All About Addiction

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What Is Addiction? What Causes 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). 

This article focuses mainly on addiction to physical substances. 

In the past addiction used to refer just to psychoactive substances that cross the blood-brain barrier, temporarily altering the chemical balance of the brain; this would include alcohol, tobacco and some drugs. A considerable number of psychologists, other health care professionals and lay people now insist that psychological dependency, as may be the case with gambling, sex, internet, work, exercise, etc. should also be counted as addictions, because they can also lead to feelings of guilt, shame, hopelessness, despair, failure, rejection, anxiety and/or humiliation. 

When a person is addicted to something they cannot control how they use it, and become dependent on it to cope with daily life. 

A habit may eventually develop into an addiction

Many of us can use substances or become engaged in activities without any significant problems. Some people, however, may experience damaging psychological and/or physical effects when their habit becomes an addiction. 

What is the difference between a habit and an addiction?

• Addiction - there is a psychological/physical component; the person is unable to control the aspects of the addiction without help because of the mental or physical conditions involved.
• Habit - it is done by choice. The person with the habit can choose to stop, and will subsequently stop successfully if they want to. The psychological/physical component is not an issue as it is with an addiction.

Put simply - with a habit you are in control of your choices, with an addiction you are not in control of your choices. 

Addiction to substances or activities can sometimes lead to serious problems at home, work, school and socially. 

The causes of addiction vary considerably, and are not often fully understood. They are generally caused by a combination of physical, mental, circumstantial and emotional factors. 

Addiction, often referred to as dependency often leads to tolerance - the addicted person needs larger and more regular amounts of whatever they are addicted to in order to receive the same effect. Often, the initial reward is no longer felt, and the addiction continues because withdrawal is so unpleasant. 

According to Medilexicon's Medical Dictionary: 

Addiction is Habitual psychological or physiologic dependence on a substance or practice that is beyond voluntary control. Withdrawal has many meanings, one of which is A psychological and/or physical syndrome caused by the abrupt cessation of the use of a drug in an habituated person.

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association: 

Substance dependence is When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders..

Addiction may include prescription medications

Most people think of illegal drugs when they hear the word “addiction”. However, prescription drug addiction is becoming a serious public health problem in the USA and many other nations. Prescription medication abuse was described as “an epidemic” by researchers from the University of Nebraska Medical Center College of Medicine in a study they reported on in November 2012. 

The scientists explained that doctors today treat pain differently than they used to years ago. This change has led to an increase in prescription drug abuse. 

In the USA in the 1990s - the decade of pain treatment - not only was there a change in medication, but also policy. Pain became the fifth vital sign doctors looked out for, along with respiratory rate, blood pressure, body temperature and pulse rate. Doctors’ offices today commonly have signs in their waiting rooms asking patients to rate their experience of physical pain from 1 to 10.

What Are The Signs And Symptoms Of Addiction?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, sleepiness may be a symptom while dilated pupils may be a sign.

Substance dependence - when a person is addicted to a substance, such as a drug, alcohol or nicotine, they are not able to control the use of that substance. They continue taking it, even though it may cause harm (the individual may or may not be aware of the potential harm).

Substance dependence can cause powerful cravings. The addict may want to give up (quit), but finds it extremely difficult to do so without help.

The signs and symptoms of substance dependence vary according to the individual, the substance they are addicted to, their family history (genetics), and personal circumstances.

• The person takes the substance and cannot stop - in many cases, such as nicotine, alcohol or drug dependence, at least one serious attempt was made to give up, but unsuccessfully.
• Withdrawal symptoms - when body levels of that substance go below a certain level the patient has physical and mood-related symptoms. There are cravings, bouts of moodiness, bad temper, poor focus, a feeling of being depressed and empty, frustration, anger, bitterness and resentment.
• There may suddenly be increased appetite. Insomnia is a common symptom of withdrawal. In some cases the individual may have constipation or diarrhea. With some substances, withdrawal can trigger violence, trembling, seizures, hallucinations, and sweats.
• Addiction continues despite health problem awareness - the individual continues taking the substance regularly, even though they have developed illnesses linked to it. For example, a smoker may continue smoking even after a lung or heart condition develops.
• Social and/or recreational sacrifices - some activities are given up because of an addiction to something. For example, an alcoholic may turn down an invitation to go camping or spend a day out on a boat if no alcohol is available, a smoker may decide not to meet up with friends in a smoke-free pub or restaurant.
• Maintaining a good supply - people who are addicted to a substance will always make sure they have a good supply of it, even if they do not have much money. Sacrifices may be made in the house budget to make sure the substance is as plentiful as possible.
• Taking risks (1) - in some cases the addicted individual make take risks to make sure he/she can obtain his/her substance, such as stealing or trading sex for money/drugs.
• Taking risks (2) - while under the influence of some substances the addict may engage in risky activities, such as driving fast.
• Dealing with problems - an addicted person commonly feels they need their drug to deal with their problems.
• Obsession - an addicted person may spend more and more time and energy focusing on ways of getting hold of their substance, and in some cases how to use it.
• Secrecy and solitude - in many cases the addict may take their substance alone, and even in secret.
• Denial - a significant number of people who are addicted to a substance are in denial. They are not aware (or refuse to acknowledge) that they have a problem.
• Excess consumption - in some addictions, such as alcohol, some drugs and even nicotine, the individual consumes it to excess. The consequence can be blackouts (cannot remember chunks of time) or physical symptoms, such as a sore throat and bad persistent cough (heavy smokers).
• Dropping hobbies and activities - as the addiction progresses the individual may stop doing things he/she used to enjoy a lot. This may even be the case with smokers who find they cannot physically cope with taking part in their favorite sport.
• Having stashes - the addicted individual may have small stocks of their substance hidden away in different parts of the house or car; often in unlikely places.
• Taking an initial large dose - this is common with alcoholism. The individual may gulp drinks down in order to get drunk and then feel good.
• Having problems with the law - this is more a characteristic of some drug and alcohol addictions (not nicotine, for example). This may be either because the substance impairs judgment and the individual takes risks they would not take if they were sober, or in order to get hold of the substance they break the law.
• Financial difficulties - if the substance is expensive the addicted individual may sacrifice a lot to make sure its supply is secured. Even cigarettes, which in some countries, such as the UK, parts of Europe and the USA cost over $11 dollars for a packet of twenty - a 40-a-day smoker in such an area will need to put aside $660 per month, nearly $8,000 per year.
• Relationship problems - these are more common in drug/alcohol addiction.

Some substance/alcohol abusers who are not technically addicted may also suffer from or cause some of the descriptions mentioned above, but they do not usually have the withdrawal symptoms of an addict or the same compulsion to consume the substance.

What Are The Causes Of Addiction?

Doctors say there is a link between the repeated use of an addictive substance and how the human brain experiences pleasure - its use has a nice reward, leading to further and more frequent use. The addictive substance, be it nicotine, alcohol or some drug actually causes physical changes in some nerve cells in the brain. Another name for a nerve cell is a neuron. Neurons release neurotransmitters into the synapses (empty spaces) between nerve cells, which are received by receptors in other neurons.

What is a neurotransmitter - it is a chemical that a nerve cell releases, which thereby transmits an (electric) impulse from one nerve cell to another nerve cell, organ, muscle, or other tissue. Put simply, a neurotransmitter is a messenger of neurologic data from one cell to another cell.

Tolerance increases

After a while, the user of the potentially addictive substance does not get the same pleasure and has to increase the dose - his/her body’s tolerance to it increases.

Eventually, the user no longer experiences pleasure from the substance and takes it simply to prevent withdrawal symptoms - taking the substance just makes them feel normal.

Experts say that when tolerance increases, the risk of addiction is much greater.

How Is Addiction Diagnosed?

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:

• 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.
• 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.
• The patient frequently takes higher-than-intended doses of the substance.
• The patient often tries to quit or cut down.
• More and more time is spent getting hold of the substance, using it, or recovering from its effects.
• The patient’s drug use causes him/her to give up social, occupational or recreational activities.
• Even though patients know it causes psychological/physical problems, they continue taking it.

What Are The Treatment Options For 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.

The doctor or addiction expert may recommend either an outpatient or inpatient residential treatment center. Withdrawal treatment options vary and depend mainly on what substance the individual is addicted to:

• Addiction to depressants - these may include dependence on barbiturates or benzodiazepines. During withdrawal the patient may experience anxiety, insomnia, sweating and restlessness. In rare cases there may be whole-body tremors, seizures, hallucinations, hypertension (high blood pressure), accelerated heart rate and fever. In severe cases there may be delirium, which according to the Mayo Clinic, USA, could be life-threatening.
• Addiction to stimulants - these may include cocaine and other amphetamines. During withdrawal the patient may experience tiredness, depression, anxiety, moodiness, low enthusiasm, sleep disturbances, and low concentration. Treatment focuses on providing support, unless the depression is severe, in which case a medication may be prescribed.
• Addiciton to opioids – Opioids are a class of drugs that are commonly prescribed for their analgesic, or pain-killing, properties. They include substances such as morphine, codeine, oxycodone, and methadone. Opioids may be more easily recognized by drug names such as Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet, and Lomotil. During withdrawal there may be sweating, anxiety and stuffy nose – symptoms tend to be mild. In rare cases there may be serious sleeping problems, tachycardia, hypertension and diarrhea. The doctor may prescribe methadone, or buprenorphine for cravings (alternative substances).
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  What Are The Possible Complications Of Addiction?

  
  Health - 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.
  Coma, unconsciousness or death - some drugs, taken in high doses or together with other substances may be extremely dangerous.
  Some diseases - people who inject drugs have a risk of developing HIV/AIDS or hepatitis if they share needles. Some substances, including specific drugs or alcohol can lead towards more risky sexual behavior (unprotected sex), increasing the probability of developing sexually transmitted diseases.
  Accidental injuries/death - people with a drug/alcohol addiction have a higher risk of falling over, or driving dangerously when under the influence.
  Suicide - the risk of suicide is significantly higher for a person who is addicted to a drug/alcohol, compared with non-addicted individuals. This is not the case with nicotine dependence.
  Relationship problems - social, family and marital relationships can be severely strained, leading to family breakups, etc.
  Child neglect/abuse - the percentage of neglected or abused children who have one or both parents with an addiction problem is higher compared to those whose parents are healthy. These figures apply to some drugs and alcohol, not to just nicotine dependence.
  Unemployment, poverty and homelessness - a significant number of drug/alcohol addicts find themselves without work or anywhere to live.
  Problems with the law - if the substance is expensive, the addicted individual may resort to crime in order to secure his/her supply, making it more likely there will be problems with police, including imprisonment.
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