Drug dependence

Prescription drug dependence is a popular topic for talk shows and news documentaries these days. A whole new group of addicts are being revealed - white collar suburbanites addicted to pills their doctors are prescribing for them.

This is a real problem in our society that has raised alarm and question among many people. Some highly addictive medications do exist and a growing number of people seem to be coming forward who are abusing these drugs.

There is no doubt that legitimate concerns have come out of the attention given to prescription drug addiction as well as some more questionable claims.

The question on many people's minds is: what is the nature of dependence and how do we know if something is addictive or if we are addicted to it?

Drug dependence can be defined as a state in which an individual feels a need for repeated doses of the drug in order to feel good or to avoid feeling bad. Addicted individuals lose control over their drug seeking behaviour.

According to the International Classification of Diseases, there are six check points for drug dependence. In order for dependence to be diagnosed, at least three of these have to be present at the same time:

  • a strong desire or compulsion to take the substance;
  • difficulty controlling substance-taking;
  • increasing tolerance (reduction in sensitivity to the effects of the substance and a need for higher doses over time);
  • physical withdrawal symptoms upon discontinuing substance use;
  • progressive neglect of alternative pleasures or interests because of the substance use; and
  • persisting with substance use despite clear evidence that it is harmful.

Certain medications, alcohol, tobacco and street drugs do have the ability to cause dependence in users.

Some confusion exists regarding the terminology of addiction. Many medications have the potential to cause one or more of the above listed effects, but are not considered dependency-forming drugs. This is because at least three of the above effects must be experienced in order for dependence to be diagnosed.

A good example of a group of drugs that has been involved in some controversy regarding dependency is the group of selective serotonin reuptake inhibitors or SSRI antidepressants.

These drugs have a high reporting of withdrawal symptoms when they are discontinued suddenly. Patients who stop taking an SSRI without gradually tapering the dose frequently experience withdrawal symptoms.

Still, these drugs are not considered addictive by the medical community. This is because withdrawal in itself is not sufficient for a positive diagnosis of dependence.

There is no evidence that SSRIs produce the other effects necessary for dependence.

For example, people taking SSRIs typically increase their dose until it is sufficient to deal with the symptoms of their mood or anxiety disorder without causing unsatisfactory side effects. Once the optimum dose is achieved, the dose does not need to continue increasing. No tolerance builds up. A person could continue taking the same dose just as effectively for many years.

Also, once a patient is taking an optimum dose of an SSRI to treat their disorder, the patient does not neglect pleasurable interests. In fact, it is more likely that once the mood disorder is treated, the individual will feel more inclined to continue or resume participation in enjoyable activities.

Further, there is no clear evidence that SSRIs are harmful to a person's health. Sometimes, unsatisfactory side effects may be experienced. In those cases, the patient can either switch to a different medication in hope of receiving its benefits without any harm, or they can discontinue use.

SSRIs are not associated with compulsion or strong desires to continue taking them beyond a necessary treatment period.

While withdrawal symptoms do constitute part of a definition of dependence, they can exist when there is no addiction.

It is best to discuss dependency issues with your doctor. If you feel you might be addicted to a prescription medication, speak with your doctor about this possibility.


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