CDC Module 2.5: Addiction

Disease Model of Addiction

• Views alcohol and drug addiction as a chronic, relapsing brain disease (physical illness) rather than a moral failing or lack of willpower

• Initially, substance use may be voluntary, but repeated use causes substantive changes in the brain that leads to loss of control

• Medical treatments play an important role in addiction treatment

[Disease Model of Addiction] All addictive substances interact with brain pathways involved with…

• Motivation and reward

[Disease Model of Addiction] When we take an addictive substance, it causes a surge of what in our brain?

• Dopamine

  • This hijacks our “reward system,” causing habit-forming connections (encourage us to repeat the “beneficial activity)

[Disease Model of Addiction] When treating diseases, the aim is to…

• Manage symptoms, NOT cure (like other chronic diseases)

Biopsychosocial Model of Addiction

• Provides a holistic, multifaceted conceptualization of the disorder

• Believes the biological aspect of addiction is significant; however, it is only one of numerous contributing factors (psychological and social factors)

• Family gene ancestry (bio) plays a significant but not independent role in addiction

[Biopsychosocial Model of Addiction] Internal Sources

• Factors that support addiction development include

  • Damage to body

  • Physical and mental illness

  • Deficit of practical life/social skills

  • Destructive life orientation

[Biopsychosocial Model of Addiction] External, Situational Sources

• Situations of stress and increased risk

• Permanent damage to important societal relations

• Negative social consequences of harmful drinking/use in the past 

PCP

• CNS depressant

• Effects are highly unpredictable and erratic

• Known to trigger psychosis

MDMA

• CNS stimulant

• Considered an amphetamine but also has hallucinogenic effects

• “Love drug”

Ketamine

• CNS depressant

• Similar to PCP but also has hallucinogenic effects similar to LSD

• Historically used as an anesthetic

Gamma Hydroxybutyric Acid (GHB)

• CNS depressant

• Originally a dietary supplement and muscle enhancer — banned by FDA in 1990

• Sometimes referred to as a “date rape” drug — victim is normally sedated and has no recollection of events

Dextromethorphan (DXM)

• Robitussin, Vicks 44, Drixoral cough

• Drink entire bottle to achieve high similar to PCP and Ketamine

Cannabis

• Multiple CNS effects (stimulant, depressant, and hallucinogen)

Standard Drink Sizes for Alcohol

• 12 oz glass of beer

• 5 oz glass of wine

• 1.5 oz shot of liquor

Alcohol Effects - Brain

• Temporary or permanent damage

• Korsakoff’s Syndrome (“wet brain”)

  • Characterized by amnesia

• Wernicke’s Encephalopathy

  • Characterized by an unsteady gait, confusion, tremors, atrophy, and difficulty with speech and problems with eye movement

• Inadequate amount of thiamin (vitamin B1)

Alcohol Effects - Liver

• Alcohol liver disease (ALD) is a major cause of illness and death in the U.S. each year

• 3 types of progressive liver disease

  • Fatty liver (hepatosis) most common and reversible with abstinence

  • Hepatitis (inflammation) more serious and reversible with abstinence

  • Cirrhosis (permanent scarring and fatal)

    • Irreversible — treatment may slow progression and reduce symptoms

Alcohol Effects - Heart

• Benefits limited to those who may have 1 drink a day

• Cardiomyopathy — a degenerative disease that is sometimes fatal due to congestive heart failure

  • Treatment involves abstinence

Alcohol Effects - Pancreas

• Pancreatitis (from chronic, heavy use) or inflammation of the pancreas

  • Associated with severe abdominal pain, weight loss, and progressive death

Alcohol Effects - Sex Hormones

• Women

  • Irregular menstruation, which can result in pregnancy issues

• Men

  • Decreased hormone levels = decreased sexual desire and performance

  • Development of reactive or absolute impotence over a period of time

Alcohol Effects - Kidneys

• Increased urinary output

  • Caused by change in the the hormone aldosterone, which regulates water in the body

Alcohol Effects - Lungs

• Body disposes alcohol in 2 ways

  • Elimination

  • Oxidation

• 10% of alcohol is eliminated from lungs and kidney

• Alcohol can cause increased fluid accumulation in lungs, which can lead to chronic lung infections

3 Stages of Relapse

• Emotional

  • Poor self-care (emotional, psychological, and physical)

  • Clients are not consciously thinking about using

• Mental

  • Cognitive resistance to relapse diminishes

  • Need for escape increases

  • Warning signs include more insistent or frequent thoughts of using

• Physical

  • When client starts using again

  • Most physical relapses are relapses of opportunity

Recovery - Obstacles

• Negative thinking

• Fear

Recovery - Focus

• Redefining fun

• Learning from setbacks

Recovery - Stages

• Abstinence (0 - 6 months)

• Repair (6 - 18 months)

• Growth (1 - 2+ years)

  • Stages are not linear, can move back and forth

  • Duration of each stage can vary

Family Dynamics of Addiction - Codependency

• Term used to describe the unique role each family member plays in the alcoholic’s family