From: 1, Introduction
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Addiction refers to “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one's behaviors and interpersonal relationships, and a dysfunctional emotional response” (ASAM, 2011). The criteria for substance use disorder in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) are contained in the category of Addictions and Related Disorders; the preferred term for the disease, and the one used in this report, is substance use disorder (or opioid use disorder).
The severity of a substance use disorder can differ across individuals and across time for the same individual. Different from opioid use disorder and addiction, dependence in this report refers to a state associated with withdrawal symptoms upon cessation of repeated exposure to a drug. It is important to note that a person who is physically dependent on a drug may not meet the definition of addiction. Tolerance refers to the diminishing effect of a drug resulting from the repeated administration of a given dose.
Abuse (as in substance abuse or substance abuser) is no longer acceptable terminology, as research has found the term to be associated with negative and stigmatizing perceptions. Accordingly, the committee avoids use of this term except when quoting other sources; when referring to abuse-deterrent formulations of opioids (those with properties designed to prevent misuse [e.g., properties to prevent crushing so the drug can be snorted or dissolving so it can be injected]); and when referring to statutes, such as the Controlled Substances Act, that use this term. The term misuse is commonly used to describe any use of a prescription medication beyond what is directed in a prescription. It encompasses such specific behaviors and motivations as (1) medically motivated use more frequently or in a higher dose than prescribed, (2) nonmedically motivated use by the person to whom the drug has been prescribed, (3) medical use by a person other than the person to whom the drug has been prescribed, and (4) nonmedical use by a person other than the person to whom the drug has been prescribed. Some have argued that use of the term “misuse” to encompass both medical and nonmedical motivations (such as “to get high”) is misleading and imprecise. While the American Society of Addiction Medicine (ASAM) acknowledges this problem, it prefers “misuse” as the umbrella term encompassing a continuum of use patterns based on degree of risk, ranging from “low-risk” and “at-risk” use to “harmful use” and addiction. Under the ASAM approach, once a patient misusing prescription medication meets the criteria for an opioid use disorder, the term “misuse” is no longer appropriate. Diversion refers to the transfer of regulated prescription drugs from legal to illegal markets. The term is not used in this report to refer to the sharing of drugs with friends, family members, or other contacts for medical or nonmedical purposes.
Traditionally, the term opiates refers to substances derived from opium, such as morphine and heroin, while opioids refers to synthetic and semisynthetic opiates. However, the term opioids is now often used for the entire family of opiates, including natural, semisynthetic, and synthetic.
Finally, the acronym MAT refers to the use of medication in the treatment of opioid use disorder, regardless of whether the medication is used in conjunction with counseling and behavior therapies. This acronym may refer either to medication for addiction treatment, where medications are used without counseling and behavior therapies, or to medication-assisted treatment, where medication is used in conjunction with these therapies. Current medications approved for treatment of opioid use disorder are methadone, buprenorphine, and naltrexone. The terms substitution therapy and replacement therapy are not accurate and therefore are not used in this report.
From: 1, Introduction
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.