I posted last night (you can tell this is serious, I really am blogging on the weekend!) about the concept of “Prozac withdrawal”. I drew a little heat from Drugmonkey about this, due to the distinction I used between “physical” and “psychological” addiction. I’ll repost what he said here:
Physical addiction should be distinguished from psychological addiction…. almost all addictive drugs are a mixture of physically and psychologically addictive.
Awww, sciC why’dya have to go and add this to such a fantastic* post? This notion is complete and utter bollocks and even worse is demonstrably harmful to the goal of getting those suffering from addiction disorders the medical treatment they need.
The trouble is that you delving into dualistic nonsense as if the “psyche” was not entirely a result of the structure and function of the body, mostly the brain. What you term “craving” is just as assuredly a “physical” effect of drug abstinence after chronic exposure as is constipation. Second, the connotation is ALWAYS that so-called “psychological” dependence issues are less important and less real. Which dredges up the notion that people should just get over it, cure themselves with will power or morals, etc. Acutely harmful, that. Thirdly, this mental set keeps us from understanding that the real problem at hand in drug abuse is indeed (long term) craving. The acute stages of withdrawal? We can deal with that relatively easily and cheaply. Life long proclivity to relapse to drug taking? Not so much.
Drugmonkey is absolutely right, and Sci considers herself justifiably spanked. So I’m feeling sheepish, and I think I need to try and rectify this situation, and get myself all better in the eyes of Drugmonkey, so I don’t have to cower in his presence the next time I see him, and then he won’t buy me drinks, and then I’ll cry. And more importantly, I want to be a better scientist than I was last night. So here it goes.
Drugmonkey is right, the idea of “physical” vs. “psychological” addiction is an outmoded concept, and is very liable to make people think the wrong things. First, if you differentiate between physical and psychological addiction, you get people thinking that one or the other is “better” or “worse”. People will think, for example, that psychological addiction is about failures in willpower, which simply is not the case, and that physical addiction is therefore more deserving of treatment. And secondly, it’s an outmoded concept in that the “psyche” IS a part of your physiology. To someone like me with the training I have received, we look at “psychological” and think brain chemistry, and I guess this is part of where I have gone wrong, but excuses aside.
“Psychological addiction” was considered merely the presence of craving and the absence of definable withdrawal features, other than generally feeling like crap. Now that we know more about the brain, we know that “psychological addiction”, such as addiction to cocaine or amphetamines (withdrawal from amphetamines won’t kill you, btw, but overdosing on them certainly will), is due to changes in the chemical levels and neuronal physiology of the brain. These are not “psychological” changes, they are physical changes. Your neurons are changes, the levels of chemicals coming from them and where they are going are changed. So “psychological addiction”, even in the absence of physical symptoms, is still the result of physical changes to your brain. Psychological addiction IS physical addiction, even if it doesn’t mean you’re throwing up everywhere or having seizures. Nowadays, most people do not even distinguish between physical and psychological addiction, and just call it addiction (probably to stop themselves from running in to the problem wall I just hit). And craving as a result of being off an addictive drug is just as much a problem in need of treatment as any seizures you may be having. It may even be MORE important. The physical withdrawal symptoms (by which I mean cold sweats and seizures and throwing up and constipation) will pass, but the craving sensation remains, and can return after years and years of being clean, coming back at the mere memory of a place where someone once did their drugs. And this craving feeling is just as physical in origin as any constipation.
Based on those criteria, you could say that Prozac is, in a sense, addictive. It changes your brain physically, and results in a withdrawal syndrome that is characteristic. BUT. So do a lot of things. Like oral contraceptives, which change your body, and your body can require some time to get over the different levels of hormones when you go off them (as pointed out by leigh, thanks for the great example! We need to get together during ScienceOnline!!) Just because things change your brain or body does not necessarily mean that those things are bad and addictie, but it does mean that your body gets used to the chemicals being there, and will react to their absence. So Prozac has a withdrawal syndrome, but that does not mean that Prozac is addictive in the traditional colloquial sense. And neither are oral contraceptives. But until we can dissociate the word “withdrawal” from the word “addiction”, the things you suffer when going off Prozac are “SSRI discontinuation syndrome”. But I don’t think we should be ashamed to call it withdrawal.
