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Are You Drug Dependent? Don't sweat it

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AMERICAN SOCIETY ADDICTION MEDICINE
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As an addiction scholar and activist, few things annoy me more than all this talk about "dependence" as a problem. I have written about this already in HuffPo as it pertains to methadone. But it's an important matter, applying to issues ranging from medical marijuana to sexual partnerships, and warrants a thorough revisit. All over the media people talk of drug and relationship dependence as issues to be fixed.

Often, dependence of any kind is presumed - without reflection - to be a problem that must be solved. For the record, every human being depends on air, food and water - are we all sick, or defective, for this reason?

Living as we do in a culture that holds independence in high regard, where self-starters are revered, it should not be surprising that sometimes our civilization gets blinded by its own light. Western individualism is a beautiful thing, affording us freedom of speech as well as freedom for sexual, religious and artistic expression. None of this means, however, that we cannot overdo it and simply run away with our ideals.

I will clear the air: if someone's only problem is drug dependence or relationship dependence, they do not need treatment (or punishment). They need a drug, or a relationship.

This applies to those who depend on insulin to survive, and to others who need antihistamines. It also applies to many forms of chemical dependency that may be more controversial, or even at odds with the law. It applies to sexual and other partnerships, be they gay, straight, familial, or something else.

Beyond the cultural backdrop, here's some medical information: With substance use disorders, dependence is the term most often used in psychiatric literature. Typically, seven symptoms are associated with clinical "dependence", and one must show at least three (within a 12 month span) just to rate among the mildest of cases (with seven out of seven normally indicating the worst of difficulties). The two main symptoms associated with physical dependence - withdrawal and increasing tolerance - are not enough even to put someone at the mild end of the pathological spectrum. Other issues - such as loss of control, obsession, and neglect of one's personal or professional duties - are required for a substance use disorder diagnosis. On it's own, physical dependence is not problematic. But this semantic foible has helped to give "dependence" a bad name in the public mind.

The same applies to emotional and other types of dependence. There is no such thing as a problem due only to dependence. There has to be a problem on top of the dependence - that is to say it must be a kind of dependence that is no good (such as emotional attachment to an abuser).

Recap: an unrealistic conception of independence - one that could only emerge in a hyper-individualistic capitalist culture - has fueled some very sloppy, and very harmful, thinking on addiction related issues. Should this be taken as an indictment of individualism or capitalism? Hardly - it is simply an acknowledgement that every culture has its quirks, and that we should be cognizant of our own.

Due to the confusion that has been generated by misuse of the term dependence, official psychiatric bodies are currently considering designating substance use disorders as addictions, and to lose the term "dependence". The term addiction was nixed years ago because it was thought to stigmatize the afflicted. Fair enough, but we have since learned that "dependence" has brought stigma and unnecessary attention to persons who depend on this or that without harm or trouble.

Many in the field, myself included, have been advocating for bringing back the term addiction. Despite some imperfections, it's the best word we have. And nothing could be worse than "dependence" - a vague and useless term that can apply even to our rapport with air, water and food.