Addiction

Definition

Definition of Addiction
People with an addiction do not have control over what they are doing, taking or using. Their addiction may reach a point at which it is harmful. Addictions do not only include physical things we consume, such as drugs or alcohol, but may include virtually anything, such abstract things as gambling to seemingly harmless products, such as chocolate - in other words, addiction may refer to a substance dependence (e.g. drug addiction) or behavioral addiction (e.g. gambling addiction).

Symptoms

Symptoms of Addiction
According to the Diagnostic and Statistical Manual of Mental Disorders, substance use is considered abusive or addictive if the person has experienced three or more of the following signs during a 12-month period:

1. Tolerance is evident when (1) a need exists for increased amounts of a substance to achieve intoxication or desired effects or (2) the effect of a substance is diminished with continued use of the same amount of the substance.
2. Withdrawal is evident when (1) characteristic, uncomfortable symptoms occur with abstinence from the particular substance or (2) taking the same (or closely related) substance relieves or avoids the withdrawal symptoms.
3. The substance is used in greater quantities or for longer periods than intended.
4. The person has a persistent desire to cut down on use of the substance, or the person's efforts to cut down on use of the substance have failed.
5. Considerable time and effort are spent obtaining or using the substance or recovering from its effects.
6. Important social, employment, and recreational activities are given up or reduced because of an intense preoccupation with substance use.
7. Substance use is continued even though some other persistent physical or psychological problem is likely to have been caused or worsened by the substance (for example, an ulcer made worse by alcohol consumption or emphysema caused by smoking).

Causes

Causes of Addiction
Addiction or substance abuse is a complex brain disease. A person with an addiction experiences cravings that persist even in the face of extremely negative consequences. During a craving, a person with an addiction misses the habit-forming drug terribly, and often he or she experiences symptoms of withdrawal.

Evidence strongly suggests that genetic susceptibilities and biological traits play a role in addictions; however, the development of an addiction is also shaped by a person's environment (for example, a person with alcoholism cannot become addicted without access to alcohol). The "addictiveness" of a drug is related to how strongly the drug activates the reward circuits in the brain. For instance, when the methamphetamine found on the street is purer (meaning that it stimulates the dopamine reward circuits more), then the number of first-time drug users who become drug abusers is higher.

Addictive substances or behaviors change the reward circuits in the brain. In other words, the brain responds to the addictive substance in the same way that it responds to very pleasurable experiences. This explains, in a general sense, why people with addictions sometimes forsake all other life activities and obligations and even their own health in pursuit of the addictive substance.

Diagnosis

Diagnosis of Addiction
In many cases, it is a family member or very good friend who raises concern about the patient’s behavior (rather than the patient himself/herself doing so). The first port of call is usually a GP (general practitioner, primary care physician, family doctor). The doctor will ask several questions, including how often the substance is consumed, whether the substance use has been criticized by other people, and whether the patient feels he/she may have a problem. If the doctor suspects there is an addiction problem, the patient will be referred to a specialist.

In cases of nicotine addiction, establishing whether or not there is an addiction is done at the GP-patient level. With more powerful substances there is usually an evaluation by a specialized addiction counselor, psychologist or psychiatrist.

• Blood Test: this may be ordered to determine whether the substance is still in the blood (whether the substance has been taken recently). It is not used to diagnose addiction.
• DSM Criteria for Substance Dependence: A patient diagnosed with substance dependence (an addiction) must meet criteria laid out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), a manual published by the American Psychiatric Association.

The criteria for drug dependence that causes significant problems must include three of the following:

1. Tolerance - the substance has less effect on the patient because their body has developed tolerance. They need more and more of it to get the same pleasure.
2. There are physical/psychological withdrawal symptoms, or the patient takes the substance to avoid experiencing withdrawal, or the patient takes a similar substance to avoid experiencing withdrawal.
3. The patient frequently takes higher-than-intended doses of the substance.
4. The patient often tries to quit or cut down.
5. More and more time is spent getting hold of the substance, using it, or recovering from its effects.
6. The patient’s drug use causes him/her to give up social, occupational or recreational activities.
7. Even though patients know it causes psychological/physical problems, they continue taking it.

Treatment

Treatment of Addiction
The first step for the addicted person is to acknowledge that there is a substance dependency problem (addiction problem). The next step is to get help. In most of the world there are several support groups and professional services available.

Treatment options for addiction depend on several factors, including what type of substance it is and how it affects the patients. Typically, treatment includes a combination of inpatient and outpatient programs, counseling (psychotherapy), self-help groups, pairing with individual sponsors, and medication.

• Treatment Programs : These typically focus on getting sober and preventing relapses. Individual, group and/or family sessions may form part of the program. Depending on the level of addiction, patient behaviors, and type of substance this may be in outpatient or residential settings.
• Psychotherapy : There may be one-to-one (one-on-one) or family sessions with a specialist. Help with coping with cravings, avoiding the substance, and dealing with possible relapses are key to effective addiction programs. If the patient’s family can become involved there is a better probability of positive outcomes.
• Self-Help Groups : these may help the patient meet other people with the same problem, which often boosts motivation. Self-help groups can be a useful source of education and information too. Examples include Alcoholics Anonymous and Narcotics Anonymous. For those dependent on nicotine, ask your doctor or nurse for information on local self-help groups.
• Help With Withdrawal Symptoms : The main aim is usually to get the addictive substance out of the patient’s body as quickly as possible. Sometimes the addict is given gradually reduced dosages (tapering). In some cases a substitute substance is given. Depending on what the person is addicted to, as well as some other factors, the doctor may recommend treatment either as an outpatient or inpatient.

Complications

Complications of Addiction
Addiction to a substance, be it a drug, narcotic or nicotine usually has health consequences. In the case of drug/alcohol addiction there may be mental/emotional as well as physical health problems. In the case of nicotine addiction the problems tend to be just with physical health.