WHAT IS ADDICTION?
Addiction is a complex brain disorder that is manifested by the compulsion to consuming substances or engagement in certain activities without thought of its consequences. It is often chronic and can distort an individual’s physical and mental function. These psychological and physical changes can linger long after the instant effects of the drug. And over time, these cravings build up a tolerance, making them want larger doses to feel the effects.
The alterations in the brain’s circuitry are what triggers the cravings for addictive drugs making it very difficult for an individual to stop. Judgement, learning, decision making, behaviour management, and memory are all hampered.
Physical dependence is when the body’s cells can’t function without the drug that they have been accustomed to and are usually manifested by painful withdrawal symptoms. This, in turn, causes most individuals to reach for these drugs just for the pain and discomfort to go away.
Psychological addiction means that the person has mental and emotional attachment to the drugs. There is an overwhelming compulsion to seek out and use the substance of choice. If they are not satisfied or cannot get what they want, it can lead to troubling emotions that have the potential to be very volatile.
It’s seldom that abusers would be able to recognize that they have crossed the line. Many of the symptoms overlap. Common symptoms are the following:
Substance abuse can be defined as continuous use of harmful substances for mood-altering reasons. These substances are not just limited to alcohol – it can also be the use of both legal and illegal drugs, and some that are not considered drugs at all (such as tobacco). Simply put, it is the use of a substance that is not intended or recommended or perhaps using more than what was prescribed.
Studies show that 1 in 20 Australians has some form of addiction or substance abuse problem. Substance abuse is found to be a major precursor to mental illness. The effects are both physical and mental and could potentially be long term.
Tobacco and alcohol are the most common substances to be abused. It is well-established that smoking-related illnesses is highly preventable.
Data also show that 13% of Australians aged 14 and over are hooked into the habit of smoking every day. Smoking-related diseases are responsible for at least 8% of the overall health burdens in Australia.
Excessive alcohol intake can lead to accidents at work or even on the most ordinary tasks. It is known to affect behaviour, where, violence is almost always the result. It is said that 1 in 6 Australians categorized as drinking at risky levels. Medical studies show that alcohol abuse is the leading cause of liver disease as well as psychological disorders.
Drug misuse regardless of intent is quite common. Some would argue that it is purely recreational and non-medical reasons and that they are not harmful. This includes the use of cannabis and amphetamines and other prescription drugs. Sedatives and painkillers also fall under this description.
In Australia, the most widely abused drugs are ecstasy, cannabis, amphetamines, and cocaine. According to studies, the use of illegal drugs raises one’s susceptibility to mental illnesses compared to those who don’t.
Signs of Substance Abuse
Substance abuse affects people from all walks of life. It does not choose regardless of one’s socioeconomic status or solely affecting just one demographic; it is everywhere.
Regardless of reason or intent, whether prescribed or purely recreational, when an individual starts experimenting with drugs, a certain pattern occurs. There is increased use, physical dependence, and ultimately, addiction. And when these behaviours progress, the person more often than not, does not recognize what is already happening.
It is quite harmless to enjoy a glass or two now and then. However, when this becomes uncontrollable and causes health issues as well as wreaking relationships, then what seemed to be a harmless habit at first has escalated into a problem.
How does one know the craving for these substances has become a habit? What are the signs?
The following are the usual signs of substance abuse:
Other signs include
Mental Health and Substance Abuse
Alcohol consumption is widespread in Australia and is closely linked with many social events as well as cultural activities. However, if alcohol consumption reaches harmful levels, then this becomes a problem. Closely associated to alcohol abuse in the increased risk of several chronic, long-lasting diseases, injuries, and even premature death. It is often attributed to violence as well as suicidal behaviours.
According to the Australian Institute of Health and Welfare, 1 in 6 (roughly 17%) of Australians consume alcohol to a degree that is harmful to them and to others. Also, 1 in 4 (26%) have consumed alcohol at levels where they were placed in direct harm on a single occasion at least once a month.
Alcohol abuse contributes to mental illnesses such as anxiety, and depression. Those with mental disorders are often than not abuse alcohol compared to those without any mental illness. Alcohol also hampers the potency of prescribed drugs such as antidepressants making them less effective.
In other people, substance abuse induces the onset of mental illness. There is an increasing number of individuals from all walks of life who are affected by a combination of mental health problems and substance abuse. One becomes vulnerable to the other. In many cases, the mental health condition is already existent when substance abuse starts, it’s just that the individual is unaware of it or hasn’t been properly diagnosed.
Chronic Disease and Substance Abuse
Substance abuse problems take a huge psychological and physical toll on a person as well as on society. Alcohol or drug abuse is a risk factor for many chronic illnesses and conditions.
The International Classification of Disease (ICD)-10, identified 25 chronic diseases that are attributed to alcohol. Certain types of cancers, tumours, cardiovascular and digestive diseases, and neuropsychiatric conditions are a result of alcohol consumption.
Substance abuse often goes hand in hand with mental illness and is therefore difficult to treat. And even if treated, it could last for the rest of the person’s life. Relapses are quite common, as such, the delivery of care can be quite challenging.
In the United States, for example, the treatment of both substance abuse AND psychiatric disorders are seldom combined. There may be centres that offer treatment for both and can be quite effective, but chances of patients following through prescribed care are occasional. While most would avail of the detoxification or medical care, patients would rarely follow through with psychiatric care. Although there are also a few centres that have established their protocols in combining both primary care and behavioural intervention, there is still a gap in the healthcare sector when it comes to integrating medical and psychiatric care into treatment for substance dependence.
A holistic approach for the management and treatment of addiction is still a long way’s off. Primary Care settings have the means to provide comprehensive care for the treatment of substance dependence and all its concurrent problems, and yet their potential has not been maximized.
With the proper bottom-up approach to restructure and reorganize the core elements and services provided by Primary Care settings, the physiologic as well as the psychiatric health of drug-dependent clients will improve drastically. More focus should be on chronic management of substance dependence.
Predisposing and Precipitating Factors of Addiction
Determinants of health such as socioeconomic status, the physical environment we grow up in, and the psychosocial factors determine our behavior. Studies have linked the strong inclination of some people for substance abuse to these factors.
Drug addiction has many parallels with chronic illnesses such as diabetes, cardiovascular disease, even Alzheimer’s, in that these conditions are heredofamilial, meaning they run in the family and they are exacerbated by environmental factors.
Genetics and lifestyle variables go hand in hand in predetermining the use of addictive substances; its escalation from normal use to excessive use, and ultimately, addiction. It is understood that some people are more vulnerable to addiction because of genetic predisposition.
There is also accumulating evidence that constant exposure to stress could induce what is termed as epigenetic changes. Stressful situations such as loss of a job, death of a family or loved one, cause modifications to the gene, thereby releasing stress hormones. These stress hormones bring about changes to the body’s systems, sets epigenetic changes in motion and adjusting the expression of other genes in the brain.
One of the systems affected by stress hormones is the brain’s reward center. The contact between this reward system and stress hormones can facilitate the start of addiction, as well as relapse on those who are in drug or alcohol recovery.
Addiction vs Compulsion
While “addiction” is a broad term, referring to the entire process by which an individual becomes dependent on a specific substance to cope with life, “compulsion” on the other hand is a narrow term.
Compulsion is described as ‘intense urge to do something’; this can often lead to certain behaviors. Compulsions may be a fraction but a crucial part of the addictive process and play a major role in obsessive-compulsive disorder (OCD). It should be noted that OCD is a psychiatric disorder and that it is classified as an anxiety disorder.
As addiction progresses, it brings in the involvement of compulsive actions to take addictive substances as well as carry out addictive behaviors. There is a repetitive pursuit of a destructive, harmful substance or behavior without regard to its negative outcomes. A person who is suffering from obsessive-compulsive disorder is more inclined to see their drug or alcohol use transition into addiction.
There was an examination to quantify both alcoholism and obsessive-compulsive behaviors called the Yale-Brown Obsessive Compulsive Scale or the YBOC. The results show that substance cravings present in adults can also be found in adolescents. The Adolescent Obsessive Compulsive Drinking Scale (A-OCDS) was developed. The range of study was confined to the 17-20 age group. The A-OCDS became a diagnostic tool in detecting alcoholism as well as impairment in function on adolescents.
Addiction vs Habit
Developing habits can be from 18 days to a full year. For most people, habit formation averages 66 days. On the other hand, breaking a habit takes about 21 days on average. However, there are other aspects to consider. Habits usually start with a regular loop based on reward circuitry of the brain. It means that there is a ‘feel good’ response as a result of an action, leading to a feel-good response from the brain. If the brain perceives that it is benefitting from the actions, it will continue to pursue these actions. This ‘feel-good’ response is triggered by the release of a neurotransmitter called dopamine.
Dopamine ferries information between neurons and contributes to feelings and satisfaction – the brain’s response to a reward system. The neuropeptide connections in the brain can dictate on the duration, the level of difficulty that a certain habit can be broken.
Some habits are healthy such as being physically fit through exercise and a healthy diet; these can also be easily modified with minimal effort. There are, however, habits that are harmful and pose a danger but are hard encoded into the brain simply because there is a ‘feel-good’ feeling. These feelings of pleasure promote and justify the harmful behavior.
Substance abusers continually want to experience that ‘feel good’ reward to the brain. They become hooked to the pleasurable feeling more and more and become emotionally dissatisfied when they can’t get it. These pleasurable experiences or the lack of it extend beyond just the emotional response, they extend to the physical reaction.
When the brain recognizes that a harmful substance is giving them a pleasurable feeling, this is when a habit becomes an addiction resulting in a physiological link. The brain instinctively rewires the “bad” habit as important and in many cases, a priority to the user in certain conditions.
Take for example drinking a glass of wine after a long day at work – when enjoyed in moderation, this may be considered a harmless habit. When this becomes constant and a glass is multiplied to several glasses, then this seemingly harmless habit has now become an addiction. The individual feels that they are powerless to control the habit, giving them no choice but to give in.
How can one tell if a habit has spun out of control? One may be experiencing addiction if the following can be observed:
From Habit to Addiction
Some behaviours and decisions are part of everyday routine. Many of them are driven by habits. Drinking coffee for instance – one may miss it but would not feel as if the world is going to end if they can’t have it. Yet some actions are done subconsciously. Take for example the red taillights of the car – when it’s suddenly cued, one automatically steps on the brake without thinking about it.
Understanding the creation of habits help shed light on the automatic response of addictive actions. Knowing how a craving is formed, the intense reward response pathway that is being introduced to the brain thereby changing its circuitry helps understand how the tenuous line between habit and addiction is crossed.
Research studies have concluded that 20-30% of habitual drug users cross the line to addiction. How is it that there are people who do drugs yet do not slide into addiction? Yet, some continue with the abuse despite the harmful and even dangerous consequences?
Neuroscience says that certain prefrontal functions such as self-control, analysis, and judgement are impaired by consistent use and consumption of large quantities of alcohol.
Drug use initially starts as goal-directed impulses coupled with an action that will provide the user with the desired outcome. When the outcome of self-directed actions has decreased its value (decreased potency of the drug, for instance), the motivation to pursue also decreases because the reward pathway hasn’t been fully satisfied. This is termed as associative learning.
This scenario changes for long-term abusers.
The lack of satisfaction from the outcome does not reduce the motivation to pursue. The parallel associative learning process now comes into play. This learning process is stimulus-based and takes on environmental prompts. Think about what drug abusers associate with getting high, sensory cues that induce them to seek out drugs – the sight and smell of their drug of choice, the enjoyment that goes with it, seeing others doing it and having fun, etc.