What is dependence?

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Dependencies are serious chronic diseases that often have far-reaching health consequences for those affected. Dependencies can often go unnoticed for long periods of time. They can affect people from all walks of life. The physical consequences of dependencies are usually directly related to the addictive substance. Psychological and social effects are present in virtually all cases of dependencies. For example, many people lose their jobs and experience conflicts with family and friends. Individuals with dependencies are often at risk of falling into social neglect or homelessness.

The addictive substance entirely dominates the lives of those concerned. For non-sufferers, it can be difficult to imagine how strong the desire for the substance can become. Unfortunately, many affected individuals do not realise the problem until it is too late. They are therefore unable to solve the problem on their own and urgently require professional help. As a result of their social decline, many sufferers lose their self-esteem, fall into depression, and experience a profound change in personality. Because of the despair and hopelessness experienced by individuals with dependencies, suicidal thoughts are not uncommon.

Depending on the substance, dependence can develop in different ways and to different degrees. Anyone who has ever been dependent remains so, even if he or she completely abstains from the substance. This means that relapses can occur – even after years of abstinence. For many illegal drugs, a dependence can develop rather quickly. In the case of alcohol, however, dependence can develop much more gradually. Many sufferers increase their alcohol consumption over the course of many years, which ultimately results in dependence.

Causes

Dependence is never the result of a single personal trauma. It is often the case that many random and traumatic events combined with numerous other factors leads to dependence. Social environment contributes significantly to the development of the personality structure. The drug itself, its accessibility, and modes of action are also influencing factors. Dependence is thus a serious, chronic mental illness, and those affected require professional medical and psychosocial support.

Image: Triangle of causes modified by Loviscach (2000)

Suchtursachen Ursachendreieck

Addictive substances and addictive behaviour

Dependencies are highly diverse. A distinction is generally made between “substance-related” forms of dependence (i.e. the dependence on a particular substance) and “action-related” forms of dependence (i.e. the dependence on a particular action).

The addictive substance can be either legal or illegal. Legal stimulants such as coffee, chocolate, or food in general can cause quite debilitating health consequences. Other legal yet addictive substances include alcohol, nicotine, or properly prescribed medications (e.g. amphetamines, barbiturates, tranquilisers, and narcotics). Illegal drugs that can cause serious dependencies include: cannabis products such as hashish and marijuana, hallucinogens such as LSD, coca products such as cocaine and crack, opiates such as heroin, and numerous “designer drugs” such as ecstasy. All legal or illegal substance base dependencies involve the risk of acute poisoning following an overdose. Many addictive substances are also life threatening.

Young people in particular are affected by action-related dependencies. Known action-related dependencies include but are not limited to eating disorders such as anorexia and bulimia, internet dependence, shopping dependence, gambling dependence, and sex dependence. This compulsive behaviour can lead to health problems and serious social or psychological damage. In the case of action-related dependence, psychological dependence can be quite strong.

The WHO definition of dependence

The WHO is involved in the worldwide incidence of dependencies and various addictive substances. The WHO defines an addiction or dependence disorder (the word addiction was recently replaced by the term dependence) as follows: “Repeated consumption of one or more psychoactive substances leading to a periodic or chronic intoxication (psychoactive: influences the perception, experiences, and behaviour of an individual). The affected individual has a strong urge to consume substance, thereby making it difficult for him or her to control the consumption or to reduce the amount consumed. A tolerance is developed, and withdrawal symptoms are present.”

At the European level, the work of WHO is supported by the EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). This EU agency aims to provide valid information about dependence. Its primary objective is to support EU Member States in the development of health strategies and the fight against drug trafficking and abuse. Providing sound scientific data should increase the understanding of dependence.

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