Addiction (or drug dependence, as the World Health Organization now recommends that it be called) is a concept that was originally clear in empirical terms, but became progressively more confused by successive attempts at official definitions. In North America there is a tendency to regard physical dependence, as revealed by a withdrawal reaction, as the cardinal feature of addiction, but this is putting the cart before the horse. The essence of addiction is drug-seeking and drug-taking behavior that has become a central element of the individual’s life pattern. If the frequency and amount of drug taking are sufficiently high, and the circumstances of use are appropriate, tolerance and physical dependence are likely to result, and social, psychiatric and medical problems of various kinds may be produced, but these are all consequences of addiction. The fundamental question is: What causes the drug-taking behavior to become so strongly established as to generate these consequences?
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