Alex Vasauskas wrote in a message to Douglas Anderson:
 TJ> What IS THE Difference BETWEEN ADDICTION AND dependence. I ran out of
 TJ> meds and started getting the shakes and I was having strange feelings
 TJ> almost like an LSD trip. I think they are as addictive as opiates
 DA> Physical and psychological dependence means that if you stop taking
 DA> the drug you will go through a withdrawal syndrome, such as the
 DA> shakes and strange feelings you were having.
 AV> Physical addiction by definition involves a physiological
 AV> withdrawal effect.  Psychological addiction means that you
 AV> repeatedly seek to duplicate an experience because you
 AV> desire the experience 
No, when are speaking of drug-seeking behavior, which is what you have 
described, we are talking about addiction - not dependence.  Any time we use 
the term dependence we are speaking of the potential for withdrawal effect, 
whether it is physiological withdrawal for physical dependence, or 
psychological withdrawal for psychological dependence.  To contrast, 
tricyclic antidepressants have demonstrated a well defined psychological 
withdrawal syndrome, although they do not cause physical dependence (thus 
they are not a scheduled drug).  On the other hand, benzodiazepines cause 
both psychologic dependence and physical dependence causing both 
psychological and physical withdrawal syndromes (thus they are scheduled 
drugs). A patient may be either physically or psychologically dependent upon 
a benzodiazepine without "seeking to duplicate the experience" or being 
addicted.  
 DA>   Everyone who is addicted is dependent, but
 DA> not everyone who is dependent is addicted.  I take blood pressure
 DA> medicine.  If I quit taking my medicine I go through a well-defined
 DA> withdrawal syndrome.  I am physically dependent on my blood
 DA> pressure medicine.  But calling me addicted to it would be
 DA> ridiculous.
 AV> Why?  Because you attach a different emotional meaning to
 AV> the words? Of course, no one probably considers themselves
 AV> addicted to air or water although we are dependent on them. 
Exactly.  My point is that the term addiction is used very loosely by health 
care professionals (I am a professor of pharmacy and medicine), without 
realizing the emotional impact of the terms on the patients.  Telling a 
mother whose child is using phenytoin for controlling seizures that her child 
is addicted to the phenytoin is like hitting her with an emotional sledge 
hammer.  However, telling her that he is dependent on the medication to 
prevent seizures is much gentler, and really much more accurate.  All I am 
asking for, and standing on the soapbox about, is accuracy in the 
rminology.
 AV> But, if you define addiction as the body's dependence
 AV> on a non-essential substance the withdrawal of which results
 AV> in a physical syndrome, it seems that dependence on that
 AV> substance (in your case a drug) is the same as addiction. 
That isn't how I'm defining addiction.
 AV> There is also the assumption that addiction in itself is
 AV> inherently bad.  
Right, absolutely.  And if you define addiction as you have above, equating 
it with physical dependence, then that isn't necessarily so.  What I'm saying 
is that we cannot equate physical dependence and addiction in our 
rminology.
 AV> life.  For example, there are physicians who will withhold
 AV> painkillers from hurting and even terminally ill patients
 AV> because the patients might become addicted.  This is absurd
I agree wholeheartedly.   And I believe that the terminology is part of the 
problem that creates this situation.
 AV> It is amazing how self-righteously hypocritical
 AV> humans can be in
 AV> their "morality".
Again I agree.  We may not be able to end self-righteous hypocrisy, but we 
can be clear about what terms mean when we use them.
Douglas
doogie@fiona.umsmed.edu
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