Making sense of addiction terminology

February 3, 2012, SAGE Publications

A new editorial released this week offers clarity and structure on confusing drug and alcohol addiction terminology for prescribers, users and regulators. "Through a glass darkly: can we improve clarity about mechanism and aims of medications in drug and alcohol treatments?" is published in the Journal of Psychopharmacology, the official journal of the British Association for Psychopharmacology, published by SAGE.

David Nutt and Anne Lingford-Hughes of Imperial College London's Unit together with Jonathan Chick from Queen Margaret University, Edinburgh suggest that a better understanding of current treatments' modes of action and targets would aid understanding in the field. This should be coupled with clarity as to exactly which or symptom stages each treatment works upon, they recommend.

Nutt's team discuss the differing uses of terms such as addiction and dependence, and outline the three main treatment avenues for addiction or dependence on drugs or alcohol: withdrawal treatment, and abstinence. Withdrawal treatment is typically well understood, but elements of the other two categories remain open to interpretation.

Physicians prescribe substitutes to prevent drug withdrawal, a preferred treatment avenue for many patients. Interaction with treatment providers can lead to patients gaining assistance with other problems, while still dependent on a drug, albeit a less harmful one. Debate still rages about methadone and buprenorphine use for , despite proof that these substitutes can reduce related crime, HIV spread and . Offering benzodiazepines or sodium oxybate (GHB) as a substitute in alcoholism treatment is even more controversial, and is not supported by some guidelines (e.g. NICE, 2011), despite evidence of efficacy. Anti-smoking aids such as patches and gum, though not labelled as such, are 'substitution' therapies because in practice many patients use these long-term.

The authors discuss definitions of abstinence - the most widely recognised goal for addiction treatment. Abstinence strictly means cutting out the addictive substance without substitution. However, some use the term to describe abstinence from street drugs while using substitute medication. Anti-depressants or anti-psychotics may be allowed if there is a mental health issue, where medications which target 'addiction' would be unacceptable.

Harm reduction - any intervention that reduces the harms of drug/alcohol use - includes social measures such as needle exchanges. In the UK this term may mean substitution treatment, particularly for heroin addiction.

The article details opioid substitution therapies, and antagonist medications such as naltrexone and nalmefene that promote abstinence. The authors also look at the pharmacological arsenal against alcohol addiction. Substitution is not such a well-worn route in this case as it is for opioids or tobacco: treatments such as sodium oxybate and baclofen may cut withdrawal and reduce drinking, and physicians can prescribe acamprosate to promote abstinence. Vitamins are also useful in harm reduction. Drink-regulating agents like naltrexone are a recent innovation, which aims to reduce the number of drinks taken at any one session. The exact terminology for this class of drugs has yet to be agreed.

Substitution has been the mainstay of treatment for tobacco addiction for years. The antidepressant bupropion (Zyban) also assists with abstinence from cigarettes. Vaccines against nicotine are also in clinical trials. As yet there are no proven pharmacological treatments for other drug addictions such as cocaine/crack dependence. Cannabis dependence is another recognized problem without proven pharmacological treatment, the authors say.

"We have seen the development and use of different terminologies for different drug addictions, which confuses prescribers, users and regulators alike," says Nutt. "Alcohol/drug dependence and addiction are huge medical as well as social problems for the treatment of which new medications could be helpful. A better understanding of the modes of actions and targets for current treatments is required."

Explore further: Suboxone is most effective in treating painkiller addiction

More information: Through a glass darkly: can we improve clarity about mechanism and aims of medications in drug and alcohol treatments? is published in the Journal of Psychopharmacology, the official journal of the British Association of Psychopharmacology, 26(2), p199 DOI: 10.1177/0269881111410899

Related Stories

Suboxone is most effective in treating painkiller addiction

November 7, 2011
Individuals addicted to prescription painkillers are more likely to succeed in treatment with the aid of the medication buprenorphine-naloxone (Suboxone), report McLean Hospital and Harvard Medical School researchers in today's ...

Study shows young adults want to recover from addiction but need help to make it happen

September 30, 2011
Young adults undergoing addiction treatment arrive ready and willing to make the personal changes that bring about recovery, but it's the help and guidance received during treatment that build and sustain those changes, according ...

Recommended for you

Intensive behavior therapy no better than conventional support in treating teenagers with antisocial behavior

January 19, 2018
Research led by UCL has found that intensive and costly multisystemic therapy is no better than conventional therapy in treating teenagers with moderate to severe antisocial behaviour.

Babies' babbling betters brains, language

January 18, 2018
Babies are adept at getting what they need - including an education. New research shows that babies organize mothers' verbal responses, which promotes more effective language instruction, and infant babbling is the key.

College branding makes beer more salient to underage students

January 18, 2018
In recent years, major beer companies have tried to capitalize on the salience of students' university affiliations, unveiling marketing campaigns and products—such as "fan cans," store displays, and billboard ads—that ...

Inherited IQ can increase in early childhood

January 18, 2018
When it comes to intelligence, environment and education matter – more than we think.

Modulating molecules: Study shows oxytocin helps the brain to modulate social signals

January 17, 2018
Between sights, sounds, smells and other senses, the brain is flooded with stimuli on a moment-to-moment basis. How can it sort through the flood of information to decide what is important and what can be relegated to the ...

Baby brains help infants figure it out before they try it out

January 17, 2018
Babies often amaze their parents when they seemingly learn new skills overnight—how to walk, for example. But their brains were probably prepping for those tasks long before their first steps occurred, according to researchers.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.