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Abstract
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In March, 2023, NHS England released a commissioning framework to action the recommendations of the Public Health England report on prescribed drug dependence. A misunderstanding of the word dependence could possibly have unfortunate consequences for patients.
The term dependence has come to be used interchangeably with addiction in common language. This conflation originates from the use of the word dependence to describe uncontrolled drug-seeking behaviour in place of addiction in the DSM-III-R, because some lay members of the committee argued that the word addiction was pejorative and the word dependence was more neutral. However, the pre-existing pharmacological definition of physical dependence refers to the "physiological adaptation that occurs when medications acting on the central nervous system are ingested with rebound when the medication is abruptly discontinued". The classic pharmacology textbook, Goodman and Gilman's The Pharmacological Basis of Therapeutics, points out that "The appearance of a withdrawal syndrome when administration of the drug is terminated is the only actual evidence of physical dependence." Importantly, a medication need not cause euphoria or other re-enforcing effects for physical dependence to develop: it is simply a consequence of the principle of homeostasis.
The DSM-5 referred to the confusion over this issue, stating that "'Dependence' has been easily confused with the term 'addiction' when, in fact, the tolerance and withdrawal that previously defined dependence are actually very normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction." Public Health England makes the same distinction...
Language: en |