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The aim of Web4Health is to give good and useful free medical advice, help and self help in the areas of mental health, psychology, personality disorders, relationships, stress, anxiety, depression, emotional abuse, substance abuse, sexual abuse, types of mental illness, etc.

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Define Relapse, Rebound, Abstinence, Withdrawal, Addiction, Tolerance and Adaptation

Written by: Jacob Palme, professor at Stockholm University.

First version: 22 Jul 2008. Latest revision: 18 Nov 2008.


 What is the meaning of the terms relapse, rebound, abstinence, withdrawal, addiction, tolerance and adaptation in description about habit-forming drugs?


Some medicines are addictive and such medicines are considered highly dangerous. Therefore, physicians are often told to prescribe them only for a shorter period of time so that addiction will not occur. Despite this there are some patients who take these medicines regularly for a long period of time. If and how dangerous this is, is a question of some controversy. There are people who have used these medicines for several years without having experienced any feelings of tolerance increase, whilst others have developed severe addiction. Most experts feel that the risk of developing a severe addiction and tolerance increase is so great that one should avoid this risk by only using these medicines for a short period of time.

Some examples of medicines that are considered to be addictive are tranquilizers and sedatives (sleeping pills), Many of these belong to a group of similar substances called benzodiazepines. Some pain killers and other medication can cause addiction after long-term use. Medicines that are considered to be addictive or in other ways are connected to certain risks are in some countries labeled with a special triangle which warns that there is some sort of danger connected to the medicine:

Several non-medicines are also addictive such as alcohol, nicotine (tobacco), caffeine (coffee, tea) and narcotics.

What is usually referred to as "addictive" is in fact a combination of several effects that in various ways are connected to each other.

Effect Description
Relapse, Rebound The symptoms that the medicine was going to cure returns when one stops taking the medicine and sometimes extra much so during the time just after one has gone off the medicine.
Abstinence, Withdrawal There are specific additional symptoms that one experiences after having stopped taking the medicine. These symptoms are more than just relapses.
Addiction One increases the dosage to such a degree in order to achieve pleasure that the ability to live and work deteriorates.
Tolerance The medicine does no longer work and one is forced to take higher dosages in order to achieve the wanted effect. New side-effects arise as a consequence of the higher dosages and the abstinence and its symptoms if one stops will become worse.
Adaptation One adapts the way of living to the medicine and will then be forced to change one's living habits if one has to stop taking the medicine. An example of this is if one lives a very stressful life and manages to continue with this due to sedatives.
How bad are the withdrawal symptoms?

Warning: This information is based on studies financed by pharmaceutical manufacturers which may have a tendency to underestimate the problems.

The degree of difficulty of the withdrawal symptoms depends on how long one has taken the medicine. For diazepines the following symptoms may occur:

If one has taken the recommended dosage Difficulties sleeping, vomiting, nausea, irritableness, sweating, etc. It can take several years to be free of all withdrawal symptoms.
If one has taken dosages larger than the recommended ones. Sometimes this can result in so called severe symptoms such as epileptic seizure, confusion, psychosis, depression.
For how long do I have to take the medicine to become addictive?

Warning: This information is based on studies financed by pharmaceutical manufacturers which may have a tendency to underestimate the problems.

In the case of diazepines it is reported that there is a strong connection between the time that one has taken the medicine and how strong one is addictive to it. The results below show patients who have taken diazepine in dosages recommended by the manufacturer.
After 10 weeks Between 3 % and 44 % experience an increase in withdrawal symptoms or relapse symptoms.
After 3 years About 50 % experience an increase in withdrawal symptoms or relapse symptoms.
Psychological addiction
Psychologists often use the word "addiction" to describe a psychologial mechanism, through which people learn to suppress anxiety through some activity such as eating, shopping or other activity which for them is used to suppress the anxiety. Psychotherapists teach such patients to listen to their inner feelings, accept the uncomfortable feelings, and find constructive solutions instead of suppression. In this case, there can also be a pharmacological dependence, for example when alcohol or drugs are used, but there can also be no pharmacological dependence on an external substance. The treatment, though, is rather similar to that for drug addiction. More.
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