To the Editor:

I enjoyed reading the May 2011 Dermatology Digest article about the patient with perioral dermatitis (“What caused this woman's addiction to steroids?”). It was a fascinating case. I was, however, concerned with the article's use of the word “addiction.” This word has specific meaning and was not used appropriately in this case. Addiction is not a diagnosis—rather, it is a description of a very complex set of circumstances and behaviors. The American Society of Addiction Medicine defines addiction this way:

Addiction is 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. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.1

The long history of misunderstanding and stigma related to addiction makes it essential for clinicians to exercise care when using the word “addiction” in medical settings. This particular case could have been described more accurately by simply noting the symptoms that occurred when the patient discontinued the steroids and that physiologic dependence had occurred, requiring a medication taper as noted. Physiologic dependence, however, is NOT addiction, but instead a common and normal adaptive response to many medications, including steroids.

Jim Anderson, PA-C, ATC

Member, Society of PAs in Addiction Medicine

REFERENCE

1. Definition of addiction (short version). American Society of Addiction Medicine Web site. http://www.asam.org. Accessed May 11, 2011.