Addiction and Dependency

THE MAN AND HIS CIGARS

By the summer of 1939, the man was very frail and suffering severe pain from inoperable oral cancer. He asked his friend and a doctor to put a stop to it all and euthanise him when the time was right. Eventually, the man died in September the same year after 45 years of tobacco addiction.

The man started smoking when he was 27. When he was in his 30s, he developed cardiac disease and was urged to break his habit. He was concerned for his health so he tried quitting but when he experienced “the misery of abstinence”, including depression, tension and a burning sensation in his chest, he was soon back to his 20-cigar a day habit. In his late 60s, he developed a cancerous growth in his mouth, but years passed before he showed it to anyone. When the growth was eventually excised, he was told once again to stop smoking, and once again he couldn’t. During the remaining years of his life, he had more than 30 surgical procedures and was fitted with a prosthetic jaw after his own was amputated.

Although this could be a story of hundreds of patients, it’s just one story and this unfortunate man was none other than Sigmund Freud, the father of psychoanalysis. Freud struggled with tobacco addiction for most of his life. He also experimented with cocaine, but he quit the drug after he almost killed a patient while under its influence. Freud’s story illustrates four basic terms connected with substance-related disorders: addiction, tolerance, dependency and withdrawal symptoms.

Freud was often photographed with cigars.

 


Although addictive behaviour is associated with the ingestion of a substance, such as drug, alcohol or tobacco, DSM 5 (the current edition of “The Diagnostic and Statistical Manual of Mental Disorders”) includes only gambling as form of addiction that doesn’t involve the use of a substance. Other addictive behaviours, such as eating, shopping or Internet surfing require further research before they are considered mental disorders in the DSM.

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