Posted by Elizabeth on September 25, 2001, at 17:03:53
In reply to Re:Elizabeth?, posted by v on September 25, 2001, at 5:16:24
Hi! I must have missed this thread...sorry about that. See http://www.dr-bob.org/babble/20010917/msgs/79454.html for the story on what I was doing for the week or so that I wasn't posting.
I forgot to ask my consultant about opioids and dopamine, and my books aren't anywhere I can get to them. (Neither is my consultant, for that matter.)You mentioned Wellbutrin. How that works is a mystery; IMO, it might be a prodrug (i.e., one or more of its metabolites are responsible for its effects). Bupropion itself doesn't seem to have much effect at prescribed doses (or at least, no effect has been found that would explain its clinical effects).
About the word "addiction:" a standard pharmacology text actually suggests dropping the word altogether because it's become so loaded. The dictionary definition you gave isn't really consistent with the way the word is used in real life. In the past, the definition that you gave was used both in medicine and in the lab (my pharmacologist buddy and I used to argue about this all the time, since he studied the subject 20 years ago < g >), but scientists no longer speak of "addicted" rats. Doctors still use the word, but it's only clear to me what they mean by it based on the context: they could be talking about what DSM-IV calls "substance dependence" (this definition, as well as the DSM-III-R and ICD-10 definitions, can be found at http://www.drugabuse.gov/DSR.html and many other sites), or they could be talking about pharmacologic or "physical" dependence (i.e., your definition). The DSM and ICD definitions are basically the same, and "physical dependence" is neither necessary nor sufficient to warrant a diagnosis of substance dependence by their definitions (which seems reasonable to me since pharmacologic dependence is a *normal*, not pathological, response to regular use of many psychoactive drugs). The authors of these newer definitions were trying to eliminate the word "addiction" by using the word "dependence," but this only seems to have caused more confusion, since "dependence" is also used to mean "physical" dependence. I don't know how to go about dealing with this ambiguity. I'd love it if everybody could just drop the stigma associated with "addiction," but when's that going to happen?
Thanks for elaborating on what you described as personality fragmentation. I don't know much about dissociative disorders, and it's helpful to hear about them from someone who knows what it's like from the inside, so to speak.
Anyway...apologies again for not responding sooner. When I got out of the hospital I had a lot of posts and emails to answer, and I probably missed a lot of them. So please don't take it personally, because it has nothing to do with you or with our conversation (which I've enjoyed).
-elizabeth
poster:Elizabeth
thread:76946
URL: http://www.dr-bob.org/babble/20010917/msgs/79579.html