Claudia Miller, MD, MS, Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive (222 MCS), San Antonio, TX 78229-3900, 210-567-7407, lutri@uthscsa.edu

Drug addiction and chemical intolerance ("abdiction") appear to share a common underlying dynamic, one that provides evidence for a new paradigm of disease. "Toxicant-Induced Loss of Tolerance (TILT)" is a proposed mechanism that bridges the gap between addiction and abdiction and has the potential to explain a wide variety of chronic conditions. Both addiction and chemical intolerance appear to involve a fundamental breakdown in innate tolerance, resulting in an amplification of various biological effects, particularly withdrawal symptoms. Although addicts seek further exposures so as to avoid unpleasant withdrawal symptoms, chemically intolerant individuals shun their problem exposures, but for the same reason-to avoid unpleasant withdrawal symptoms.

Features of both chemical intolerance and addiction include: Multi-system symptoms, especially central nervous system symptoms; multiple, chemically unrelated substances affecting the same individual; caffeine, alcohol,nicotine, drugs being implicated; stimulatory and withdrawal symptoms; heightened sensitivity to physical stimuli (noise, light, heat, cold, touch, vibration) during withdrawal phase; cravings and bingeing; habituation; genetic predisposition; ill-defined physiological mechanisms; lack of biological markers; lack of effective drugs for treating the condition; detox/withdrawal requiring 4-7 days; links to violence, physical/sexual abuse, suicide; and disruption of work, family and social relationships.

These observations raise critical questions: do addictive drugs and environmental pollutants initiate an identical disease process? Once this process begins, can both addictants and pollutants trigger symptoms and cravings? TILT opens a new window between the fields of addiction and environmental medicine, one that has the potential to transform neighboring realms of medicine, psychology, psychiatry and toxicology.

Learning Objectives:

• Identify five unifying features of chemical intolerance and addiction.
• Describe how TILT and unpleasant withdrawal symptoms result in abdiction and addiction.
• List ten chronic health problems associated TILT.

Keywords: Alcohol Use, Environmental Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.