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This approach runs counter to the broadly held view that addicts are so incapacitated by drugs that they are unable to modify any of their behaviors. It also suggests a base for improved strategies for reducing the negative health consequences of injection drug use for the individual and for society. What Matters in Addiction Scientific research and clinical experience have taught us much about what really matters in addiction and where we need to concentrate our clinical and policy efforts. However, too often the focus is on the wrong aspects of addiction, and efforts to deal with this difficult issue can be badly misguided. Any discussion about psychoactive drugs inevitably turns to the question of whether a particular drug is physically or psychologically addicting. In essence, this issue revolves around whether or not dramatic physical withdrawal symptoms occur when an individual stops taking a drug, what is typically called physical dependence by professionals in the field. The assumption that often follows is that the more dramatic the physical withdrawal symptoms, the more serious or dangerous the drug must be. This thinking is outdated. From both clinical and policy perspectives, it does not matter much what physical withdrawal symptoms, if any, occur. First, even the florid withdrawal symptoms of heroin addiction can now be easily managed with appropriate medication. Second, and more important, many of the most addicting and dangerous drugs do not produce severe physical symptoms upon withdrawal. Crack cocaine and methamphetamine are clear examples: Both are highly addicting, but cessation of their use produces few physical withdrawal symptoms, certainly nothing like the physical symptoms accompanying alcohol or heroin withdrawal. What does matter tremendously is whether or not a drug causes what we now know to be the essence of addiction: compulsive drug seeking and use, even in the face of negative health and social consequences. These are the characteristics that ultimately matter most to the patient and are where treatment efforts should be directed. These behaviors are also the elements responsible for the massive health and social problems that drug addiction brings in its wake.

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