A state of
adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid
dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Physical dependency to opiates/narcotics is a physical disease based on underlying
psychological, environmental, genetic and biochemical issues. This involves the central nervous system and is
caused by long-term opiate intake, changing the normal activity in the brain and neuro-receptors called kappa and mu
receptors. Neurons (cells particular to the nervous system) normally produce their own natural opiates (endorphins);
continued use of opiates cease the production and function, degenerate, and eventually slow down the natural release of
the endorphins which bind to the kappa and mu receptors. These are the naturally occurring endorphins responsible for our
general feelings of wellbeing and the ability to overcome pain. Constant administration of external opiates which also bind
to the kappa and mu receptors, as is the case in opiate addiction, causes grave changes in neuronal function, greatly decreasing
the ability of these cells to produce endorphins.
For the addicted individual, natural endorphins have almost entirely been substituted by outside opiates: the nerve cells
decrease their own endorphin production because they have become dependent upon these external sources. Thus, without these
external sources, the addicted individual who is slowly withdrawn has no tolerance for pain and so experiences increasing
withdrawal discomfort. This is similar to an individual peeling a Band-Aid off very slowly.
Tolerance » A state of adaptation in which exposure to a drug induces
changes that result in a diminution of one or more of the drug's effects over time.
"The defining characteristic of addiction is compulsive, out-of-control drug use despite serious
negative
consequences. . . . "Effective management depends on conceptualizing addiction as a chronic, relapsing medical
illness. . . . "Tolerance and dependence are neither necessary nor sufficient for addiction. Indeed, withdrawal
symptoms from cessation of addiction drug use tend to resolve within days to weeks and therefore cannot account
for the profound persistence of relapse risk, which has been well documented in addicted populations." Nov. 28, 2002, JAMA (vol. 286, No. 20,pp 2586-2594)
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