Addiction versus tolerance

I am often asked by patients whether or not they are addicted to their pain medications. I guess a good place to start is to define addiction. Addiction is a compulsive and repetitive action that is harmful to the individual. This implies that you repetitively repeat an action even though you realize it affects are harmful in some way to your existence. There are many addictions, shopping, gambling, drugs, etc. things such as over eating or sex are not really addictions because our body naturally desires them and thus they are biologically hard wired into our desire system, for example, you can’t be addicted to breathing since your body naturally craves it. Thus addiction really involves craving of something that you don’t natural need to survive and that is harmful to your well being. This is where things can get confusing since taking pain medications to actually treat pain is not harmful. It is only harmful when you are taking them for reasons other than pain, such as for depression or to escape reality. Confusion also exists because there is a difference between addiction and tolerance. Addiction, we already discussed. Tolerance is the adaptation to the usage of some substance that causes your body to require more of that substance to get the same effect. Tolerance is a natural reaction to any medication. Tolerance leads to physical dependence on the drug. Physical dependence means that without the particular substance an individual will develop withdrawal symptoms. This occurs with most medications, even blood pressure medications. If you take blood pressure medications and suddenly stop taking them, you’ll experience a withdrawal effect where your blood pressure goes out ragiously high. The same occurs with chronic pain medications except you’ll experience elevated pain along with other effects. Thus, if you take pain medications for legitimate pain then you aren’t addicted to the medications but you can develop a physical dependence or tolerance to them. People who are addicted to pain medications may not realize it due to denial. People may initially start utilizing pain medications for real pain but then they may become addicted to them. Addiction is really a state of mind, some people are more prone to addiction than others, but addiction can occur to most people. Again, denial is a big issue since most addicted people will deny their addiction. That is part of our job as physicians, to reconize addiction in our patients. Commons signs that we look for are common things such as doctor shopping, taking pain pills to treat depression, rapid escalation in drug usage, and other drug seeking behavior. Drug addiction is a serious issue and thousands of people die very years due to drug abuse but we also need to realize that there are people who truly need pain medications for their pain. That is where we, as physicians must inform our patients of the risks but also constantly evaluate our patients for potential addiction. It is a tough job to try to help people but at the same time try to control their behavior. I hope this helps people better understand addiction.

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