A few days ago my daughter asked the following question in one of her emails home from college:
“Random question, I have a friend here who believes that most drugs are not actually addictive, is that true?… They said that especially weed was not addictive at all.”
Let’s set about answering it. First, as always, we must consider our definitions. I assume that when speaking of drugs you mean non-prescription use of generally mind altering substances (such as alcohol), some of which are often illegal to possess or use (such as cocaine, heroin, amphetamines, etc). If your friend has a different definition of drugs, please let me know.
The word addictive requires a little more clarity. It comes from the word “addiction”, the definition of which from the Free Online Medical Dictionary is below:
“Addiction is a persistent, compulsive dependence on a behavior or substance. The term has been partially replaced by the word dependence for substance abuse. Addiction has been extended, however, to include mood-altering behaviors or activities. Some researchers speak of two types of addictions: substance addictions (for example, alcoholism, drug abuse, and smoking); and process addictions (for example, gambling, spending, shopping, eating, and sexual activity). There is a growing recognition that many addicts, such as polydrug abusers, are addicted to more than one substance or process.”
The question “are drugs addictive” then could be restated “is non-prescription use of mind-altering substances such as alcohol or marijuana likely to cause persistent, compulsive dependence on that substance?” Since definitions often make for dull reading, I will assume that we all agree what “persistent” and “compulsive” mean.
The sine qua non for psychiatric diagnoses in modern American medicine is the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). DSM IV states that substance dependence is diagnosed as follows.
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifest by three or more of the following, occurring at any time in the same 12 month period:
1. Tolerance, defined as either a markedly increased amount of the substances needed to achieve the desired effect, or a markedly diminished effect with the same amount of the substance.
2. Withdrawal, as manifested by certain clinical symptoms (depending on the substance) or the need to take a closely related substance to avoid withdrawal symptoms.
3. The substance is taken over a longer time period or in larger amounts than initially intended.
4. There is a persistent desire or unsuccessful efforts to reduce or control substance use.
5. Significant time is used to obtain the substance, use the substance, and/or recover from its effects.
6. Important social, occupational or recreational activities are reduced or eliminated because of substance use.
7. The substance use is continued despite knowledge of it causing or exacerbating significant physical or psychological problems. For example, a person continuing his alcohol use despite receiving a diagnosis of alcoholic hepatitis.
Note that dependence can be physiological, in which case symptoms of tolerance and/or withdrawal are present, dependence can be psychological, in which case there is a need for the substance with symptoms of tolerance or withdrawal, or it can be both.
It does not take much observation of the world around us to realize that many people who use substances such as alcohol or marijuana are dependent on those substances. Marijuana is less likely to result in physical dependence than tobacco, heroin, cocaine, or alcohol, but it is nonetheless addictive. Other non-prescription drugs, and even prescription ones, are also associated with dependence.
The DSM IV includes a handy table listing substances that are commonly associated with dependence. They include alcohol, amphetamines, cannabis (marijuana), cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine (PCP), sedatives, hypnotics (sleeping pills), and anxiolytics.
Substance abuse is frequently found with substance dependence. It is characterized by at least one of the following in a 12 month period:
1. Recurrent substance use resulting in a failure to fulfill a major obligation or role in home, school or work.
2. Recurrent substance use in situations in which it is physically hazardous (drinking and driving).
3. Recurrent substance related legal problems.
4. Continued substance use despite persistent or recurrent social problems related to the substance (arguing with a family member about substance use).
Just as it is easy to think of people in our experience, and certainly in my practice, who have been dependent on drugs, it is easy to think of people who abuse substances. During our time in Schweinfurt at least two soldiers died when they got drunk, fell asleep, and aspirated their vomit. Another had just returned from Bosnia when he got drunk and fell asleep on railroad tracks. Marijuana causes a loss of peripheral vision and contributes to motor vehicle accidents. Some people rob and even kill to get drugs; certainly extreme evidence of abuse.
In summary, drugs (as defined above) are addictive. Please let your friend know that drugs are not to be trifled with and are best avoided. There are too many good and wonderful things to enjoy in life to cloud one’s mind and endanger one’s life with drugs.