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Medical Definitions of Addiction

Chemical addiction is a chronic relapsing condition characterized by compulsive drug-seeking and abuse and by long-lasting chemical changes in the brain. Chemical addiction is the same irrespective of whether the drug is alcohol, amphetamines, cocaine, heroin, marijuana, or nicotine. Every addictive substance induces pleasant states or relieves distress. Continued use of the addictive substance induces adaptive changes in the brain that lead to tolerance, physical dependence, uncontrollable craving and, all too often, relapse. Dependence is at such a point that stopping is very difficult and causes severe physical and mental reactions from withdrawal. The risk of addiction is in part inherited. Genetic factors, for example, account for about 40% of the risk of alcoholism. The genetic factors predisposing to addiction are not yet fully understood. [2]

In 2001, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine jointly issued "Definitions Related to the Use of Opioids for the Treatment of Pain," which defined addiction as a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. [3]

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has categorized three stages of addiction:
  1.  preoccupation/anticipation
  2.  binge/intoxication, and
  3.  withdrawal/negative effect
These stages are characterized, respectively, everywhere by constant cravings and preoccupation with obtaining the substance; using more of the substance than necessary to experience the intoxicating effects; and experiencing tolerance, withdrawal symptoms, and decreased motivation for normal life activities. The term drug addiction is then used as a category which may include the same persons who under the DSM-IV can be given the diagnosis of substance dependence or substance abuse. [3] 

[1] Mayfield D, McLead G, Hall P. The CAGE Questionnaire. Am J. Psychiatry 1974: 131:1121
[2] MedTerms™ Medical Dictionary
[3] 2001 "Definitions Related to the Use of Opioids for the Treatment of Pain,", the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine
[4] Koob G, Kreek MJ (2007). "Stress, dysregulation of drug reward pathways, and the transition to drug dependence". Am J Psychiatry

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