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Understanding Addiction

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UNDERSTANDING ADDICTION

The word “addiction” may conjure up an image of a sluggish heroin junkie or an erratic crack head. It could also bring to mind a chain smoker or a staggering drunk. Once reserved to describe the state of clinical dependence on a substance as a result of extended abuse, the concept of addiction is widening and includes activities that seem less obviously harmful at the surface. Addiction may not always be as visible as track marks or as noticeably threatening as a drunk-driving accident. The concept of addiction isn’t just abstract to the layperson. It’s been controversial within the mental health community as well. The most widely-used reference in the medical mental health community, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is due to be published by the American Psychological Association in its fifth revision in April 2013. Its purpose is to create a common language between practitioners so that diagnoses will be consistent from one clinician to the next (DSM-5 Development). In the book, the word “addiction” was forgone in favor of either “substance dependence” or “substance abuse,” in a very narrow decision. Charles O’Brien, a member of the committee that worked on the revision between DSM-III and DSM-IV, stated that the difference was a single vote. In an editorial published in the American Journal of Psychiatry, O’Brien urged the committee responsible for the changes being made in the fifth revision not to make the same mistake as they made in the 1980s, which he believes has prevented patients from receiving adequate classification and care in that time. This denial, he says, comes as a result of equating “dependence,” which is the normal physiological reactions of tolerance and withdrawal associated with repeated doses of a medication, with the stigma of addiction, especially for those who need…...

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