Differences in Addictions: Acute vs. Non-Acute Toxicity
All addictions share unifying characteristics: a dopamine high; and the development of tolerance. Still, there’s at least one factor that divides addictions into two categories, and that’s acute toxicity.
Most addictive drugs — alcohol, heroin, synthetic opiates, cocaine, methamphetamine – are acutely toxic: take too much at once and they’ll kill you.
Drugs like marijuana, nicotine or caffeine, on the other hand, aren’t like that. They can be addictive, but they aren’t acutely toxic. Similarly, non-drug addictions, like gambling, result from behaviors that aren’t acutely toxic.
Addiction to acutely toxic drugs is a progressive disease that, without treatment, ends in death. That’s because of the way tolerance develops. The brain’s defense to excessive drug use is to make the dopamine system successively less efficient over time. But the result is that just to feel normal, a user has to increase the dose and frequency to respond to ever-worsening tolerance. The body can adapt to that increased drug use, but only to a point. The basic rule of toxic substances always applies: take too much and you die. So, the inexorable process of deepening tolerance involves a paradox: your brain and body can adapt to tolerate a level of drugs that might be deadly to occasional users. But eventually, as addicts continue to increase the dose and frequency, they get closer and closer to the acutely toxic threshold. The process culminates in a lethal dose, even for someone as highly tolerant as a late-stage addict.
Addiction to drugs that aren’t acutely toxic – you never hear about fatal overdoses of caffeine, nicotine or marijuana — don’t involve the same lethal threat. Nor do behavioral addictions like gambling. Accordingly, addiction to non-acutely-toxic drugs or behaviors is the exception to the rule that addiction is a progressive, fatal disease.
Unfortunately for these addicts, not being forced to face the ultimate decision to get sober and live or keep using and die may make a moment of clarity more difficult. Still, many people addicted to drugs or behaviors that aren’t acutely toxic can face up to their addictions without the life-or-death threat. Attendance at Marijuana Anonymous and behavioral anonymous programs (Gamblers Anonymous, etc.) attests that a goodly number conclude they can’t live normal lives if they continue in their addictions despite having no fear of dying from overdose.
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