Addiction

Why is Addiction a Disease?

What is Addiction?

Who is at Risk?

How does the brain become addicted?

What is the difference between Dependence vs. Abuse?

How does addiction hijacks the brain?

Videos:  See videos for other information

Identifying addiction and Self-assessments

Other Resources

Opioid Addiction Treatment Options

Pain - Medline Plus....

Personal Note

SEE Literature for more information

 

Why is addiction a disease? The Selfish Brain- Learning from Addiction “There are two types of diseases acute (rapid onset and rapid progression of symptoms) and chronic (gradual onset of progressively more sever symptoms).

  • Addiction is a chronic disease… the time between physical health and obvious debilitation is a long and drawn out process. It is a chronic disease that the prospect of recurring relapse is high. Due to adaptation and compensation over time, a person changes his entire lifestyle and the entire spectrum of human actions on physical, psychological, behavioral and social levels. When the physical aspect of disease is treated (i.e. an addict stops using) without treating other aspects, the untreated levels induce relapse to the previous disease state. A total recovery program is essential- physical, psychological, and spiritual. If a person recovers physically but fails to recover psychologically, behaviorally, and socially, his illness will continue to limit him. Physical recovery alone is only partial recovery. Recovery is dependent upon a change of lifestyle.”
  • Addiction is a complex, lifelong, incurable family disease. Dishonesty is at the heart of addiction. One inescapable element of addiction is dishonesty. A person cannot be an addict without being a liar- to oneself, to those who care, and to the community at large.
  • Addicts, like other sick people i.e. diabetics, area not responsible for their diseases, they are fully responsible for their behaviors during every stage of the disease, including how to manage their illness.
  • Addiction produces reward by stimulating the brain’s pleasure centers. As long as a behavior produces right now pleasure, it is repeated, regardless of the long-term consequences. When the brain’s reward or pleasure centers are stimulated, the brain sends out powerful signals to repeat the pleasure-producing behaviors. The brain knows only ‘more’ and ‘no more’ or ‘on’ and ‘off.’ The selfish brain does not know the importance of delayed gratification.
  • Addiction is a complex biopsychosocial disease, meaning that is has biological, psychological, and social roots.
  • Addicts are not likely to get well unless they are accountable for their behaviors.

Comparing diabetes to addiction is very useful in understanding the disease of addiction.

Diabetes

Addiction

Monitor Diet

Learn to eat healthy

Abstain from too much sugar

Abstain from any mind altering drugs or alcohol

Monitor sugar level regularly

Random drug tests

Insulin

May need medication to prevent craving

Doctor helps establish levels for glucose regulation

Doctor/councilor helps establish guidelines for strategy to prevent relapsing

Exercise helps circulation

Exercise helps brain to heal faster

Symptoms of coma: increased thirst, fatigue, shortness of breath, stomach pain, fast heartbeat

Signs of overdose: (varies depending on drugs... example for narcotics) slow shallow breathing, clammy skin, convulsions, coma

Attend support groups- to educate self and have a group of friends who understand some of your struggles.

Attend support groups- to educate self and have a group of friends who understand some of your struggles and support you in staying clean and healthy.

A diabetic cannot avoid blood sugar imbalances simply by abstain from eating sugar. He/she will need to change their eating habits and monitor their food intake. Educating oneself about the disease is essential to avoiding diabetic shock. Joining a diabetic support groups is often very helping. The same can be said for an addict. Abstaining from an abused substance is not enough for an addict to recovery or learn to control their addiction. Besides abstaining he/she will need to be educated on many aspects of addiction such as triggers to avoid; eating healthy, exercising, learning how to make good decisions, and living in a healthy environment. Support groups are often a key to recovery for an addict.

 

What is addiction?  American Society of Addiction Medicine Definition
  

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Facts about Addiction:

  • An addicted brain is different, altered from typical brain.
  • Drugs erode the voluntary acts of an individual. The brain’s reward pathways are hijacked due to the spikes of the brain chemical dopamine through repeated drug use.
  • Approximately 40% of addicts suffer from co-occurring mental disorders.
  • Addiction is The fact that drug courts have been so successful demonstrates that coerced treatment is as effective as voluntary treatment.
  • 75% of people struggling with addiction are employed.
  • MYTH- Addicts and alcoholics have to hit bottom – whatever that is- before they become sober, but the reality is that everyone is different – there is no telling what will impel someone to seek treatment.
  • An addict is far more likely to relapse on hard drugs if they drink or smoke marijuana.
  • Addiction is NOT a willpower problem. Addiction occurs in an area of the brain called the mesolimbic dopamine system that is not under conscious control.
  • 95% of all adults dependent on or abusing alcohol stated drinking before age 21
  • 2002 SAMHSA – The younger kids are when they first use marijuana, the more likely they are to use cocaine and heroin and become dependent as adults.
  • Often accompanied by other illnesses, in particular mental health disorder.

Addiction is a lifelong disease in which medical treatment plays a potentially important but limited role.  Dealing realistically with the addiction of a loved one is called detaching with love. It means doing what we can to help the addicted person and then honestly admitting our limits. 

“There is a deeply spiritual dimension to addiction, as dishonesty and self-centeredness play major roles in the addiction to alcohol and other drugs. Other diseases such as diabetes, asthma, and rheumatoid arthritis (ordinary biological diseases) do not have this dimension.  Unlike these diseases recovery from addiction is not a matter of seeing the doctor and taking some pills for a week or so. ”

How does the brain become addicted?

  • Drugs of abuse activated the same brain circuits as do behaviors linked to survival, such as eating, bonding and sex. The drug causes a surge in levels of a brain chemical called dopamine, which results in feelings of pleasure. The brain remembers this pleasure and wants it repeated…
  • The need to obtain and take drugs becomes more important than any other need, including behaviors (like eating) that are truly necessary for survival. The addict no longer seeks the drug for pleasure, but for the need to relieve distress.
  • Eventually, the drive to seek and use the drug is all that matters, despite devastating consequences.
  • Using drugs and alcohol repeatedly over time alters brain chemistry and function
  • What brain changes cause such a dramatic shift in the addict’s thinking…
  • Reduced normal dopamine activity. Drugs of abuse produce very large and rapid dopamine surges, and the brain respond by reducing normal dopamine activity. Eventually, the addict is incapable of feeling any pleasure – even from the drugs they seek to feed their addiction.
  • Altered brain regions that control decision-making, judgment, memory, learning, desires and emotions have been affected. The resulting lack of control leads addicted people to compulsively pursue drugs, even when the drugs have lost their power to reward.

“The addictive process moves in, undoes or weakens what the brain knew before, and them teaches it something else entirely.”

Science of addiction & the brain:  (for additional information see helpful links)

Who is at Risk?  

  • In general, the more risk factors an individual has, the greater the chances that taking drugs will lead to abuse and addic
  • Nature and nurture influence a person’s vulnerability or predisposition to abuse.
  • Heredity is a critical factor in developing a substance addiction. Genetically complex means that many genes play a role in shaping addiction risk.
    • Some people inherit a genetic predisposition to drug or alcohol dependence.        
    • Others inherit a personality or behavior disorder that makes them more susceptible to addiction
  • Those who start using in their teens are more likely to become addicted later.
  • Emotional, physical and sexual abuse victims. 
  • Traumatic events

Risk of Addiction:

  • Personal Factors
    •   1.Age and Sex: Males and among people ages fifteen to thirty.
    •    2.Genetic predisposition is important.
    •    3.Being impulsive.
    •    4. Oriented to the present rather than being oriented to delayed gratification
    •    5.Having personal values that focus on one’s own feelings of pleasure rather than on concern     for others, and having no religious or spiritual values
  • Environmental Factors
    •    1.Being exposed frequently to alcohol and other addicting drugs
    •    2.Living in a family that tolerates use and/or excessive alcohol use
    •    3.Having a community that tolerates addiction and its consequences
  • Substance of Choice Factors
    • ((Cocaine and heroin (heroin is a semi-synthetic opiate as are many opiate based prescription drugs and within the prescription drugs there is a wide variety of strengths    OxyContin being one of the most powerful) are far more likely to produce addiction than is  alcohol, give the same level of use, genetic vulnerability, and social tolerance.
  • Routes of Administration Factors: (swallowed, smoked, injected, sniffed)

When does abuse turn into dependence/addiction? Read below to get a better understanding of these two terms.
(Although there are some books, and literature that differentiate between addiction and dependence, the important issue isn’t the definition but the fact that at this point the person needs help to reduce and/or eliminate the drug (s) from his/her body.)

Substance refers to alcohol, and legal or illegal drugs.
DSM-IV Substance Abuse Criteria Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:
Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).

  1. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
  2. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
  3. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

 Note: The symptoms for abuse have never met the criteria for dependence for this class of substance. According to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time.

DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

  1.  Important social, occupational, or recreational activities are given up or reduced because of substance use.
  2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  3. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
  4. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
  5.  The substance is often taken in larger amounts or over a longer period than intended.
  6.  A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  7.  The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

 American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183)

Adolescent Addiction is Different...

  • Generally have smaller body size, a lower tolerance for substances, and a brain that is not fully developed…putting them at greater risk for abusing drugs and at greater risk for physical and other consequences related to their use.
  • Substance use may also negatively effect their mental and emotional development
  • Family involvement plays a critical role in an adolescent’s treatment and recovery because they typically a part of a larger family unit and live with their families.
  • Few adolescents attend treatment because they recognize they have a problem- need to be forced.

Identifying Addiction: Staying Sober: A guide for relapse prevention

  • Addiction means powerless over use of alcohol or other drugs
  • Addiction both feeds on and causes self-centeredness, sensitivity to criticism and dishonesty
  • Addicts are not responsible for their disease, but they are responsible for what they do about their disease
  • Abstinence is necessary for recovery from addiction, but is not sufficient for complete recovery
  • Getting well has a spiritual dimension that overcomes self-centeredness and dishonesty
  • Recovery most often comes from participation in the lifelong fellowship of a twelve Step program, such as AA or NA
  • Addiction is a family disease- family members commonly suffer from co-dependence..usually need to participate in the process of recovery.

SELF SCREENING TESTS
 

Additional Resources

HBO- Addiction A great website.

Personal Thoughts:  Maybe one day science will be able to test carriers of the addiction gene. Sadly, this is not predictable today. 

Using alcohol as an example:

  1. Some people drink socially and never have a problem regulating or stopping when he/she chooses.
  2. Some people drink for years. Slowly increasing their intact and tolerance... abuse often turns to addiction.
  3. Some people love alcohol from day one and drinking quickly consumes their life.
  4. Some people drink, begin to abuse, then decide to stop and quit drinking. These people have developed a bad habit which may appear to be addiction but the difference is when this person decides/chooses to quit he/she doesn’t have the same struggles that a person with the disease.

For people without an addiction it is often hard to understand just how difficult it is for someone with an addiction to stop using or become abstinent. Understanding the disease helps to understand how and why the person struggles not only with being abstinent but with learning new skills and strategies for maintaining a healthy lifestyle.

PERSONAL NOTE:   Addiction is a family disease meaning it tends to run in families and that it affects the family not just the person who has the addiction.  

 The family will need to educate themselves on this disease and elements of recovery. This may involve change. For example, when someone in the family is diagnosed with diabetes typically the family makes changes to their meals and snacks. They become aware of what triggers insulin imbalances and look for symptoms of a diabetic coma... i.e. increased thirst, fatigue, nausea vomiting ... It benefits everyone to learn about the disease. (see table below)

If you take the time to understand the disease of addiction it will greatly help everyone involved in the recovery process this includes the addict, family members, and possibly co-workers. You want to help establish a success recovery environment. Also, remember that relapsing is frequently part of recovery but that doesn’t mean an addict has to hit rock bottom before working on recovering. “Tendency to relapse is part of the disorder not a failure of treatment.” HBO Addiction

In the beginning I just accepted the fact that addiction is a hereditary disease. During the past few years I have read many books trying to educate myself to better understand how this disease has affected our family.

There are many theories about how and/or why a person becomes addicted. The disease model is the most widely accepted model. Some people struggling with addiction may view the disease model as an excuse to use because “I have a disease.” This person takes the role of a victim.

There is often discussions about addiction being a disease vs. a choice. Yes, a person with an addiction has made some poor choices but one thing a person would not choose that is to be is an addict. Often a person is seeking to avoid the pain of withdrawal instead of the enjoying the feeling from getting high, or doing things that are morally wrong or against their values, or in and out of jail or rehab.... Who would choose this life?  This is not to say a person doesn’t have a choice. There are many choices to make: stop using drugs, find new drug-free friends, avoid environments such as places a person used drugs, attend AA/NA meetings, eat healthy, exercise, attend church, seek God for strength and hope, set new goals or renew old goals.... There are many choices to make. But one thing a person doesn’t choose is who will suffer with addiction, who will experiment and be able to quit ... The best choice is not to tempt fate... Don’t use drugs (this include alcohol).