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View Diary: GUS: The "H" Word vs. The "A" Word (182 comments)

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  •  If someone else can step in and explain, (0+ / 0-)

    I'd much appreciate it.  Sorry aoeu, but I'm not following you up to this point.

    On the television screen were ballerinas. -- Kurt Vonnegut

    by bsmechanic on Tue Aug 24, 2010 at 08:38:02 PM PDT

    [ Parent ]

    •  I *think* I understand what he is getting at. (1+ / 0-)
      Recommended by:

      To back up a bit, though, we're talking about two different components to addiction: physical addiction and psychological dependence.

      Most addicts experience both, but for a few, it's purely physiological. Those are the people for whom a pharmacological or holistic intervention alone is enough to keep them from relapse, as they are not struggling with the impulse once the physiological withdrawal has been removed. Think a non-addictive personality doing a self-motivated step-down after a significant amount of time on Vicodin or Oxycontin, sometimes with the help of a mild anti-anxiety medication and acupuncture. They might have developed a physical dependence, but that's as far as it goes.

      On the other hand, most addicts experience both things, but the mechanisms are not identical. Psychological dependence informs behavior but is separate from the phenomenon of building up a physical tolerance to a substance. And as aoeu states, a person's ability to tolerate a substance does not necessarily progress in a linear, ever-growing fashion.

      For many substance abusers (alcoholics and addicts alike), their psychological addiction to a substance may outstrip their physical addiction at the outset, while their physical tolerance may progress but plateau and then nosedive as substance-abuse-related illnesses impact an individual's ability to consume ever-larger quantities of their substance of choice.

      So at the "top end" (outset) and "bottom end" (end-stage) of their addictive process, they may have motivation to abuse a substance that outstrips their ability to physically tolerate that substance in the amounts they attempt to ingest. Think substance-crazy newbie addicts who try anything they can get their hands on, just about every meth addict ever, and almost every late-stage alcoholic who is experiencing profound nerve and liver damage due to chronic alcohol abuse. They either attempt to either endlessly chase the nonexistent (thanks to increased tolerance) high or consume ever-larger amounts of their substance of choice just to "feel normal" but eventually their body just quits on 'em.

      Make more sense?

      •  This makes more sense, though (1+ / 0-)
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        my understanding has always been that late-stage alcohol abusers experience decreased, or reverse tolerance:

        Heavy alcohol consumption over a period of years can lead to "reverse tolerance". A liver can be damaged by chronic alcohol use, leading to a buildup of fat and scar tissue. The reduced ability of such a liver to metabolize or break down alcohol means that small amounts can lead to a high BAC and more rapid intoxication.

        I am clear with the difference between physical addiction and psychological dependence.  Your example of the non-addictive personality weaning off pain medications is a really good one.

        My contention in this thread with aoeu was likely ill-advised in a community diary, as well as being fueled by a want for definition of terms such as "top side" and "bottom side", and not being clear.  I'm going to uprate comments accordingly, and participate in future discussions with more discretion than I showed here (hopefully).  

        Thanks Vacationland.

        On the television screen were ballerinas. -- Kurt Vonnegut

        by bsmechanic on Wed Aug 25, 2010 at 06:34:03 PM PDT

        [ Parent ]

        •  No worries, bsm. (1+ / 0-)
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          I've had some experience trying to interpret responses from people talking about substance abuse issues using all sorts of initially confusing terminology (responses to surveys and focus group questions, for example); it can be really difficult to figure out what a person's getting at if you aren't using the same vocabulary to describe the same phenomena. There are a surprising number of terms used to describe common concepts like beginning/end, early/late, light/moderate/heavy, easy/difficult, etc. It can be frustrating to feel like you're almost on the same page as someone, but not quite, and just as confusing to feel as though you're not understanding/being understood when discussing the same issue (very common in focus groups). It's all good! :-)

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