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Heroin Addiction and Related Clinical Problems: 2001, 03, 2 (pages: 7 - 20)

The problem of drug dependence

Tagliamonte A., Maremmani I.

Summary: Knowledge about psychoactive substances has always had to challenge sociocultural dogmas and expectations, which usually prevail over scientific evidence. Along with that, addictive disorders have mostly been thought to arise from a choice of inappropriate sources of stimulation and blame addressed at addicts who lack judgement. The definition and assessment of the differences between use, abuse and dependence have therefore been a controversial matter. Stimuli differ in nature and different dynamics are there for behaviours to be elicited and structured. Some objects are pursued along with the need for them, as soon as they become unavailable, whereas others are craved for most strongly when they are available. Behavioural dynamics are crucial in discriminating between what we struggle not to run out of, and what we strive to win, i.e. between loss avoidance and self-empowerment. Need-satisfying behaviours tend to dwindle through satisfaction, and develop through the experience of frustration, whereas pleasure-seeking is reinforced by success and is structured upon subjective reward. Both forms of behaviour are displayed as habits, and stay functional as long as control over behavioural production is maintained. The neurobiological bases for these conceptualizations are discussed, and clinical models are described to draw a line between physiological habits and addictive diseases, and between benign transient behavioural conditioning and the proneness to malignant relapse which underlies true addiction. The debate on addictive diseases, setting aside the question of resorting to irrational methods, should be referred to strictly medical models, so as to let meaningful interventions follow scientific knowledge.