>the hard part is usually "what to do instead" for the next n decades.
Agreed. And (as you've no-doubt guessed by now), I would argue that this second, harder phase of recovery has very little to do with addiction per se, in both it s mechanisms and coping strategies.
>there is a useful distinction to be made between what I would call "addiction" and "dependence" though.
I'd have to think about this a bit more, but even though I agree the distinction is practically useful for treatment, it's once again a distinction of degree rather than kind. In both cases, there is a physiological habituation to a substance that causes unpleasant withdrawal symptoms. Something analogous to the pleasure-seeking behavior of bona fide addicts is still there, I think, when you consider that drug-dependent people will consume a substance to "feel normal".
>dependence is merely a tradeoff that may or may not be worth it.
I'd quibble about merely, since the worm can turn mighty quick, and people are generally pretty bad at knowing how deep in the hole they are. But I take your general point.
> I'd have to think about this a bit more, but even though I agree the distinction is practically useful for treatment, it's once again a distinction of degree rather than kind. In both cases, there is a physiological habituation to a substance that causes unpleasant withdrawal symptoms. Something analogous to the pleasure-seeking behavior of bona fide addicts is still there, I think, when you consider that drug-dependent people will consume a substance to "feel normal".
I've mostly agreed with you up until here, but having known both heroin addicts and a few PM patients, I don't agree with this at all. while there is a significant minority of PM patients that are addicts in disguise, I genuinely don't believe most of them enjoy taking their prescription. at least in theory, the PM patient works with their doctor to find a dose that adequately manages their chronic pain while minimizing impairment and other unpleasant side effects like nausea and constipation. the addict seeks the highest dose they can get away with (not arousing suspicion of employer/family, being able to afford it, etc.). the intention behind the use is very different.
more generally, my working definition of addiction is something like this: a) inability or extreme difficulty in regulating b) an activity or use of a substance that c) negatively impacts one's health, interpersonal relationships, or other meaningful goals. the PM patient clearly satisfies b). but I would argue they don't satisfy a) if they are able to stick to what they've agreed with their doctor and haven't specifically chosen that doctor for being a total pushover. they don't satisfy c) at all: the drug is what allows them to participate in something like an ordinary life. in extreme cases, it is what allows them to exist at all.
btw, I could also have chosen SSRIs as my example for dependence. I think the PM example is better for teasing apart addiction vs dependence, since there is a bit of overlap in reality. but SSRIs are interesting because they do not demonstrate the same tolerance building effect as other psychoactive drugs, nor are they (commonly) used recreationally. nevertheless, people do report fairly nasty withdrawal symptoms from abrupt cessation of SSRIs. you can google "ssri brain zaps" if you're curious.
tl;dr: addiction and dependence can look similar from the outside. one simple heuristic for distinguishing them is how the person behaves after acute withdrawal subsides. the addict will always feel the temptation to go back, and resisting that temptation is usually a lifelong struggle. the person who was merely dependent will stop and never look back if they find an alternate solution to their problem.
Agreed. And (as you've no-doubt guessed by now), I would argue that this second, harder phase of recovery has very little to do with addiction per se, in both it s mechanisms and coping strategies.
>there is a useful distinction to be made between what I would call "addiction" and "dependence" though.
I'd have to think about this a bit more, but even though I agree the distinction is practically useful for treatment, it's once again a distinction of degree rather than kind. In both cases, there is a physiological habituation to a substance that causes unpleasant withdrawal symptoms. Something analogous to the pleasure-seeking behavior of bona fide addicts is still there, I think, when you consider that drug-dependent people will consume a substance to "feel normal".
>dependence is merely a tradeoff that may or may not be worth it.
I'd quibble about merely, since the worm can turn mighty quick, and people are generally pretty bad at knowing how deep in the hole they are. But I take your general point.