HJBR Mar/Apr 2022

DRUG ADDICTION to translate the English addiction. 27 Ger- man uses non-Latin roots, such as Abhän- gigkeit (dependence), Sucht (addiction), and Rausch (intoxication). In Roman law and in the MiddleAges, addiction was the sentence pronounced against an insolvent debtor who was given over to a master to repay his debts with his work. Thus, the addictus was a person enslaved because of unpaid debts. According to the Oxford English Dic- tionary, the term “addict,”in the meaning of “attached by one’s own inclination, selfad- dicted to a practice; devoted, given, inclined to” has been used since the first part of the 16th century. However, addiction, in its current medical meaning of “state of being addicted to a drug; a compulsion and need to continue taking a drug as a result of tak- ing it in the past” has been in widespread use only since the 20th century. In medi- cal English, addiction replaced older terms, such as “inebriety.” The difference between the terms depen- dence and addiction has long been debated. The meaning of these terms among public health professionals can only be understood in the light of their historical development. Addiction is defined as “strong depen- dence, both physiologic and emotional” in Campbell’s psychiatric dictionary. 28 In 1964, the World Health Organization rec- ommended that the term drug dependence replace addiction and habituation because these terms had failed to provide a defini- tion that could apply to the entire range of drugs in use. Historically, the archetypal model of addiction was opiates (opium, heroin), which induce clear tolerance (the need to increase doses), severe physical withdrawal symptoms when use is discon- tinued, and have serious consequences for the social, professional, and familial func- tioning of users. The spread of the concept of addiction to other substances, notably nicotine, occurred only in recent decades. 29 The diagnosis of tobacco dependence or addiction did not exist in the Diagnostic and Statistical Manual of Mental Disor- ders, 2nd ed (DSM-II, American Psychiat- ric Association in 1968). 30 In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) 31 this diagnostic category was called “nicotine”dependence instead of “tobacco” dependence. A similar historical evolution was observed with the Interna- tional Classification of Diseases (ICD), the World Health Organization’s Classification of Diseases: the ICD-10 Classification of Mental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines (ICD- 10, published in 1992,) 32 contains a category for tobacco dependence, whereas the previ- ous classification, the International Classi- fication of Diseases, 9th Revision (ICD 9), 33 devised in the mid 1970s, had no such spe- cific category and offered only a category for nicotine abuse. The current labeling of “dependence” in the Diagnostic and Statis- tical Manual of Mental Disorders, 4th ed, Text Revision (DSM-IV-TR) 34 is confusing. During the preparation of the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised. (DSM-III-R), 35 committee members disagreed as to whether “addic- tion” or “dependence” should be adopted.A vote was taken at a committee meeting and the word “dependence” won over “addic- tion” by a single vote! As pointed out by O’Brien, the term “addiction” can describe the compulsive drug-taking condition and distinguish it from “physical” dependence, which is normal and can occur in anyone taking medications that affect the brain. 36 For instance, pain patients requiring opiates become dependent, but are not automati- cally addicted. CONCLUSION - A COMPLEX ILLNESS Cultural history suggests that our rela- tionship with drugs is more complex than the paradigm of the laboratory rat that is trained to self-administer cocaine. In most cases, we actively seek addictive drugs, and are not passive victims. History illustrates that our relationship with substances is shaped by multiple factors, including cul- ture, society, religion and beliefs, individ- ual psychology (addictive, anxious, anti- social personalities), cognition (addiction as a “learned” behavior), neurobiology, and genetics. Addictive behavior results from the conjunction of a substance and a personal- ity. Addiction is not only a substance, but “Addiction, in its current medical meaning of ‘state of being addicted to a drug; a compulsion and need to continue taking a drug as a result of taking it in the past’ has been in widespread use only since the 20th century. In medical English, addiction replaced older terms, such as ‘inebriety.’”