Addiction and dependence have real medical meanings and in the context of this discussion and we shouldn't mix them up. See this very short and to the point lancet medical journal summary, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...
>Addiction (synonymous with substance use disorder), as defined by the DSM-5, entails compulsive use, craving, and impaired control over drug taking in addition to physical dependence. The vast majority of patients taking medications such as opioids and benzodiazepines are doing so as prescribed by clinicians, with only 1·5% of people taking benzodiazepine being addicted, for example. Physical dependence is much more common than addiction. Importantly, withdrawal effects occur irrespective of whether these drugs are taken as prescribed or misused.
>Failure to distinguish between addiction and physical dependence can have real-life consequences. People who have difficulty stopping their medications because of withdrawal effects can be accused of addiction or misuse. Misdiagnosis of physical dependence as addiction can also lead to inappropriate management, including referral to 12-step addiction-based detoxification and rehabilitation centres, focusing on psychological aspects of harmful use rather than the physiology of withdrawal.
>It should be made clear that dependence is not the same as addiction. The problems with prescribed drug dependence are not restricted to the small minority who are misusing or addicted to these drugs, but to the wider population who are physically dependent on and might not be able easily to stop their medications because of withdrawal effects. Antidepressants (superkuh note: and caffeine) should be categorised with other drugs that cause withdrawal syndromes as dependence-forming medications, while noting that they do not cause addiction.
There has been a major shift in how addiction is understood in modern research, but you have it backwards- your perspective of chemical addiction or direct chemical mechanism being important is the old discredited concept, not the new one, which sees it as a psychological process that requires no direct chemical mechanism at all.
The explanation for the headaches is that coffee raises blood pressure short term, and the blood vessels in the brain prepare for the predicted caffeine ingestion, and if it doesn't come there will be a mismatch.
This chemical dependence is often the number one reason people cannot physically stop their psychological process. Potential effects from quitting include simply dying, or with less strong chemical dependence, feeling anxiety or generally ill.
Severity of withdrawal symptoms from caffeine also varies substantially from person to person. It’s probably not directly killing anyone, but for some people it can be brutally unpleasant and disabling for at least several days.
Then there’s the beverage industry who pointed out there’s caffeine in tea leaves and other plant material and that it’s not a threat: (1) US vs 40 barrels and 20 kegs of Coka-cola. Ultimately reducing the amount of caffeine in soft-drinks.
Round and round we go allowing companies to use chemicals to keep us buying their consumables.
(1) https://en.wikipedia.org/wiki/United_States_v._Forty_Barrels...
I get what you’re saying. Dopamine withdrawal is real though and if you no longer get dopamine from an action or you physically prevent yourself from receiving that dopamine, it can be just as debilitating as cigarette withdrawal or kicking a (soft) drug habit.
Then there’s the opioids…
Exactly, this is why the idea of addiction is more appropriately focused around the actual real world impacts rather than specific chemical mechanisms- the difficulty quitting and the negative impacts on your life. If it's strong enough to overpower your will and destroy your life, that is sufficient, it doesn't matter exactly how.
When it comes down to it, something like an amphetamine drug or other stimulants that directly increase synaptic dopamine, vs a behavior like gambling addiction that exploits the brains instincts and wiring in other ways to still cause the increase in synaptic dopamine are not fundamentally, categorically different in a way that one or the other shouldn't be taken seriously and considered a "real addiction." Either can completely destroy some peoples life, and for other people can be easily controlled and used in moderation.
No. That lancet article very well refutes the point you are trying to make. I'm flabberghasted by your interpretation. Could you please try to support this interpretation with quotes? I can't even begin to understand how to converse with this point of view since such a POV does not exist in the lancet article. I've read it a handful of times and now once again trying to understand you. But it's not there. I recommend you re-read the article.
I have quoted the appropriate bits supporting my, and the articles very title's, claims already in the other comment in this thread and you may refer to it.
Even non-psychiatric drugs like NSAIDs, insulin, hypertension medication, etc. can have a withdrawal effect.
I might be mistaken, but I am under the impression that addiction is psychological in nature. Take gambling addiction, for example, I am not certain if there is any physical withdrawal effect, but there is definitely a psychological compulsion.
It's hard for me to know where to start, because I feel similarly confused about where you might be coming from, and I don't know your level of background in reading and interpreting biomedical papers. However, I can elaborate a bit on my thinking and mention that I am an academic biomedical researcher that reads, publishes, and peer reviews biomedical papers - but I am not a psychiatrist or medical doctor. This is not my field of expertise, I'm not trying to argue from authority, just mentioning where I'm coming from.
First, for context, this correspondence article is in The Lancet Psychiatry, so is targeted at psychiatrists, and is able to avoid a lot of background that they can safely assume the reader already has, like the diagnostic criteria for common conditions.
You are using the term "chemically addictive," which is not used in the article, and which is a term that simultaneously implies both "physical dependence" or "substance dependence" and "addiction" from back when the two were mistakenly assumed to be one in the same. This article is emphasizing the fact that they aren't the same thing, and both can exist independently of one another. Since that is really the only singular point in the article, and is really hammered home over and over, I cannot see how pulling out quotes would help. I think our disagreement comes from the surrounding context not mentioned, not the contents of the article itself.
The article describes that as of the DSM-5 they directly address the confusion between the two, and separate them into two entirely different things. While not explained in the article, it is important to realize that the DSM-5 now includes behavioral addictions together with drug addictions, and considers physical dependence and/or other types of direct chemical modulation of the reward system to be a contributing factor in many cases, but not essential, for addiction.
This distinction is extremely important, because it allows for addiction without substance dependence to be taken just as seriously, and properly treated and addressed clinically or by other means.
Previously, because of the history of this mistaken connection, psychiatrists and patients would wrongly dismiss (as you are with caffeine) the possibility of serious addiction without a direct chemical dependence mechanism. This left people whose lives were being destroyed by things like gambling and sex addictions to be dismissed as not serious, and not allow them to get real help. On the flip side, it also made doctors wrongly afraid to administer drugs that caused chemical dependence but not addiction, for fear that it would lead to addiction in patients.
However, I would argue that while addictive, the level of addiction potential from caffeine is pretty limited because of the fact that it has pretty severe adverse/toxic effects if you take too much, and the enjoyable aspect saturates out pretty quick. Taking a lot more than a normal amount, enough to damage your health, feels awful, so people aren't likely to become addicted to doing so. Counter-intuitively, the most addictive drugs have low acute toxicity and so you can take increasingly huge doses of them and it continues to feel good rather than just make you uncomfortable and sick like a high dose of caffeine.
Here's where you seem confused. The article is not saying this. It is explicitly saying that medications which one builds up a tolerance to and experiences withdrawal symptoms from are not addictive.
>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.
You are claiming the article's distinction between addiction and dependence is discussed in order to make a claim about substance abuse and addiction without dependence. This is not in the text at all. What the heck?
I have the decades of domain specific knowledge and time spent reading neuroscience journal articles to know that I don't have to read between the lines of the article here. It's not an opaque or jargon hidden meaning. It's quite plain: dependence is not addiction. Not, "addiction can happen without dependence" which is not addressed or relevant to the paper or this HN discussion about caffeine.
It seems like we’re talking past each other somehow, perhaps one or the other of us misunderstood what the other is saying, but I don't see any value in continuing further.