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What is addiction

Lecture notes 

Terminology 

Distinction between:

  • Drug use - any scope of use of illegal drugs 

  • Drug misuse - used to distinguish improper or unhealthy use from use of prescribed medication or alcohol 

  • Drug addiction - substance use disorders at the severe end of the spectrum 

Avoid the use of the term substance “abuse’ 

What is addiction: 

“A treatable, chronic medical disease involving complec interactions among brain circuits, genetics, the environment and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences” 

“Addiction” is the DSM-5-TR 

Substance use disorder:

  • Taking substance in larger amounts or longer than you’re meant to 

  • Wanting to cut down or stop use without success

  • Spending a lot of time getting, using or recovering from the use of the substance 

  • Cravings and urges to use the substance 

  • Use of substance effecting work, home, schooling 

  • Continued use even after problems in relationships 

  • Giving up important activities (e.g., social, occupational, recreational) because of use 

  • Continuing to use substances despite danger 

  • Continuing to use despite knowing of a physical or psychological problem related to the substance 

  • Mild: 2-3 symptoms 

  • Moderate: 4-5 symptoms 

  • Severe: 6+ 

Addictive disorders: 

  • Gambling disorder

    • Persistent and recurrent problematic gambling behaviours leading to clinically significant impairment or distress, as indicated by the individual exhibiting four or more symptoms in a 12-month period 

    • The gambling nehabiour is not explained by a manic disorder 

Tolerance 

  • A regular user of a drug becomes less responsive to the drug over time 

    • A need for more of the drug to achieve the same effect 

    • A diminished effect when the dosage remains the same 

  • Form of neuroadaptation where the brain achieves a new stage of homeostasis 

  • Different forms 

    • Pharmacokinetic 

      • Liver increases the number of enzymes to metabolate the drug 

      • as the body becomes faster as this more is needed to get the same effect 

    • Pharmacodynamic 

      • The brains receptors respond to the regular presence of the drug by becoming less effected by it 

      • Either increase in number or become less effected by it 

      • User has to take more in order to feel something 

    • Behavioural 

      • Known to be specific to the context in which it is admitted 

      • Only see tolerance effect when testing occurs in same environment 

Withdrawal 

  • Physical and psychological changes caused by cessation/cutting down of a drug 

  • Presence of withdrawal symptoms will differ across individuals depending on:

    • How long they’ve been using it 

    • Type of drug 

    • Characteristics of the individual 

    • Approach taken to cut down/stop drug use 

Screening for substance use problems 

  • Audit C 

  • Assist 

    • Questions used to determine a risk score 

Placebo/Nocebo effects

After a dummy treatment/sugar pills:

  • Placebo - Improvements in physical or mental health 

  • Nocebo - Declines in physical or mental health 

  • Expectancy in considered a central component of these effects 

Summary 

  • The terminology we use to describe substance use is important 

  • Addiction is a severe form of substance use disorder, and is highly complex 

  • Substance use disorders and other addictive disorders are clinically recognised in the DSM-5 

  • There is psychological component to substance use, and our expectations are very powerful