Addiction

Etymology and introduction of the term in Psychopathology

The addiction term is of etymology Latin E, AD-dicere “to say to”, and expressing a membership in term of Esclavage.

To be addicté was thus, with the Moyen-âge, a ordinance of a Tribunal, obliging the Débiteur which could not refund its Dette differently, to pay its Créancier by its work.
Thereafter, in the language English E, as of the 14th century, addiction could indicate the contractual Relation of Soumission of a Apprenti with his Maître, then to approach the modern direction little by little, by indicating passion S nourished and morally répréhensibles.
Toujours in English language, the word addiction is completely integrated in the popular speech to indicate all devouring passions and the dependences (it is a sex-addict - a sexual addicté, has one says Bill Clinton time of the business Monika Lewinsky), within the framework of the culture American E, of origin Puritan E, which preaches the Lutte against of such passions attached to the unrestrained research of the Plaisir. It is this popularity of the term among Anglo-Saxons which explains its ambiguity: the Scientifique S english-speaking often hesitate to use it (for example, it was withdrawn from DSM-IV, the American and international handbook of psychiatric diagnosis S, with the profit of the term of “dependence”), whereas other scientists apparently use it without problem, granting a Définition to him precise and operational. In the French-speaking countries (with share the Quebec), the word new and being used by the specialists, it has from the start one will have scientific.

It is Freud which it first used the term by illustrating a “primitive need” (letters with Wilhelm Fliess) which belongs to the condition of any human being: the Infans is dependant on his/her mother for her survival. It is of this paramount state which would have badly evolved/moved that the “addictions would derive”.

Karl Abraham in 1908, Sandor Rado in 1933, Otto Fenichel in 1945 and Herbert Rosenfeld in 1968 are Psychanalyste S which contributed to enrich the definition by the term by deepening it. It was a question for them of analyzing of them the mechanisms unconscious, instinctual, regressive and different from the psychotherapeutic and psychoanalytical point of view.

Concept of dependence

The dependence characterizes the whole of Symptôme S which appears in relation to the catch of a specific substance. The weaning belongs to this whole of symptoms.

The dependence term thus has a direction less broad than the addiction term.

The dependence is one of the factors being used to evaluate the dangerosity of the Drogue S ( to see detailed article Classification of psychotropic the ).
It is estimated by the efforts made to get the product and by energy spent to arrive at the Abstinence.
It is variable according to two big factors: properties of product (pharmacological properties, mode of consumption, degree of purity, etc) and the predisposition of the user (personality, antecedent of use, personal situation, etc).

Dependence according to the DSM-IV

DSM-IV presents the dependence like an inappropriate mode of use of an involving product of the physical and psychic signs. It appears by the appearance from at least three of the signs hereafter over a one year period.

a tolerance which results either in an increase in the amounts for a similar effect, or by a clearly decreased effect if the amounts are maintained in their initial state.
a syndrome of weaning in the event of stop or a catch of the product to avoid a syndrome of weaning.
an incapacity to manage its own consumption, the user consumes longer or more than he wanted it.
of the unfruitful efforts to control consumption.
an increasingly important time is devoted to the research of the product.
the social activities, cultural or of leisure are abandoned because of the importance which takes produces it in the daily life.
a continuation of consumption in spite of the conscience of the problems which it generates.

Dependence according to the CIM-10

CIM-10 presents the dependence like the demonstration from at least three of the signs hereafter over a one year period and having persisted at least a month or having occurred in a repeated way.

a compulsif desire to consume the product.
of the difficulties of controlling consumption.
appearance of a syndrome of weaning in the event of stop or reduction of the amounts or a catch of the product to avoid a syndrome of weaning.
a tolerance with the effects (increase in the amounts to obtain a similar effect).
a total disinterest for all that does not relate to the product or its research.
a continuation of consumption in spite of the conscience of the problems which it generates.

Types of dependences

One distinguishes two types of dependences.

physical dependence: state where the organization compares to its own operation the presence of a developing product of the sometimes serious physical disorders in the event of lack (non-attendance of the product in the organization), the whole of these disorders constituting what is called the syndrome of weaning. The physical dependence is related to the adaptation mechanisms of the organization to a prolonged consumption and can be accompanied by a Accoutumance.
psychological dependence: insistent and persistent desire to consume which can sometimes result in psycho-somatic demonstrations (true physical pains without physiological cause). The psychological dependence is much related to the characteristics of the individuals (emotional practices, states, lifestyles) that with the product itself. Very widespread examples of psychological dependence are the Dépendance with work, with the physical-activity or intellectual, which can sometimes lead to overwork. A Anglo-Saxon term indicates it under name “ Workaholic ”.

The distinction is not completely any more of topicality from the point of view of current research and especially for the treatments, one being intricate with different in a sometimes indistinct way.

Mechanism

Regarded a long time as a character trait marked by the absence of will, the psychic mechanisms of the addiction are now better known and one starts to distinguish better and better the centers from the brain implied by the dependence even if this research remains very complex to interpret.

The diagram drawn from the Béhaviorisme highlights on its side the dysfunction of the Reward system which would be the pivot of the phenomena of dependence.

Psychoanalytical interpretation rests on the question of ontogenetic developments relating to the satisfaction of the needs (hunger, love, etc) and to their intrication with the sexual instinct (Libido) and destructiveness. Freud in the second topic tried to elucidate the compulsion to repeat like a manifestation of the Death instinct. Its successors took again these theories under the angle of the object-relationships ( the Absence of Pierre Fédida) or the Ordalie as mechanism Inconscient at the base of the play between life and died.

The question of the predisposition Génétique still remains to be elucidated.

Many psychic theories, Neurological S and Biologique S try to explain the mechanisms of the addiction and that of the dependences.

The simple explanation of the cycle defined by the regulation of Endorphine S interns and external insufficient and is exceeded. SNC is probably more complex than this kind of diagram.

Treatments of the addictions

It evolved/moved, initially aiming at treating the individual, then in a more systemic approach, seeking to include/understand and treat the whole of the problem, of the networks gangster and financial of production of drugs upstream to the problem sociétal and family. The majority of the countries established a planning of the care often especially based on more or less repressive legislative measures and large campaigns of information and prevention.
For example, in France, within the framework of the General states on the prevention , new a Plan addictions 5 years was presented in November 2006 by the Minister for health and solidarity, which will reinforce the specialized consultations of care and accompaniment of the patients, but a.N.P.A.A. which wishes to take part in this plan considers it regrettable that to 26 recommended measures, none relates to the prevention of proximity which she considers essential. (which lost 20% of its subsidies in 2006, which obliged it to lay off several organizers.

The treatment aims initially the Abstinence for the drug addicts, thanks to a weaning acquired by various means, with or without Opiacé S in decreasing amounts, in hospital or ambulatory medium, with or without support of a Psychothérapie. These methods concern primarily the dependant people with opiates until the Années 1980 where the policy changes for the whole of the treatments.

The AIDS and the fight against its diffusion involve the treatment of the héroïnomanes in the medical field of the epidemic S. the substitution therapies with the Méthadone take the step on any other form of therapy. One starts to speak about policy of Réduction of the risks by privileging a medical approach by in particular the distribution of the syringes, the widening of the indications to the treatments Méthadone, even of the controlled distribution of heroin in certain countries (Suisse, Canada) with provision of buildings of injections clean and tallied by ancillary medical personnel.

Until the appearance and the recognition - late in France - importance of the AIDS and its diffusion by divisions of materials of injections, the treatments of drug-addiction was the object of many controversies.

For some, the opiate are necessary to the drug addicts via an analogy with the diabetic and his Insuline. It is then a question of widely distributing the methadone which must stabilize drug-addiction by helping the patients to leave the illegality and while giving access to him a certain autonomy.
For others (Claude Olievenstein), this legal drug-addiction or medicalized replaces an alienation by another. For them, the goal is then to help of the héroïnomanes to leave their dependence while reaching freedom. It is also a question of countering therapeutic Secte S or communities of which some promulgate a brutal conditioning.

The appearance of the AIDS will support the installation of methods aiming at limiting the transmission of the virus relegating for some to the second plan the question and the psychological or social significance of drug-addiction.

It has as been for this time as one speaks more dependence and that this category extends to all forms of conduits and/or abuse. Some think that this extension to the disadvantage of throwing the disorder on the question from the psychopathological point of view and that it is difficult to establish a bond between a addict with the video games or the car, and a cocaine addicts or alcoholic in addition to their difficulties of fighting against their “ need”.

These two approaches are at the origin of a sometimes virulent controversy.

Criteria of addiction

They are numerous and vary as much as the theoretical points of view and references which underlie them. But the majority of them are built on the model known as Bio-Socio-Psycho who renvoit with the biological aspects (potential addictogene of the product, possible previous genetic), with the sociological aspects (context, home environment, school, etc) and with the psychological aspects (personality of the subject).

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