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Picking over the bones of addiction: opiate users

May 20 2009
There‘s little biological difference between what goes on in the heads of gambling addicts and crack addicts Depending on your poison, you should be shouting foul and have the hump, especially if your addiction is not opiate-based. What happens those people who are substance addicted to cocaine, amphetamines, alcohol or cannabis? And what about the other lot; those people addicted to certain behaviours, which include gambling, exercise, pornography or sex? Don't they have the same rights as the opiate user? Don't they have a compulsive and obsessive disorder? Isn't the crack addict or gambler the same as the heroin addict, who feeds his/her addiction by stealing or embezzling? When it comes down to it, they're not doing it because they like it, they're doing it because they have to. A recent article in the New Scientist supported this notion and asked the question "can gambling, shopping sex, and gaming be as addictive as the hardest drug?" When we do something pleasant or use drugs, dopamine is released in the brain, which then in turn triggers the desire to keep using or pursuing pleasurable behaviours. There is an emerging body of evidence to suggest that addictions are nearly all the same. There is very little biological difference between what goes on in the head of a gambling addict and that of someone addicted to crack. Certainly they have more in common than they are different. The World Health ICD-10 (International Classification of Diseases) defines someone as being substance dependent if they have exhibited in the past year three or more of the criteria below: - A strong desire or compulsion to use. - Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use. - A physiological withdrawal state when use has ceased or been reduced, as evidenced by the characteristic withdrawal syndrome, or use with the intention of relieving or avoiding withdrawal symptoms. - Evidence of tolerance, such that increased doses are required in order to achieve effects originally produced by lower doses. - Progressive neglect of other pleasures or interests because of substance use, increased amount of time necessary to obtain or take substance, or to recover from its effects. - Persisting with use despite clear evidence of overtly harmful consequences. Ring any bells? So why is it, when there are plenty of researchers who now support this broader definition of addiction do we only give substitute prescribing to the heroin addict? There are many people with 'addiction issues'. They steal, sell themselves and their behaviours affect the wider community, but they can't get their drug of choice on the NHS, as the heroin addict can. As we all know, it's not the coming off that's the problem, it's the staying off that remains the difficulty. Maybe the funding for addictive disorders needs to be more equitably distributed, less on enforcement and more on treatment and support.