Addiction

Definition

  • Addictive diseases
    • These are complex primary disease states that typically manifest as both physical and behavioral symptoms.
    • They are brought on by a confluence of genetic, psychosocial, and environmental factors.
    • Their essential elements are frequently defined as continued substance use or other maladaptive behavior.
  • Addiction occurs when a psychoactive drug is taken for a sufficiently long period of time and in sufficient doses to cause either tolerance or withdrawal symptoms.
    • Tolerance: It is represented by the need for an individual to take more of a given substance to achieve a given effect, or by the decrease in perceived effect over time when a substance is taken in an unchanging dose.
    • Withdrawal: It is represented by the presence of observable physiologic change following drug discontinuation.
    • Physiologic addiction need not be present for addictive disease to exist.
  • Alcohol is a drug that is physically addictive and causes physiologic addiction in all humans.
    • Any person who drinks alcohol has the potential to become intoxicated, and their tolerance and withdrawal symptoms will vary depending on how much and how long they consume alcohol.
  • Substance use: A quantity-oriented term, as it contains all those activities in which substances are used in any quantity other than zero.
    • Within the psychiatric framework, addiction can be caused by alcohol and other sedative drugs, amphetamines, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, and steroids.
    • The use of addictive substances can come to an end as a result of remission, recovery, agonist therapy like methadone, or a controlled environment.
  • Since substance use quantity and frequency are unrelated to disease severity, they are neither useful nor predictive indicators of disease progression.

Disease Course and Epidemiology

  • Addictive illnesses: These are primary illnesses in that they are not symptoms of other disease states.
    • It is only natural for people to try to pinpoint the reason they contracted a disease, and many of them end up blaming depression, anxiety, or particular life stresses for their addiction.
  • Addictive diseases: These are involuntary in the sense that those who suffer from them did not choose to be ill, but this does not absolve those who suffer from addictive illnesses of the responsibility required to recover from their illness.
  • Discontinuation of the addictive behavior is a requirement during the action and maintenance phases.
  • Controlled use or cutting back is an ineffective treatment approach.
  • Prevalence: It refers to the percentage of a given population with a given diagnosis at a specific cross-section in time.
    • The Epidemiologic Catchment Area (ECA) study indicates a lifetime prevalence of alcohol disorders to be 23.8%, with a one-year prevalence of alcohol disorders to be 11.9%.
    • The National Comorbidity Survey (NCS) showed a lifetime prevalence of alcohol dependence to be 20.1% in men, with a one-year prevalence of 10.7%.
  • Incidence: It refers to the risk that any one member of the study population will become afflicted with the disease under study in a specified period of time.

Treatment

  • Stopping substance use is only the first step in the treatment of addiction, and a maintenance program must be followed after this to be effective.
  • Successful medical treatment typically entails a blend of therapeutic modalities, the management of any physical or behavioral comorbidities, and the patient's active participation in 12-step support groups.
  • Opioid and nicotine dependence have both been proven useful with pharmacotherapy.
  • Disulfiram (Antabuse) is the only medication that has been shown to be effective in the long term treatment of alcoholism.

Relapses

  • Common myths about relapse:

    • The relapse takes place because the patient wants to relapse.
    • The patient needs to hit bottom before recovery is possible.
    • Relapse means the patient has begun using substances again.
    • Dry drunk: An individual is thinking in the same manner as one who is actively using.
    • Once a relapse has taken place, complete loss of control will result.
    • Relapses often consist of a brief episode of use, after which the patient suddenly and quickly returns to sobriety.

  • An individual’s risk of relapse may fall within any of three groups

    • Recovery prone
    • 40% of addicts attempting recovery fall into this group.
    • Some attain sobriety with no clinical intervention and no attendance at self-help groups.
    • Transitionally relapse prone
    • 20% of all patients periodically relapse, generally within treatment.
    • These patients often enter a long-term sobriety within 3–5 years.
    • Relapse prone
    • This group of 40% are thought to develop progressive patterns of more severe episodes.
    • Levels of functioning decrease during periods of abstinence.
    • These patients often die of their illness within the first two decades of treatment.