Tuesday, March 14, 2017

The Facts on Addiction vs. Dependency, Part 2

So fundamentally, we now have two groups of individuals who "need" to take opioids: those who are dependent on opioids to relieve chronic pain and those who are addicted to opioids to get high. Doctors whose routine includes seeing patients on long-term opioid prescriptions, depending on the state in which they practice, usually must declare themselves as belonging to one or both of two specialty fields: pain management or addiction recovery. Both certifications come in handy when a person with a chronic pain condition develops an addiction, but few doctors are genuinely qualified for both, nor would want to be, since patients with either condition are going to share the characteristic of being emotionally exhausting to deal with. I can only imagine how compassionate you would need to be to have a full caseload of individuals living with that much stress.

So let's take a closer look at some important terminology because I believe that the media and political pundits either ignorantly or deliberately mislead the public on these points. "Dependency" can be either physical, psychological, or both, but it is both incorrect and unfortunate that the general public associates any of these conditions with a distinct phenomenon known as "addiction." I hope that I can adequately distinguish between them for you here.

Let's start with physical dependency. This is something that all living creatures have. Chemicals upon which we are all physically dependent include things like diatomic Oxygen and water, but there are hundreds more. There are also nutrients like vitamins and minerals. Physical dependency, then, is a need for something external to be taken and absorbed internally in order for the organism to survive. It is a fact that some, however, are genetically configured to need more or less of these things. People who have diabetes have a glucose deficiency and many are required to add a regimen of insulin injections to their daily routine in order to maintain optimal functioning of their liver. Those who have asthma do not have a deficiency, but rather a disorder that overproduces certain cells in the body called eosinophils. These cells in abundance actually end up attacking the cells in the lungs, causing them to inflame and making it difficult to take in Oxygen sufficiently. Corticosteroids, like Fluoxetine, inhibit the body's unnatural overproduction of those eosinophils. Insulin and corticosteroids are, for diabetics and asthmatics respectively, a physical dependency.

Psychological dependency is very similar to physical dependency. There are certain chemicals in the body, hormones and neurotransmitters, that are critical to the efficient and optimal operation of our nervous system including the brain. Psychological dependency is a subcategory of physical dependency then, but is focused on biological functions that specifically involve the brain. It could include mood-altering medications being given to those who are clinically depressed or even an individual drinking soda or coffee to intake the caffeine their need to help deter the onset of a migraine headache. It could also include administering L-DOPA to patients with Parkinson's Disease to help them stabilize their control over their shaking hands.

There are areas where dependency "crosses over" and includes facets that are both physical and psychological. This could include hormone treatments for women who have difficulty controlling their moods or body temperature during their menopausal years. I also do not believe that it is a stretch to include chronic pain patients taking properly-managed opioids. I think that I am, myself, a perfect individual example of this. Although there are always unavoidable side effects to medications, I think that my ability to take narcotics without "getting high" proves that the medication is only working within my body (and brain) to suppress pain without stimulating the "pleasure center" within my head.

With each type of dependency mentioned above, an individual is genetically predisposed to a certain disease or disorder that involves their body or brain overproducing or underproducing a chemical that is a natural part of living and functioning. That imbalance requires external intervention, and forces an individual to be dependent on that external intervention to maintain themselves in the way that those who are "healthy" do naturally.

This leads me to the final condition, addiction. The distinction between all types of dependency and addiction should already be obvious to you. Addiction involves the massive and often repetitive abuse of certain chemicals that leads to the body or brain to overproduce or underproduce certain chemicals. Sufficiently abused, a chemical essential to life can cease to be produced by the body at all. The distinguishing component between dependency and addiction, then is that the imbalance requiring external intervention is set off either involuntarily by an unlucky set of genes or voluntarily by a person acting stupidly.

All this is complicated by the fact that a person's genes might not specifically cause a disorder to develop, but they could make a person more susceptible to developing one. In do many ways, like my own genetic disorder, every one of us could be sitting on a time bomb. My own doctors have said that my condition could just have easily manifested itself moments after birth or not been triggered by anything over my entire lifetime. So a person might not realize that they have a vulnerability or a predisposition toward addiction, but let's be smart about this... a drug that has a side effect of creating a euphoric sensation is going to be something that both body and brain would like repeated. Only a rational mind can then reason over the more primal system, to cut ourselves off before we are willing to forsake the things that had previously meant something to us in order to obtain this new "high."

Unfortunately, there is a very fine line between seeking relief from pain and seeking pleasure and this is the very idea that is being misrepresented by the media. A person who is willing to do almost anything to get a reprieve from pain (including the option of suicide) might not outwardly appear any less desperate than the person who is seeking to relieve their symptoms of withdrawal by getting high again. However, and this is my entire point of focus, "the physical dependence on medication" and "an addiction to drugs" are very different and the general public needs to know and understand that difference.

Please make a point of emphasizing this difference at every opportunity that you can, and take a moment right now to invite at least two people you know to visit this site and subscribe for themselves. 

The next step, of course, is trying to actually figure out how to solve this problem. I do have some thoughts about that, but first, let me explain why the current so-called solutions are not working.

Next blog: "Bad Solution #1: Association Theory" (on or about Sunday, March 26)