Alcohol Abuse Addiction
Alcohol Abuse Addiction:
Terminology Needs To Be Specific
By Ned Wicker The 45th annual Wisconsin Association on Alcohol and Other Drug Abuse (WAAODA) Spring Conference was all about change, as much as it centered on accepted standards. Entitled “A New Perspective: The Changing Face of Addiction Prevention, Treatment and Recovery Services,” the conference got off to a rousing start with a discussion on terminology, neuroscience and now that impacts treatment by Dr. Carlton Erickson of the University of Texas. As the old saying goes, the more things change the more they stay the same, the WAAODA groups has seen its share of change over the years and Erickson encouraged them to brace themselves for more. Erickson, professor of pharmacology at the UT brought the conference up-to-date on current terminology and thinking. That sounds rather mundane, but it was interesting to look around the large banquet hall and see how many people had different understandings of common issues. For example, what is the cause of addiction? Is it caused by a genetic condition, socio-economic circumstances, or is it by the substance itself? However, the major issue is to how to overcome, and so it becomes necessary to at least agree on terms. Erickson’s lecture was divided into three major parts – terminology, neuroscience and how neuroscience relates to treatment. Focusing on terminology, it’s amazing how the therapists, doctors, counselors and other professionals had their own definitions and views. Let’s get on the same page. Erickson centered on the DSM IV criteria, adding that the DSM V, due in 2013, is going to change everything. People will often use substance/chemical/drug abuse interchangeably with substance/chemical/drug dependence. Because the public thinks they are the same, that creates a stigma. That’s controversial and reminded me of a college professor who told us that usage determines meaning. That is, if the uninformed masses use a word incorrectly its meaning changes to the incorrect form. I was always bothered by that. Abuse and dependence are to entirely separate issues and Erickson drew the distinction rather nicely. Drug abuse is people making bad decisions, like college students drinking in bars on a Saturday night. Dependence is not a choice. It’s a diseased caused by a brain “dis-regulation.” Throw in the term addiction and the misunderstanding creates folk lore. For example Erickson shared, “I’m addicted to my cell phone.” You’ve probably heard that “Crack babies are addicted.” He added a personal favorite of mine, “Marijuana is not addictive.” These folk-lore tales add to the confusion. Crack babies are babies in distress, mainly because there are other factors. Moms may also use alcohol and are poorly nourished. The babies are not addicted and just because there is withdrawal, according to DSM IV, they are not necessarily addicted. Chemical dependence is characterized by impaired use of the drug. People will tell you that “I can quit any time.” Can they? Users can’t stop, it’s a brain disease and people can’t stop without help. It’s not the amount of the drug taken, or the frequency of use, or having withdrawal from the drug, it’s the inability to stop using. Erickson says that more controversy is coming with DSM V, which will eliminate the terms abuse and dependence. We still have a couple of years to wait, but DSM V could center on “substance use disorder” as the debate over terms continues. Be ready for some spirited discussion in the next couple of years before the new standards are released. On the surface DSM sounds like an invitation to have an argument, but it’s important to do the clinical trials, share the data and have discussion on specific language that will serve to advance the science and treatment of the disease. Erickson asked the audience an interesting question, “If there was a cure for addiction would that be a good thing?” Well, of course, wouldn’t it, or does the human condition specify that if I don’t fall prey to the substance, I’ll fall prey to something else and thus to be human is to be “addicted” to something? The criteria for “addiction” or “substance use disorder” are being evaluated and the disease would be considered moderate if one to three criteria were present, and severe is four or more were observed. Again, more trials are unfolding and more changes are coming. The science advances and our understanding changes. Terminology is important because folk lore isn’t science. Inexactitude, shouted loudly and continuously isn’t truth. To follow the debate, go to http://www.dsm5.org/Pages/Default.aspx. Erickson’s site is an excellence resource and can be found at
http://www.utexas.edu/research/asrec/.
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