There has been much confusion over the concept of addiction, habit, and dependency. Even drug experts have problems with clear definitions. To me, the word are interchangeable because they simply describe repetitious behavior in the presence of a signal for starting that behavior. Somebody lights a cigarette near a smoker and that signals the train of behavior to start smoking. A heroin addict is offered some heroin and he takes it. The strength of the habit, addiction, or dependency depends on how often the person involved responds to the stimulus when it is presented.
A man who cannot refuse a drink has a strong drinking habit. Another who drinks regularly but can easily refuse a drink has a weaker drinking habit. The confusion arises when for some people there seems to be no external signal for the start of the drug-taking behavior. The person merely reports a craving for the drug. In such cases, the drug-taking has been so prolonged that the slightest external signal or internal bodily change can trigger the train of activity for seeking the drug.
Some drugs – heroin, alcohol, and barbiturates – produce profound bodily changes; withdrawal of the drugs creates physical symptoms, among them nausea, trembling, and chills. The onset of such changes, or even the presumed onset, is enough to signal the start of drug-taking for people who have used these a long time. When one observes a person who has been termed an addict one sees an individual who returns again to his drug. If you take it away, he seeks it out. There is nothing different in this from the behavior of a person with a “drug habit” or a person who is “dependent” on a drug.
It is the behavior that counts. The greater his addiction, habit, or dependency – pick your own word – the more persistently does he return to the drug, even in the face of increasing psychological, social, and physical punishment or threat punishment. Many people believe that physical dependency is the only sign of addiction; that is, believe only drugs like heroin are truly addicting because upon withdrawal there are physical symptoms. However, amphetamines and cocaine, for which there are no physical symptoms when the drug is removed, create the same sort of strong habit heroin can.
Indeed, some believe that cocaine is far more addicting than heroin because for many the rewarding nature of the stimulation is more powerful in inducing repetition of the drug-taking behavior. Physical dependency on drugs like heroin, morphine, alcohol, and barbiturates is real enough, however. But the theory of reinforcement suggests that it is only a negative reinforcement of an already established habit. For example, imagine a rat in a cage in which there is a pedal bar that the animal has learned to press with its paw.
At various intervals of time a bell rings within five seconds after the ring an electronic shock is delivered to the rat’s feet unless he presses the bar. After a few experiences with the bell and the shock, that will press the bar every time the bell rings. In the case of addiction, the “bell” is the first vague sense of discomfort that the addict feels when he has not had his drug for a few hours or days. The electric shock is analogous to the nausea, the trembling, the delirium he will feel if he continues to withhold the drug. To avoid the shock of these withdrawal symptoms, the addict takes the drug.
Heroin addicts say they take heroin to “feel normal. ” However, the origin of the habit and whether or not to continue it depend more on the rewarding features of the drug than on the anticipated punishment that accompanies withdrawal. One of the more persistent theories of addiction holds that a drug creates a biochemical change in the body that, in turn, produces the irresistible desire for it. In the case of alcohol, where the chemical problem has been most studied, the search for such a change has proved vain, although there are physical changes that occur over a long period of time.
One is tolerance: drug users find that they must increase their drug intake with time in order to maintain the level of rewarding effects. After a period of tolerance, long-time alcohol drinkers find that less alcohol will produce the desired effect – but that’s only because the liver has become inefficient in destroying the alcohol, allowing more of it to stay in the blood and reach the brain. Another, quite popular theory asserts that addition results from a particular personality deficit. But so far the search for the alcoholic personality or the heroin-addict personality has been in vain.
In part the difficulty stems from the fact that psychologists and psychiatrists can at best only speculate about the addict’s pre-addictive personality and life style, both of which have been dramatically changed by his drug-seeking behavior. The heroin addict, for example, is usually described as weak, immature, and psychologically dependent. But was he that way before he started using heroin? Some drugs experts say yes, but they have little evidence to back up their contention. The sequence of events for drug-habit (addiction) formation for any drug seems to be as follows:
1. The potential drug user finds himself in a social milieu where the use of a particular drug or a number of drugs is common and approved. It is in fashion.
2. Social encouragement from friends or self-encouragement (for social reasons) leads to a few trials of the drug. At first it may produce uncomfortable effects, but these are overridden by stronger reinforcement of self- or social approval.
3. The drug user becomes increasingly aware of its pleasurable effects, which may be tranquilizing, stimulating, delusion creating, sedative, or just diverting.
4.The pleasurable effects can then become the reinforcing agent for the act of taking the drug. The more pleasurable the effects, the more powerful the reinforcement, and the more likely it is that the drug will become a habit or addiction.
5. Those drugs that produce physical dependence, like heroin, morphine, alcohol, and barbiturates (and, some say, cigarettes), negatively reinforce the habit and prevent easy exit. Powerful reinforcing drugs like cocaine and amphetamines can induce strong habits without physical dependence; that is, they may be addictive.