addiction - Terminology and usage
Decades ago addiction was a pharmacologic term that clearly referred to the use of a tolerance-inducing drug in sufficient quantity as to cause tolerance (the requirement that greater dosages of a given drug be used to produce an identical effect as time passes). With that definition, humans (and indeed all mammals) can become addicted to various drugs quickly. Almost at the same time, a lay definition of addiction developed. This definition referred to individuals who continued to use a given drug despite their own best interest. This latter definition is now thought of as a disease state by the medical community.

Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). Unfortunately, terminology has become quite complicated in the field. To wit, pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence); psychiatrists refer to the disease state as dependence; most other physicians refer to the disease as addiction. The field of psychiatry is now considering, as they move from DSM-IV to DSM-V, transitioning from "dependence" to "addiction" as terminology for the disease state.

The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological dependence (or simply addiction ). Addiction is now narrowly defined as "uncontrolled, compulsive use"; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered compulsive, but to the definition of some it is not categorized as "addiction". In practice, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components.

There is also a lesser known situation called pseudo-addiction.{(Weissman and Haddox, 1989}} A patient will exhibit drug-seeking behavior reminiscent of psychological addiction, but they tend to have genuine pain or other symptoms that have been undertreated. Unlike true psychological addiction, these behaviors tend to stop when the pain is adequately treated.

The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal. While opiates are essential in the treatment of acute pain, the benefit of this class of medication in chronic pain is not well proven. Clearly, there are those who would not function well without opiate treatment; on the other hand, many states are noting significant increases in non-intentional deaths related to opiate use. High-quality, long-term studies are needed to better delineate the risks and benefits of chronic opiate use.

Not all doctors agree on what addiction or dependency is. Traditionally, addiction has been defined as being possible only to a psychoactive substance (for example alcohol, tobacco and other drugs) which ingested cross the blood-brain barrier, altering the natural chemical behavior of the brain temporarily.

It is generally accepted that addiction is a disease, i.e., addicts have no 'will' and cannot stop even if they want to. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, cutting, and shopping, so these behaviours count as diseases as well and don't cause guilt.

However, these are things or tasks which, when used or performed, cannot cross the blood-brain barrier and do not fit into the traditional view of addiction. Symptoms mimicking withdrawal may occur with abatement of such behaviors; however, it is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. In spite of traditionalist protests and warnings that overextension of definitions may cause the wrong treatment to be used (thus failing the person with the behavioral problem), popular media, and some members of the field, do represent the aforementioned behavioral examples as addictions.

In the contemporary view, the trend is to acknowledge the possibility that the hypothalamus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicals (alcohol, nicotine etc.) when addictive activities take place. For example, when an addicted gambler or shopper is satisfying their craving, chemicals called endorphins are produced and released within the brain, reinforcing the individual's positive associations with their behavior.

Recently, some have modeled addiction using the tools of Economics, for instance, by calculating the elasticity of addictive goods and determining to what extent present income and consumption has on future consumption.

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