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The nature of addiction
Transcript of The nature of addiction
The hero in classical Greek tragedy possesses a tragic flaw, hubris, that will be his or her undoing.
Today, in real life as in drama, the source of personal tragedy is often some sort of compulsion or obsession.
The "fatal attraction" may involve a person, a substance, or an activity.
Erick David Arguello, M.A., M.Ed., Psy.D.
According to the Dictionary of Word Origins (Ayto, 1990), addiction comes from the Latin Addictus
Having given over or awarded to someone or being attached to a person or cause.
Addiction - substance abuse literature
Brain disease (Leshner, 2006)
a sin (Rosin, 2000)
a sense of helplessness (Dodes, 2003)
Excessive behavior (Orfor, 2001)
a bad habit (Peele, 2004)
A personal choice (Schaler, 1999)
an expression of self-determination (Szasz, 2003)
a moral and a spiritual deficiency (Dalrymple, 2006; Morell, 1996)
Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR) (American Psychiatric Association [APA], 2000)
Avoids using the term addiction
It used the terms
dependence and abuse
DSM V -
New name - Substance use disorder
“Recurrent legal problems” criterion for substance abuse has been deleted from DSM-5
Addition: craving or a strong desire or urge to use a substance
Criteria for Substance Abuse
A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
B. The symptoms have never met the criteria for Substance Dependence for this class of substance.
Criteria for Substance Dependence
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12 month period:
Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome for the substance
The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance related absences, suspensions, or expulsions from school; neglect of children or household
Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
Recurrent substance related legal problems (e.g., arrests for substance related disorderly conduct)
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequence of intoxication, physical fights)
The symptoms have never met the criteria for Substance Dependence for this class of substance.
1) Tolerance, as defined by either of the following
3) The substance is often taken in larger amounts or over a longer period than was intended
4) There is a persistent desire or unsuccessful efforts to cut down or control substance use
With Physiological Dependence:
Evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present)
Without Physiological Dependence:
No evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)
5) A great deal of time is spent on activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain smoking), or recover from its effects
6) Important social, occupational, or recreational activities are given up or reduced because of substance use
7) The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect
b) Markedly diminished effect with continued use of the same amount of the substance