Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Religion and Injury

Addiction and physical dependence are not the same thing.

Briefly, addiction is a chronic, relapsing disease characterized by compulsive drug-seeking and use and by neurochemical and molecular changes in the brain. It is a physiological and psychological compulsion for a habit-forming substance. In extreme cases, an addiction may become an overwhelming obsession. It involves uncontrollable craving, seeking, and use of a substance.

For chronic pain patients, the physical dependence created by long-term use of drugs such as Oxycontin and numerous others is anticipated. Dependence is a state of adaptation manifested by a drug class-specific withdrawal syndrome produced by abruptly decreasing blood levels of the drug, and/or administration of an antagonist. Tolerance also develops, which means that over time, a higher dosage of the medication is needed to achieve the same level of pain relief.

Physical dependence and the “high” of addiction are not synonymous, but because both share symptoms of withdrawal, addiction is frequently and incorrectly equated with physical dependence.

This is why it is important not only to attempt to verify whether the patient is, in fact, in pain, the degree of that pain, the past history of substance abuse of the patient, the criminal history of the patient, and even the existence of family/friends who make demands upon the patient for access to their prescribed medication.

Increasingly, prescribing physicians require a drug contract and drug screening for patients who are maintained on high levels of opiates.

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