Dr. MJ Bazos MD,
1. Addicts are bad, crazy, or stupid.
Evolving research is demonstrating that
"addicts" (people who are dependent according to DSM criteria) are not bad
people who need to get good, crazy people who need to get sane, or stupid people
who need education. "Addicts" have a brain disease that goes beyond their use of
2. Everyone who uses cocaine or heroin is
Science is doing its best to develop ways to
diagnose those people who willfully make bad choices about their use of drugs,
and those who are born with or develop pathological dependence (addiction) on
drugs. Most people can use cocaine or heroin for awhile and stop using when they
decide to stop. Others ("addicts") cannot stop without medical and structured
3. Marijuana is not addicting.
According to the latest (DSM) accepted
diagnostic criteria, an unknown percentage of the population can become
dependent ("addicted") to marijuana.
4. Caffeine is addicting.
Actually, caffeine probably is not addicting,
according to DSM criteria. While people have marked withdrawal symptoms from
using too much caffeine, withdrawal alone is not sufficient to diagnose
dependence ("addiction"). Also, caffeine does not have a significant effect on
the "addiction pathway" (medial forebrain bundle) of the brain.
5. Anyone who drinks too much, too often,
is an addict.
A person addicted to (dependent on) alcohol is
called an "alcoholic". If this "myth" were true, then most college students
would be alcoholics, or alcohol addicted. In fact, most college students abuse
alcohol, while some show dependence on alcohol at some point in their drinking
6. You cannot overdose on alcohol.
Alcohol has a lethal dose of around 24 ounces
(1.5 pints) of distilled spirits for a 70-kg (150-lb) male, when the beverage is
drunk rapidly (within one hour or less). The mechanism of death is respiratory
depression (cessation of breathing due to toxic effects of alcohol or aspiration
of, drowning on, one†s own vomit).
7. Club drugs are new, not very dangerous,
Club drugs include ecstasy, GHB, ketamine,
rohypnol, methamphetamine, and LSD. We don†t have much solid research on
club drugs, but most have been around for 10-20 years or more. Emergency room
reports indicate they are very dangerous, especially when mixed with alcohol.
Because they are not from new drug classes, we can predict their effects rather
well. However, we have little evidence about their "addictability".
8. Heroin should be legalized for
treatment of cancer pain.
It is difficult to rationalize the legalization
of heroin, since it breaks down in the body to the legal drug morphine.
Increasing the dose of morphine will give the same analgesic effects as heroin.
9. Crack is more addicting than cocaine
While there are more "crack" addicts observed on
the streets, this is probably because crack is cheaper and easier to obtain than
cocaine powder. But there is no pharmacological reason why the form of a drug or
the route of administration should change the addiction liability of a drug. In
fact, science is beginning to realize that the drug is not the cause of
"addiction"; rather, the susceptibility of the person to the drug determines how
much "addiction" (dependence) develops.
10. Euphoria = addiction.
Euphoria is "a sense of well-being". Cocaine
produces tremendous euphoria, whereas nicotine produces mild euphoria. Yet most
experts agree that nicotine and cocaine are equally "addicting". Euphoria is the
reason why people use drugs ("to get high"). Dependence ("addiction") occurs in
some, but not all, people who experience euphoria. People who experience
dependence have a brain disease.
11. Addiction is a will-power
This is an old belief, probably based upon
wanting to blame addicts for using drugs to excess. This myth is reinforced by
the observation that most "treatments" (including Twelve Steps) for alcoholism
and addiction are behavioral (talk) therapies.
12. Addicts should be punished, not
treated, for using drugs.
Science is demonstrating that addicts have a
brain disease that causes them to have "impaired control" over their use of
drugs. If we want to punish people for using drugs, we should punish those who
are willfully abusing (DSM diagnosis) drugs.
13. Research is less important than
Throughout history, medical diseases have always
been treated before scientists learned the causes of the diseases. Through
research, causes can be found, and better treatments (more effective for more
sufferers, at reduced cost) can be developed. (If we had continued to develop
treatment for polio instead of trying to find the cause, today we would have
computerized iron lungs!)
14. Alcoholics can stop drinking simply by
attending A.A. meetings.
The key word here is "simply". A.A.
doesn†t work for everyone (even for many people who truly want to stop
drinking). For most people, A.A. is a gut-wrenching, lifelong working of the
twelve steps. Scientists theorize that people who "get better" in A.A. are
somehow learning how to overcome (or compensate for) their brain disease.
15. Drugs cause addiction.
An interesting scientific question is: If drugs
cause addiction, then why doesn†t everyone who uses drugs too much, too
often, become dependent ("addicted")? Scientists are looking into the genetic
and other unknown factors that cause some people to become dependent while
sparing others of this brain pathology.
16. Methadone should not be used for
treating heroin addicts.
While methadone is a drug that produces
dependence, methadone has been shown to reduce the craving for the dangerous
illegal drug heroin. By placing an "addict" into a controlled methadone program,
clinicians can monitor the progress of the addict, encourage abstinence from
heroin, help the addict find a job, and gradually reduce the methadone dose.
Some people, however, choose to take methadone in place of heroin, which is less
dangerous than injecting heroin "on the street".
17. LSD causes "madness".
While LSD causes hallucinations, these are
temporary and somewhat different than the hallucinations of schizophrenia. Long
ago, clinicians gave LSD to human volunteers to produce psychotic symptoms, so
they could test potential new anti-psychotic drugs on the volunteers. LSD in
normal people, however, does not cause "madness".
18. THIQs are a cause of alcoholism.
This is an old theory, which was very attractive
in the early 1970s. It suggested that alcoholics, when they drink, form
opiate-like THIQs (abbreviation for several artificially-formed chemicals) in
the brain, to which they become dependent. Later research was not able to
consistently find THIQs in the tissues of alcoholics compared to those of
non-alcoholics. Thus, the "THIQ theory" is no longer popular among most
19. "Crack babies" are a major problem.
Actually, fetal alcohol syndrome babies are a
major problem. While there are babies born of mothers who use cocaine or crack
during pregnancy, most of these women also use other drugs and have other
prenatal problems. "Crack baby" is a pejorative, media-generated term that is
not scientific. Such babies, when they are born, are more accurately described
as "babies in distress".
20. Addicts cannot be medically
Actually, addicts are medically detoxified, when
appropriate, in hospitals all the time. But can they be medically treated after
detox? New pharmacotherapies (medicines) are being developed to help patients
who have already become abstinent to curb their craving for addicting drugs.
These medications reduce the chances of relapse and enhance the effectiveness of
existing behavioral (talk) therapies (including Twelve Steps). Such drugs
include naltrexone (ReVia) and bupropion (Zyban).
21. Drugs have equal addiction
It is logical to consider that every drug is not
equally addicting. Addiction potential is related to many factors, including the
susceptibility of the individual to dependence production, and the ability of
the drug to act at the "addiction site" (the brain's pleasure center).
Obviously, all drugs are not the same in their site of action in the brain.
Criteria for Drug Abuse and
A. A maladaptive pattern of drug
use leading to impairment or distress, presenting as one or more of the
following in a 12-month
recurrent use leading to failure to fulfill major
recurrent use which is physically
recurrent drug-related legal
continued use despite social or interpersonal
B. The symptoms have never met the
criteria for substance
A. A maladaptive pattern
of drug use, leading to impairment or distress, presenting as three or more of
the following in a 12-month period:
- tolerance to the drug's actions
- drug is used more than intended
- there is an inability to control drug
- effort is expended to obtain the drug
- important activities are replaced by drug
- drug use continues in spite of negative
B. Two types of
dependence can occur:
- with physiological dependence (with item 1 or 2),
- without physiological dependence (neither item 1
Adapted from the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 1994, published
by the American Psychiatric Association, Washington, D.C. Also available in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision (DSM-IV-TR), 2000.