More myths about alcohol and other drug addiction.

In the January 2005 issue, I discussed five myths concerning drugs and addiction that I felt treatment professionals needed to know about. That commentary was so popular that I decided to discuss some more.

The following myths are adapted from the University of Texas's Addiction Science Research and Education Center website ("Exploding Drug Myths" folder).

Euphoria equals 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 both are very "addicting" (recent studies indicate that about one-fifth of cocaine users become dependent; about one-third of people who use nicotine products do so). Euphoria is the reason why people use drugs ("to get high"). Dependence occurs in some but not all people who experience euphoria.

Therapeutic painkillers (such as morphine) produce a high rate of addiction. Actually, since we know that "addiction" is actually "dependence" as defined by the DSM-IV, we now know that the likelihood of becoming dependent on opioid painkillers when they are used therapeutically is low. Where the confusion comes in is when people erroneously believe that "withdrawal" is synonymous with "addiction." Many people given these painkillers will go through withdrawal but will never want or need the drug again.

As an example, there is no evidence that hydrocodone products (such as OxyContin) produce more dependence than do other powerful painkillers. On the other hand, drugs containing hydrocodone are highly abused (used by people who want a "high"). This is related to the character of the drug formulations, but the abuse-ability has little to do with the "addictiveness" of the products.

There is a high rate of addiction when stimulants are used to treat ADHD. We do not yet understand why "addicting" drugs produce a low rate of dependence when used therapeutically. Studies have found that few children (accurately diagnosed) with attention-deficit/hyperactivity disorder (ADHD) become dependent upon stimulants such as Ritalin, dextroamphetamine, Adderall, etc. In fact, if such children are not treated, they tend to self-medicate with worse drugs (cocaine, alcohol, marijuana) later in life.

"Marijuana is not addicting." This myth should be put to rest. According to the latest DSM diagnostic criteria and scientific studies, about 9 percent of users can become dependent on ("addicted" to) marijuana. Marijuana, although pharmacologically quite safe compared to alcohol and nicotine, is definitely "addictive" to those people who have a risk for chemical dependence.

Ecstasy is highly addicting. Although this very well may turn out to be true, there is no scientific evidence that Ecstasy produces dependence. Most people don't use the drug long enough to produce serious withdrawal symptoms or other signs of "impaired control over use of the drug." Because of this lack of data, it is not clear whether users of Ecstasy will satisfy the necessary DSM criteria for "drug dependency." (If you believe otherwise, support more research on this drug. We need more factual information.)

People addicted to one drug are addicted to all drugs. While this sometimes occurs, most people who are dependent on a drug may be dependent on one or two drugs, but not all. This is probably a result of how each drug "matches up" with the person's brain chemistry. If a person has a dysregulation of, for example, endorphin function in the mesolimbic reward pathway associated with heroin dependency, he/she might or might not have a dysregulation of dopamine, which would be related to cocaine dependency.

Carlton K. Erickson, Ph.D., is director of the Addiction Science Research and Education Center at the University of Texas at Austin's College of Pharmacy.

References

Brick, J. and Erickson, C.K. Drugs, The Brain, and Behavior: The Pharmacology of Abuse and Dependence. Haworth Press, Binghamton, N.Y. (1999)

www.utexas.edu/research/asrec

By Carlton K. Erickson, Ph.D.

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