kyburg | Some kind of wonderful -

You'll hear me rant about overmedication a lot - well, it's a sore point. Giving pills is cheap - compared to long-term talk counseling with active therapy. Trouble is, the pills stop working. Oh, you can cycle through a ton of stuff - it's out there - but the expensive, labor-intensive-with-a-real-person is where long term results lie (unless you're one of the people who truly HAVE a chemical issue, and one of the hallmarks of THAT is the pills don't stop working and you don't have to cycle, yadda ya).

Then I hear about Cymbalta. Holy chrome. This stuff is being prescribed off-label right, left and center for things OTHER than depression...and damn if it isn't doing some incredible things, mostly related to pain relief (and we all know I think that's going to be HUGE when it happens).

But for depression? *wiggles hand* Not so much. Read about coming off it and UH.

...and so many, many reports are from people who came to this medication because - you guessed it - they needed to cycle from something else.

I have to wonder about what this all about - and if the cycling is a Good Thing, or a sign that this is not the right way to treat depression, period.

Yeah, maybe I do more than wonder. Like - NO.

Here's a thought for the day - isn't it still addiction when it's legal and you don't have to worry about getting it on a daily basis? You go without and you're not going to feel good, yanno. But get your drug and everything is fine.

What makes that okay?

As for me, I'll pass. And yes, I know that's a privilege.

Flat | Top-Level Comments Only

Yep, I'm a pharmacist, and these are technical terms.
Basically, I have chronic pain. I take at least 2 doses of Lortab every day. If I don't take it, I suffer. I am dependent. i take it as directed, but I'll have to taper off over time to be able to stop taking it without feeling like butt.
If I start taking more than I am prescribed, mixing it with other things to get high, that's addiction. It's also abuse. But people who are dependent are not considered addicts unless they break the rules and start acting all funny.
You could say that people are dependent on antidepressants, and they are also dependent on insulin if they are diabetics.
BUT, we are using these things more than we should, we really don't have a lot of knowledge about how the brain works, it's all theory. Because once you open one up to look under the hood, it stops working. We have to cycle and try different things because we really have no idea what we are doing. It makes me mad that we don't know more. Bipolar folks really get the short end of the stick here.
And yes, everyone should start with therapy when they get their pills. If they get stable and comfortable, just continue the pills if the reason for the depression is continuing. And when you have a bad spot, go back to therapy on as add needed basis.

And what do we do when none of it works? Would you believe shock therapy? Ewwwww. I don't like the idea of loss of memory.

I hear it's still the gold standard for treating intractable depression. Wouldn't a man to man talk with a doorknob do the same thing?

*shakes head* I have addicts in the family, dearling. It does not matter how one uses the object of addiction...the hallmark is that they can't do without it and lose all control of their lives in the face of it. If you're addicted to peanut butter, you're going to eat it on corn on the cob and cinder blocks...but you'll never do without it, or else.

You can abuse and not be addicted. The twinkies who do cough syrup with their pals? Abuse. The person who doesn't do anything without having a drink first? Addict.

Some abuses indicate addictive behavior - but one is NOT the same as the other.

Make sense?

It totally makes sense, but that was what I was taught in pharmacy school and in seminars on pain control.
Shock treatment is quite effective, but the cost is so high. Each patient has to decide for themselves. I don't think I'd do it.

Oh, I'd have words if they tried that with me in the room. LOUD ones.

Words matter. Words being used badly in a teaching environment? To titled professionals who control other people's lives.

Loud words. VERY loud words that matter, hon.

I'm sorry, but in this case, you're the one abusing words here. On the subject of these particular medications, you're trying to redefine well-established words to fit your own agenda, using vague rationales and contradictory statements.

As

drlaurac pointed out, abuse, dependency and addiction are well-understood technical terms and do not mean the same thing as each other. You're trying to redefine "abuse" as meaning "use I disagree with" and "addiction" as meaning "any dependency that I don't like", which is just bogus, and borderline propagandist.

If I start taking more than I am prescribed, mixing it with other things to get high, that's addiction. It's also abuse. But people who are dependent are not considered addicts unless they break the rules and start acting all funny.

If you do anything with a drug besides take it as prescribed - that's abuse. Not addiction.

People who are dependent on a drug need it to function, but are aware of the dependency and continue to use it as directed.

People who are addicted can not live without it, and often have other psycho-social aspects that preclude definition as dependency. I might define dependency and addiction as the difference between awareness and denial. It also includes abuse - but abuse in and of itself does not indicate addiction. It might indicate stupidity, but that's another story.

She's also claiming she was 'taught' per the original statement above - which does not even jive with your own defense. Abuse, dependency and addiction are well-understood terms that mean different things - if you look again, you'll see that one is the other 'if I do weird stuff with it.'

I've known a lot of folks who have really pushed the envelope with pain meds and alcohol, for example, when they've been on them. It's stupid, but it isn't addiction. It's abuse. Not the same thing - even by your own defense.

Addiction is not abuse writ large. Dependency is not addiction writ small. Abuse is using a hammer to open jars of pickled beets.

Reacting emotionally, perhaps? It would be within tolerances, considering the subject matter.

But you'll have to allow the accusations are inflammatory, dude. Gimme a break.

First of all, what "defense" are you referring to? I never claimed to be defending anything (except perhaps the English language, but I'm pretty sure that isn't what you meant). And are you referring to me or to you when you ask about reacting emotionally? If you're referring to me (which I'm guessing you were), why is it you assume this is an emotional subject? Could it possibly be because you've presumptuously assumed you know everything about me and my positions on these subjects? Could it be because you automatically assume anybody who doesn't agree with you must be a certain kind of person? This is not the first time you've condescendingly (and erroneously) implied you know all about me in order to belittle an opposing point of view. As a tactic it's both arrogant and rather telling, and something I'd expect to see in a Republican campaign, but not here. Please check your prejudices. Maybe you don't know as much about everyone as you think you do.

Moving along, however, regarding the definitions in question, with the exception of the "start acting all funny" bit, which I (and I think any reasonable person would) assume was a colloquial generalization on

drlaurac's part, and not a literal quote of what was actually taught,

drlaurac's definitions of these terms, while not entirely complete, are essentially correct, and yours are substantially less so.

Specifically, in a pharmaceutical sense, "abuse" means using something in a way contrary to its directed use or its intended purpose. (as a side-note, even the useful off-label applications you mention above are actually abuse, BTW. Abuse has nothing to do with whether something works or not, or whether it has good or bad results, it only has to do with whether it's being used the way it was intended to be used.)

(And no, actually, using a hammer to open jars of pickled beets is not abuse. The hammer is being used for its intended purpose (hitting things), and thus by definition is not being abused. Just because you don't believe it's the right choice to apply it in that way does not mean the application itself is abuse.)

"dependency" is fairly obvious, and I don't think we have a lot of disagreement on that term. Anything which requires somebody keep using it in order to maintain a particular condition or state is a dependency (what state is being maintained is really irrelevant to the term).

"addiction" is specifically a dependency which has become a compulsion or obsession. That is, the dependency on a substance has affected the person to the point where they can no longer make rational judgements about its use. The important point here is the decision making process of the individual in question. Addiction is almost inevitably coupled with abuse, because obviously if one is no longer able to rationally control one's usage, one is extremely unlikely to continue to use something only as directed.

Therefore, in answer to your originally posted question with the example of a legal drug used, rationally, as directed, no, that is not addiction. Attempting to characterize it as such is an abuse of the term.

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