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Variations in addiction: The molecular and the molar in neuroscience and pain medicine

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Abstract

This article critically examines two versions of addiction, the neuroscientific model of addiction as a brain disease and the behavioural model of addiction developed by pain medicine. By juxtaposing these different ways of seeing and acting on addiction, the article challenges the assumption that addiction is a constant and singular entity that can be identified outside a particular context. It also highlights the uses, limitations and tensions of each approach. The molecular gaze of the chronic relapsing brain disease model has the potential to undermine the stigmatization of addicts, while the therapeutic gaze of pain medicine recognizes that changes in the brain produced by long-term drug use are not in themselves pathological. The article suggests that the brain disease model is limited in its scope because it removes addiction from the social context in which it is experienced. On the other hand, the molecular knowledge produced by brain-based research is likely to challenge the ability of pain medicine to maintain clear-cut distinctions between dependence, the drug-seeking behaviour of pain patients and addiction.

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Notes

  1. For example, the current Wikipedia entry on addiction states that ‘in medical terminology, an addiction is a state in which the body relies on a substance for normal functioning and develops physical dependence, as in drug addiction’. However, it explains, ‘common usage of the term addiction has spread to include psychological dependence, enabling it to be applied to problems like compulsive overeating’ (emphasis added). Here the physical/psychological distinction is used to distinguish between a dependence on psychoactive substances (real addiction) and a dependence on non-drug activities (metaphorical addiction).

  2. One of the arguments for replacing the term substance dependence with the term addiction is that it is less likely to be confused with physical dependence.

References

  • Aronoff, G.M. (2000) Opioids in chronic pain management: Is there a significant risk of addiction? Current Review of Pain 4: 112–121.

    Article  Google Scholar 

  • Acker, C. (2003) Take as directed: The dilemmas of regulating addictive analgesics and other psychoactive drugs. In: M.L. Meldrum (ed.) Opioids and Pain Relief: A Historical Perspective. Seattle, WA: IASP Press, pp. 35–55.

    Google Scholar 

  • American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th edn, text revision, Washington DC: American Psychiatric Press.

  • Ballantyne, J. and LaForge, K.S. (2007) Opioid dependence and addiction during treatment of chronic pain. Pain 129: 235–255.

    Article  Google Scholar 

  • Bell, K. and Salmon, A. (2008) Pain, physical dependence and pseudoaddiction: Redefining addiction for ‘nice’ people? International Journal of Drug Policy 20: 170–178.

    Article  Google Scholar 

  • Brena, S.F. and Sanders, S.H. (1991) Opioids in nonmalignant pain: Question in search of answers. The Clinical Journal of Pain 7 (4): 342–345.

    Article  Google Scholar 

  • Brennan, F., Carr, D.B. and Cousins, M. (2007) Pain management: A fundamental human right. Anesthesia & Analgesia 105 (1): 205–221.

    Article  Google Scholar 

  • Borsook, D. et al (2007) Reward-aversion circuitry in analgesia and pain: Implications for psychiatric disorders. European Journal of Pain 11: 7–20.

    Article  Google Scholar 

  • Compton, P. (2008) Should opioid abusers be discharged from opioid-analgesic therapy? Pain-topics.org 2 January, http://pain-topics.org/pdf/Compton-OpioidUseProblems.pdf, accessed 19 January 2009.

  • Compton, W.M. and Volkow, N.D. (2006a) Abuse of prescription drugs and the risk of addiction. Drug and Alcohol Dependence 83S: S4–S7.

    Article  Google Scholar 

  • Compton, W.M. and Volkow, N.D. (2006b) Major increases in opioid analgesic abuse in the United States: Concerns and strategies. Drug and Alcohol Dependence 81: 103–107.

    Article  Google Scholar 

  • Craig, D. (2006) Emotions and psychobiology. In: S.B. McMahon and M. Koltzenburg (eds.) Wall and Melzack's Textbook of Pain, 6th edn. Philadelphia, PA: Elsevier.

    Google Scholar 

  • Cromie, W.J. (2002) Pleasure, pain activate same part of brain. Harvard University Gazette, http://www.hmo.harvard.edu/gazette/2002/01.31/01-pain.html, accessed 19 January 2009.

  • Doweiko, H.F. (1993) Concepts of Chemical Dependency. Pacific Grove, CA: Brooks/Cole Publishing.

    Google Scholar 

  • Fiellin, D. and O'Connor, P. (2002) Office-based treatment of opioid-dependent patients. New England Journal of Medicine 347: 817–823.

    Article  Google Scholar 

  • Fraser, S. and valentine, k. (2008) Substance & Substitution: Methadone Subjects in Liberal Societies. New York: Palgrave Macmillan.

    Book  Google Scholar 

  • Gallagher, R. (2005) Opiods for intractable pain: The good, the bad and the ugly. Pain Medicine 8 (2): 103–104.

    Article  Google Scholar 

  • Gourlay, D.L., Heit, H.A. and Almahrezi, A. (2005) Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. Pain Medicine 6 (2): 107–112.

    Article  Google Scholar 

  • Heit, H.A. (2001) The truth about pain management: The difference between a pain patient and an addicted patient. European Journal of Pain 5 (A): 27–39.

    Article  Google Scholar 

  • Hunt, S.P. and Urch, C.E. (2006) Pain, opiates and addiction. In: S.B. McMahon and M. Koltzenburg (eds.) Wall and Melzack's Textbook of Pain, 6th edn. Philadelphia, PA: Elsevier.

    Google Scholar 

  • Hyman, S.E. (2005) Addiction: A disease of learning and memory. The American Journal of Psychiatry 162 (8): 1414–1422.

    Article  Google Scholar 

  • International Association for the Study of Pain. (2007) IASP Pain Terminology, http://www.iasp-pain.org/AM/Template.cfm?Section=Pain_Definitions&Template=/CM/HTMLDisplay.cfm&ContentID=1728, accessed 17 January 2009.

  • Jovey, R.D. et al (2003) Use of opioid analgesics for the treatment of chronic noncancer pain – A consensus statement and guidelines from the Canadian Pain Society, 2002. Pain Research and Management 8 (A): 3A–14A.

    Article  Google Scholar 

  • Keane, H. (2002) What's Wrong with Addiction? Melbourne, VIC: Melbourne University Press.

    Google Scholar 

  • Keane, H. (2008) Pleasure and discipline in the use of Ritalin. International Journal of Drug Policy 19 (5): 401–409.

    Article  Google Scholar 

  • Kirsh, K.L., Jass, C., Bennett, D.S., Hagen, J.E. and Passik, S.D. (2007) Initial development of a survey tool to detect issues of chemical coping in chronic pain patients. Palliative and Supportive Care 5: 219–226.

    Article  Google Scholar 

  • Koob, G.F. (2006) The neurobiology of addiction: A neuroadaptational view relevant for diagnosis. Addiction 101 (1): 23–30.

    Article  Google Scholar 

  • Koob, G.F. et al (1999) Neurobiology of drug addiction. In: M. Glantz and C. Hartel (eds.) Drug Abuse: Origins and Intervention. Washington DC: American Psychological Association, pp. 161–190.

    Chapter  Google Scholar 

  • Krivanek, J. (1988) Addictions. Sydney, NSW: Allen & Unwin.

    Google Scholar 

  • Kuhar, M. (2010) Contributions of basic science to understanding addiction. BioSocieties 5 (1): 25–35.

    Article  Google Scholar 

  • Large, R.G and Schug, S.A. (1995) Opioids for chronic pain of non-malignant origin – caring or crippling. Health Care Analysis 3 (1): 5–11.

    Article  Google Scholar 

  • Leshner, A.I. (2001) Addition is a brain disease. The Addiction Recovery Guide Website, http://www.addictionrecoveryguide.org/articles/article151.html, accessed January 2009.

  • Levine, H.G. (1978) The discovery of addiction: Changing conceptions of habitual drunkenness in America. Journal of Studies on Alcohol 39 (1): 143–174.

    Article  Google Scholar 

  • Littlejohn, C., Baldacchino, A. and Bannister, J. (2004) Chronic non-cancer pain and opioid dependence. Journal of the Royal Society of Medicine 97: 62–65.

    Article  Google Scholar 

  • Lusher, J., Elander, J., Bevan, D., Telfer, P. and Burton, B. (2006) Analgesic addiction and pseudoaddiction in painful chronic illness. The Clinical Journal of Pain 22 (3): 316–324.

    Article  Google Scholar 

  • Loitman, J.E. (2000) Pain management: Beyond pharmacology to acupuncture and hypnosis. Journal of the American Medical Association 283 (1): 118–119.

    Article  Google Scholar 

  • McLellan, A.T., Lewis, D.C., O'Brien, C.P. and Kleberg, H.D. (2000) Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association 284 (13): 1689–1695.

    Article  Google Scholar 

  • MacDonald, G. and Leary, M. (2005) Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin 131/2: 202–223.

    Article  Google Scholar 

  • Manchikanti, L. (2006) Prescription drug abuse: What is being done to address this new drug epidemic? Pain Physician 9: 287–321.

    Google Scholar 

  • Massachusetts General Hospital. (2001) Study finds brain’s reward areas also activated by pain; imaging study may lead to improved diagnostic, treatment methods. Science Daily, http://www.sciencedaily.com/releases/2001/12/011206073539.htm, accessed 19 January 2009.

  • Meldrum, M.L. (2003a) A capsule history of pain management. Journal of the American Medical Association 290 (18): 2470–2475.

    Article  Google Scholar 

  • Meldrum, M.L. (2003b) The property of euphoria: Research and the cancer patient. In: M.L. Meldrum (ed.) Opioids and Pain Relief: A Historical Perspective. Seattle, WA: IASP Press, pp. 131–139.

    Google Scholar 

  • Melzack, R. (1990) The tragedy of needless pain. Scientific American 262 (2): 27–33.

    Article  Google Scholar 

  • Newlin, D.B. (2008) Are ‘physiological’ and ‘psychological’ addiction really different? Well, no!…um, er, yes? Substance Use & Misuse 43 (7): 967–971.

    Article  Google Scholar 

  • Pasero, C.L. and Compton, P. (1997) Pain control: When does ‘drug-seeking’ behaviour signal addiction? The American Journal of Nursing 97 (5): 17–18.

    Google Scholar 

  • Passik, S.D. and Kirsh, K.L. (2004) Assessing aberrant drug-taking behaviors in the patient with chronic pain. Current Pain and Headache Reports 8 (4): 289–294.

    Article  Google Scholar 

  • Portenoy, R.K. (1996) Opioid therapy for chronic non-malignant pain: Clinicians’ perspective. Journal of Law, Medicine & Ethics 24 (4): 296–309.

    Article  Google Scholar 

  • Portenoy, R.K. (2000) Current pharmacotherapy of chronic pain. Journal of Pain and Symptom Management 19 (1): S16–S20.

    Article  Google Scholar 

  • Portenoy, R.K. and Foley, K.M. (1986) Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases. Pain 25 (2): 171–186.

    Article  Google Scholar 

  • Quintner, J.L., Cohen, M.L., Buchanan, D., Katz, J.D. and Williamson, O.D. (2008) Pain medicine and its models: Helping or hindering? Pain Medicine 9 (7): 824–834.

    Article  Google Scholar 

  • Robinson, T.E. and Berridge, K.C. (2003) Addiction. Annual Reviews in Psychology 54: 25–53.

    Article  Google Scholar 

  • Room, R. (1998) Alcohol and drug disorders in the international classification of disease: A shifting kaleidoscope. Drug and Alcohol Review 17: 305–317.

    Article  Google Scholar 

  • Rose, N. (2003) The neurochemical self and its anomalies. In: R.V. Ericson and A. Doyle (eds.) Risk and Morality. Toronto, ON: University of Toronto Press, pp. 407–437.

    Google Scholar 

  • Rose, N. (2007) The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. New Jersey: Princeton University Press.

    Book  Google Scholar 

  • Rosenblum, A., Joseph, H., Fong, C., Kipnis, S., Cleland, C. and Portenoy, R.K. (2003) Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. Journal of the American Medical Association 289 (18): 2370–2378.

    Article  Google Scholar 

  • Saunders, J.B. (2006) Substance dependence and non-dependence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD): Can an identical conceptualization be achieved? Addiction 101 (1): 48–58.

    Article  Google Scholar 

  • Savage, S.R. (1996) Long-term opioid therapy: Assessment of consequences and risks. Journal of Pain and Symptom Management 11 (5): 274–286.

    Article  Google Scholar 

  • Savage, S.R, Covington, E.C., Heit, H.A, Hunt, J., Joranson, D and Schnoll, S.H. (2001) Definitions related to the use of Opioids for the treatment of pain: A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine, http://www.painmed.org/pdf/definition.pdf, accessed 26 October 2009.

  • Seymour, J., Clark, D. and Winslow, M. (2005) Pain and palliative care: The emergence of new specialities. Journal of Pain and Symptom Management 29 (1): 2–13.

    Article  Google Scholar 

  • Streltzer, J. and Johansen, L. (2006) Prescription drug dependence and evolving beliefs about chronic pain management. American Journal Psychiatry 163 (4): 594–598.

    Article  Google Scholar 

  • Sullivan, R.J. and Hagen, E.H. (2002) Psychotropic substance-seeking: Evolutionary pathology or adaptation? Addiction 97: 389–400.

    Article  Google Scholar 

  • Weaver, M. and Schnoll, S. (2007) Addiction issues in prescribing opioids for chronic non-malignant pain. Journal of Addiction Medicine 1 (1): 2–10.

    Article  Google Scholar 

  • WHO Expert Committee on Drug Dependence. (1993) WHO Expert Committee on Drug Dependence: 28th Report. Geneva: World Health Organization. WHO Technical Report Series 836.

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Acknowledgements

The authors are grateful to the organizers and participants of the ‘Addiction, the Brain and Society Conference’ for providing a stimulating forum for the presentation of this work. Comments from Caroline Acker, David Courtwright, Deanne Dunbar, Howard Kushner, Colin Talley and Scott Vrecko deserve particular acknowledgement.

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Authors and Affiliations

  1. School of Humanities, Australian National University, Canberra, ACT 0200, Australia

    Helen Keane

  2. Coffs Harbour Health Campus, Coffs Harbour, New South Wales, 2450, Australia

    Kelly Hamill

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Correspondence to Helen Keane.

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Keane, H., Hamill, K. Variations in addiction: The molecular and the molar in neuroscience and pain medicine. BioSocieties 5, 52–69 (2010). https://doi.org/10.1057/biosoc.2009.4

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