4:08:32
In reply to Bipolar Addict Taking Meds, Too., posted by Bruce G. Stewart on May 13, 1999, at 14:10:12
first, we should all commend Bruce for his success these last few years in keeping clean, and wish him further success.
Second, I wish to add to his warning. Those of us who have had problems with drugs should indeed be sure to seek out doctors who are well versed in the field of drug abuse, and we should immediately tell all; but we need also be wary of those physicians who uncritically accept all the beliefs common in the 'recovery community' whether or not they have any scientific backing. Such practitioners might deprive us of medications that may be very useful--indeed, of 'officially proscribed' meds that may even greatly aid our ability to not use other drugs in a destructive manner. There is no good dogmatic substitute for intelligence.
Posted by Bruce G. Stewart on May 24, 1999, at 13:31:44
In reply to Re: Bipolar Addict Taking Meds, Too., posted by alan on May 23, 1999, at 4:08:32
alan... I agree completely with your followup message. I am a "backup sponsor" to someone is dual diagnosed (schizophenia and addict) whose primary sponsor does not understand the need for medication at all. My role in helping this person is mostly with dealing with medications and psychiatry. He seems to be doing quite well on both fronts these days. *smile*
This is the end of the thread.
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