Alcohol or Drug Dependence (addiction) occurs when an individual develops a particular neurochemical response to a mood-altering substance. It should not be confused with the chemical effect that each different drug has on an individual (e.g. heroin has a different intoxication effect, withdrawal effect and long-term damage to the individual than alcohol, methamphetamines or benzodiazepines).
The difference between abuse and dependence
Alcohol or drug dependence (addiction) differs from alcohol / drug abuse, or indeed (controlled) alcohol / drug use that can be read about here in that is a lifelong illness that develops in a smallish percentage of people to the use of any mood altering drug. Dependence / compulsion can also occur in relation to mood altering behaviours as is described here. Drug dependence (yes alcohol is just another drug) has to do with the “reward system” in the brain and thus parts of the limbic system. These primitive memory and emotional neurological systems in most animals “reward” certain behaviours, at least partly to preserve the life of the individual and the species. A similar neurochemical response occurs pretty much irrespective of the specific drug being imbibed, and a byproduct of the “reward” is a degree of loss of control (powerlessness) that occurs as the individual considers using more of the drug in order to experience more of the mood altering “good” feeling. In one experiment a rat continued to push a lever dropping small amounts of cocaine into its cage without drinking, eating or sleeping until it died. Of course, human beings have more developed frontal lobe systems than rats that allow us more control over our behaviour (even in the face of an experience that feels amazing). Thus, provided we keep our drug use (or behavioural mood altering experience) within controlled limits we are able to control our drug use behaviour as well as other associated high risk behaviours (eg. Still practicing safe sex or leaving our car at the pub and taking an Uber home). Even for non addicts though, if we imbibe sufficient quantities of a mood altering substance we might reach a point where we lose control (become powerless over the substance we are using) and end up using significantly more than we meant to / practicing other high risk behaviours. Most alcohol users can recall at least one occasion when they drank “too much” and ended up with mild to severe damages / potential damages (where they placed themselves in a higher risk situation but got away with it on that occasion). For example a significant minority of sexually violent crimes occur against individuals who are inebriated at the time. Of course, a rape victim is IN NO WAY EVER IN ANY SITUATION responsible for being raped, no matter what situation they placed themselves in. However, it remains a statistical fact that drug or alcohol inebriation by the victim is definitely correlated with being raped. You can read more on safety precautions that can help prevent you from becoming a victim of rape on my other website Tools for Health and Wellness. Equally, of course many people who are severely inebriated in a social environment do not fall victims to sexual crimes, despite the higher risk environment. Another way of “escaping” potential damages while severely intoxicated might be the guy who drives drunk and yet on this occasion doesn’t drive over a child on their way home. And no driving drunk with “good intentions” does not mean that the driver who does drive someone down bears no responsibility for their actions. Here they are INTENTIONALLY taking a high risk of PERPETRATING an offence, despite admittedly NOT INTENDING for the accident to happen. I digress… the point is that many controlled drinkers have had moments of consuming sufficient quantities of a mood-altering substance that they too have lost control. Most of us controlled users though learn from these experiences and so they dry up (to excuse the pun).
The neurochemical process of addiction
With the neurochemical process of addiction though what develops over time is that the dose correlation between the amount of the substance being consumed and the amount of dopamine being released into the synapse within the reward system changes. Therefore, less and less of the substance is required to achieve the same neurochemical “reward” and associated higher level of powerlessness. Eventually, twenty tequilas by a non-addict might equate to just one by an addict in terms of the reward system effect and resultant loss of control. Hence the Fellowship motto: “One drink, one drunk”. Substance dependence (addiction) is unfortunately a progressive illness and one where while protracted periods of abstinence lead to alleviation of addictive behaviour and diminished cravings, it does not alter the underlying neurochemistry. An addict in recovery who falls off the wagon so to speak will pick up pretty much where they left off, with the same level of powerlessness. Drug / alcohol dependence can over time be seen to differ from drug / alcohol abuse in that the drug abuser eventually comes out of that “phase” and either quits the substance or uses it in a controlled manner. Sadly, due to the progressive nature of substance dependence the neurochemical changes in an addict mean that they only become more powerless over mood altering substances the longer they keep using. Thus, while they might have temporary periods of more controlled use – generally linked to particular life events such as a new romantic partner or new job – their drug / alcohol use ultimately becomes out of control again. In the psychiatric Diagnostic and Statistical Manual 5 (DSM-V) all maladaptive substance use problems are (perhaps unhelpfully) thrown together under Drug Use Disorder (eg. Cocaine Use Disorder or Alcohol Use Disorder). Each of these alcohol or drug use disorders is a Prescribed Minimum Benefits (PMB) condition in South Africa, which means that if you are on a medical aid then (and irrespective of the quality of your medical aid plan) they need to grant you 12 outpatient psychotherapy sessions (at their normal rate). In the psychiatric Diagnostic and Statistical Manual 5 (DSM-V) all maladaptive substance use problems are (perhaps unhelpfully) thrown together under Drug Use Disorder (eg. Cocaine Use Disorder or Alcohol Use Disorder). Each of these alcohol or drug use disorders is a Prescribed Minimum Benefits (PMB) condition in South Africa, which means that if you are on a medical aid then (and irrespective of the quality of your medical aid plan) they need to grant you 12 outpatient psychotherapy sessions (at their normal rate). There are four relevant categories pertaining to Alcohol and Drug Abuse: