Line between taking medicine regularly and addiction?

Great Debates
21

In the 80s ? 90s ? the question about if caffeine is ‘addictive’ was the subject of dispute within NIDA (or whatever it was called then). It was clear that there was a moral dimension to the question: is there anything wrong with being ‘addicted’? What if you enjoy being ‘addicted’? What should the NIDA attitude be to coffee? What should they be doing about it? Should medical researchers be doing medical research into addictive drugs on themselves?

The case was made by the non-coffee drinkers that caffeine fell within the same biological category as opiates, and should be banned within the NIDA. The case was made by the coffee drinkers that it wasn’t doing any damage, was moral overreach, and that alcohol prohibition had poor epidemiological support and had been rejected by the voters.

The outcome was that the coffee drinkers won. The agreed medical and legal meaning of ‘addictive’ includes ‘harmful’ Coffee isn’t addictive by agreed definition. For better or worse, that’s were the line is drawn.

22

The LDS church regards drinking coffee a sin, but not an addiction.

23

As a former caffeine addict… I am a software engineer, a career basically fueled by coffee.

At my worst, in a high stress job, I was working 12 to 15 hour days, and I needed that boost to get me through the day. And gradually got stronger and stronger and more frequent brews to keep the caffeine up.

And then, it was weekend, and I could feel a need for something although I could not really identify what it was.

Caffeine is still the only addictive chemical for which I can’t identify the craving. In my misbegottem youth, I could identify certain illegal chemicals which I might crave based on their unique effects, but caffeine, I always had to think about it.

As an example, I hypothetically do a few lines of cocaine, eventually go to bed. In the morning, I would know precisely what my brain craved. I would not have any, at that point, and I am reasonably sensible so I did not act on that desire to get more.

But miss a cup of coffee? That was tough. I eventually learned the subtle signs, but at that point I was giving up caffeine (and cocaine) anyway.

I’m like, 8 years free of caffeine and over 12 years past cocaine. Caffeine was way more difficult to give up. More than nicotine.

24

My pithy take.

If you use drugs because they make you feel good, that’s not a problem. But if you use drugs because they are the only thing that make you feel good, that’s a problem.

I don’t think a daily caffeine habit is an addiction. It might be a dependency, in that you don’t feel good if you go off of it, but unless the caffeine use rises to a dysfunction in one’s daily life, I don’t think it rises to the level of addiction.

As an example of that distinction, Harry Truman started each morning with a shot of bourbon. I don’t think he was addicted, though, unless this morning ritual interfered with his daily functioning, or if he went to extreme lengths to complete the task.

25

Good news for my caffeine habit

https://jamanetwork.com/journals/jama/article-abstract/2844764

A moderate intake of caffeine is associated with a reduced risk of dementia. This follows on other studies that found moderate drinking of coffee and tea are associated with slightly longer lifespans.

It’s only an association. Maybe people who are developing dementia don’t enjoy the effects of caffeine as much, and use less. Still, it’s reassuring and adds to a growing buddy of research that doesn’t show any harm from a caffeine habit like mine.

I think I’ll head downstairs and enjoy a morning cuppa soon.

26

Years (and years) ago, I was in a pretty bad accident. I was on a bike - she was in a car.

I was immobile. When I got a little better, I still had to crawl to the bathroom. Literally. Enter opiates. They were a wonder drug. I had to have them to function. A bunch of PT later and I wanted them more than needed them. I can recall the day I crossed over.

Unfortunately, back then, getting them was laughably easy - so I ran my tolerance up pretty high. Which made quitting a painful and herculean ordeal.

But I did it. On my own, the hard way. After a few trial runs I quit cold turkey.

Because my body is still in bad shape I actually have a RX for them but its been probably 6 months since I broke down and took one (5mg).

There was that time I was addicted. Now that I’m past it - I don’t even think about them anymore.

27

Last time I was in a hospital was 6 months ago, for something trivial.

I was not in pain. I told the doctors I was not in pain. I was prescribed oxycodone anyway. And then the pharmacy “accidently” forgot to give me the oxycodone pills along with my other drugs.

Loose prescribing and loose control. What could go wrong?

28

Of course the flip side of this are the draconian laws controlling stimulant medications for legitimate purposes such as ADHD. The law will not fill my prescription any more than two days in advance, which means if the pharmacy doesn’t have my meds on hand, and there’s a delay, I experience significant withdrawal.

I had to change to a hospital pharmacy clear on the other side of town just to get my meds consistently.

And I have to call my doctor every month for a refill. If the doctor happens to be out of office, or if I need the pills on a weekend, I’m screwed. I’ve been taking this medication for ten years. They should have rule relaxation for good behavior.

(On the other flip side, my psychiatrist will prescribe me with liberal quantities of Ativan (benzos), which I use, on average, four times a month.)

29

I hurt my back a while ago and ended up in the ER. They gave me pethadine at hospital and a prescription for tramadol. Both of these are opiates. I hated the feeling. I ended up throwing away the tramadol. I don’t know if I could get addicted to that, because I found it so unpleasant.

As an aside, maybe I am lucky because in my youth, when my friend group was trying out the usual list of illegal drugs, they did not take for me. Even cigarettes: I tried to get into them as a teenager because it was so rebellious and cool. I couldn’t do it. Weed: makes me severely paranoid. So far all the things that cause addiction problems seem to be rejected by my biology for one reason or another. Except alcohol; I can happily have a few drinks every now and then.

30

Physical dependency is when your body malfunctions when the substance is withdrawn, regardless of whether you think you need it or not. For example, when you stop taking opiates or alcohol, all sorts of bad things can happen. Actually heavy caffeine users can have some serious physical dependency, though it’s not life-threatening.

Psychological dependency can be about one or two different things. There’s a strict definition where you just think you need the substance a lot more than you do. People quitting marijuana will be very anxious that they can’t face life without it, they’ll avoid quitting for years. But when they finally do rip off the band-aid and quit, they often find it was a lot easier than they thought, and they wonder why they didn’t do it earlier. Psychological dependency.

Then there’s a more broad definition of psychological dependency in which the substance has actually done stuff to your brain chemistry that withdrawing the substance will produce some severe effects on your mood (irritability, depression, anxiety, etc). So not any effects that you directly feel in your body, but psychological effects that are definitely caused by physical change in your brain chemistry.

As far as addiction, there’s surprisingly little agreement on how to define it. In my opinion, addiction is when a chemical dependency hijacks your behavior to the extent that you’re making choices that negatively affect important aspects of your life and the people around you.

Coffee forms some surprisingly strong dependencies in all the ways I mentioned above, it really hurts not to have it if you’re dependent on it. But not to the degree that it’s going to make you rob a liquor store, prevent you from sustaining long-term employment, or compel you to give handjobs behind the 7-11 to get money for your next latte. If you can’t get coffee you’ll just be uncomfortable for a few days/weeks and then get over it.

And as far as this question -

I guess the question is, why does this matter to you? You can sustain a coffee habit for a lifetime. Sometimes there are good reasons not to, like high blood pressure. But it sounds like you’ve got a negative stigma in your mind around addiction as a concept, and you’re wondering if that transfers to your coffee habit. A degree of puritanism if you will, in fact you mentioned the LDS church as someone who might judge you.

Only you can really decide what that means to you. Maybe you feel more psychologically secure knowing you’re strong enough to get through life without a substance, that you won’t be hurting if coffee goes to $80 a pound, that you have mastery and control over your moods and mental states. Those are all certainly worthy goals to pursue if you feel like it.

But otherwise, if caffeine isn’t increasing the risk of anything like high blood pressure, cardiovascular disease, or mood problems, you don’t need to judge yourself an addict. You’ve got a habit, everyone’s got one, it’s fine. But if you’re accepting that you’re a lifelong caffeine user, you should of course be getting physicals to uncover any potential reason that you shouldn’t be using caffeine.

31

One hallmark of addiction is that it re-wires your brain to completely scramble these signals. You think the substance improving or sustaining your quality of life, but it’s actually doing the opposite. That’s what makes addiction so insidious. It worms its way into your thoughts, beliefs, and moods to make you think that things that are helpful are harmful, and vice-versa. i.e. folks who think alcohol gives them energy in the afternoon, but also makes them sleepy at night, and that people trying to make them quit are just trying to persecute them.

In addiction, the help/harm signals are totally scrambled and unreliable for any purpose except for justifying continued use. So that completely destroys the usefulness of a rubric like “is it improving or degrading my life.” Outsiders can see it, but the addict is simply too self-brainwashed.

32

You don’t need to be a heavy user. It’s true that some people are moderately heavy caffeine users and don’t become physically dependant. But i drink one mug of strong tea a day when I’m at home. (I often have more caffeine when I’m traveling.) And i am physically dependant. If I don’t get my caffeine, I’ll get a migraine. I need to taper down very carefully to stop taking caffeine without withdrawal symptoms. (Yes, i drink ¼ of a mug of weak tea one of those days.)

But i agree with the rest of what you say about coffee. The enormous majority of people hooked on coffee live normal productive lives, and don’t do anything destructive if they can’t get their fix. And as I’ve said above, there’s even some weak evidence that’s it’s good for you (on average, ymmv).

33

Food is something which people create their own dependency on by linking unhealthy foods to biological needs. For instance, when someone is thirsty, they drink something sweet loaded with tasty flavors and calories rather than plain water. This creates a pleasure feedback system where the body artificially creates feelings of thirst in order to have the pleasure of a sweet drink. This is demonstrated by people who say they can’t give up their soda habit, diet or regular. And the same with foods. Rather than seeking out foods just to satisfy their actual need for calories and nutrition, they seek out foods which give the highest amount of pleasure. If they feel hungry at 2pm, they’ll have a cookie. If they keep doing that, it almost becomes an addiction where they start having daily cravings for that 2pm cookie. It has nothing to do with the body actually needing the calories or nutrition from the cookie. The person’s brain is seeking out pleasurable feelings, and it has learned that creating cravings for a cookie at 2pm is one way to get that need satisfied. But if instead they snacked on something like plain yogurt, they wouldn’t develop cravings. That wouldn’t give the same dopamine rush that comes from eating sweet/fatty foods, so their brain wouldn’t see it as a way to get more dopamine rushes.

34

Mother nature stepped in on my behalf. Back then, I could take handfuls (literally) and no ill effects.

If take one now I’ll be throwing up soon. Not sure how that happened but I’ll take it.

35

A large percentage of Americans (and probably people in other countries) are addicted to caffeine. But caffeine addiction has few serious attendant problems, either for the patient or for society as a whole, so on the list of problems to be fixed, it’s a really, really low priority.

36

That’s a form of what is now used as the medical definition, which I also mentioned above. But –

One of the reasons people smoke is that it improves the quality of life. Even after you adjust for the reset base level, nicotine still makes you calmer. And, complemented with coffee, allows you to adjust in real-time how calm/alert you are.

People who quit have to balance this against the loss of quality of life: lung damage, early death, out-of-pocket expense etc.

37

I like Melbourne’s comment that a cigarette or a cup of coffee can improve one’s life. I saw it today when my manager was enraged at work and decided to smoke a cigarette. She came back three minutes later and transitioned to Billie Burke from the Wizard of the Oz. She’d been trying to quit but needed the cigarette more than anything today!

38

This is why vapes and patches were invented.

39

That’s weird. Nicotine has always pepped me up, not made me calmer. It’s what I’d use when I needed focus and a burst of energy, stuff like pulling all nighters. I could feel my pulse quicken and my body feel “tighter.”

Then again, I don’t always react like most others do to drugs. I’ve been prescribed opioids in the form of hydrocodone twice and also once a cough syrup, and the hydrocodone felt no better than a Tylenol and I only took four or five total from both prescriptions, and the cough syrup was the only cough syrup that ever worked for me, but no euphoric effects. I experimented with kratom for a month and never felt an effect from it. Same with kava. THC make me mostly paranoid. Xanax/benzos I definitely feel and am very careful with. Alcohol was my drug of choice before I quit.

Such different reactions in different bodies.

40

I can report the new pain pump thingy(intrathecal device) works.

It uses a tiny tiny amount of some opiate.

It wasn’t an easy implant procedure. The testing wasn’t easy. I had to completely go off all pain meds 3+ days before hand.

Now, 2 weeks out, surgery site has healed. We got it tweaked just about right. I feel so much better.

I don’t have the feeling I’m in a drug induced haze all day. Not sleepy headed or being goofy.

It works. Right now..

It’s not for everyone. I can’t imagine it would help certain kinds of pain.

I had gotten to the point where I was either writhing in pain or a drugged zombie. So this is My answer. And it’s successfully doing as advertised.