Substance Abuse Counselling | Rehab at Home

Key ASpects of Addiction

Addiction is a complex, chronic disorder that involves the use of a substance or performing an activity repetitively generating a vicious cycle of reward and compulsion despite the severely detrimental effects associated.

Addiction, although mostly referred to the dependence on a substance of abuse such as alcohol, heroin, nicotine, cannabis, methamphetamine, or cocaine, can also be related to other behavioural addictions such as gambling addiction, internet addiction, sex addiction, workaholism, codependence and even being a compulsive shoplifter, exerciser or adrenaline seeker.

According to the World Health Organisation (ICD-10), a patient must meet 3 or more of the following symptoms during the previous year to be categorised as 'dependent on a substance of abuse'. [1]

A strong desire or sense of compulsion to take the substance
Difficulties in controlling substance
Withdrawal symptoms
Developing tolerance
Neglect of alternate pleasures or interests
Persistent use despite knowledge of the harmful consequences

How does Addiction Occur?

As with other chronic relapsing conditions, like diabetes, which develops in those with family history and bad dietary habits, addiction has a predisposition to developing in individuals with related risk factors.

In contrast, those with protective factors have a less likely chance of developing an addiction.

Risk factors associated with an increased risk of developing Addiction include;

Genetic predisposition - seen in 50% of addicts [2]
Harmful family background - lack of parenteral supervision, psychological trauma at home, separate parents, habits of parents, aggressive behaviour in childhood.
Negative socio-economic environment - community poverty, bad company, availability of drugs at school, and neighbourhood.
Psychological issues - depression, stress, overworking, exhaustion, mental trauma, anti-social behaviour.
Time and method of use - Studies have shown those who start using drugs of abuse at an early stage face more harmful effects. Intravenous drug use, as opposed to oral intake, increases the risk of addiction.

Protective factors associated with a decreased risk of developing addiction;

Healthy family background - parenteral monitoring and support, meaningful and positive relationships
Positive environment- Anti-drug policies in school, neighbourhood resources, good grades.

What Happens in the Brain?

The general conception about drug addiction often leads to cornering the addicts from society considering them to be immoral. However, it is important for us, to understand that addiction is a disease, and quitting a substance of abuse is extremely difficult.

Although the initial decision to take drugs is generally voluntary, with continued use, a person's ability to exert self-control becomes impaired. It worsens to an extent that higher doses of the drug are required to simply feel ‘normal’. This is a factor called tolerance. Brain imaging shows physical changes in areas of the brain that are important for judgment, decision making, learning, memory, and behaviour control.

Most drugs of abuse indirectly or directly affect the reward system of the brain by increasing its dopamine levels. Dopamine is a neurotransmitter that is intermediate in cognitive functions such as motivation, emotion, regulating movement, and controlling behaviour. Abnormal and unnatural increases in dopamine levels, cause dopamine receptors to down-regulate, hence requiring higher and more frequent drug use to stimulate the receptors.

Treating Addiction

Treating addiction is important to prevent the decline of the health status of the patient and to safeguard the social life of the addict. Modern medicine recommends combining behavioural therapy with medications. The programs are tailored to address each patient considering the type of drug used, the psychiatric, environmental, and social problems faced. It is important to note that the presence of a support system of friends and family can go a long way in recovery.

References

[1] - The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines.

https://www.who.int/substance_abuse/terminology/ICD10ClinicalDiagnosis.pdf

[2] - Bevilacqua L, Goldman D. Genes, and addictions. Clin Pharmacol Ther. 2009;85(4):359-361. DOI:10.1038/clpt.2009.6

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