ADDICTION

Historically, addiction has been defined as physical and psychological dependence on

psychoactive substances (for example alcohol, tobacco, heroin and other drugs) which cross
the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain.

Addiction can also be viewed as a continued involvement with a substance or activity despite
the negative consequences associated with it. Pleasure and enjoyment would have originally
been sought, however over a period of time involvement with the substance or activity is
needed to feel normal. Some psychology professionals and many laymen now mean
'addiction' to include abnormal psychological dependency on such things as gambling, food,
sex, pornography, computers, internet, work, exercise, idolizing, watching TV or certain
types of non-pornographic videos, spiritual obsession, cutting and shopping

Drug Addiction

The related concept of drug addiction has many different definitions. Some writers give
drug addiction to the same meaning as substance dependence, others for example provide
drug addiction a narrower meaning which excludes drugs without evidence of tolerance or
withdrawal symptoms.

The American Society of Addiction Medicine has this definition for Addiction. 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 the individual pursuing reward and/or relief by
substance use and other behaviors. The addiction is characterized by impairment in
behavioral control, craving, inability to consistently abstain, and diminished recognition of
significant problems with one’s behaviors and interpersonal relationships. Like other chronic
diseases, addiction involves cycles of relapse and remission. Without treatment or
engagement in recovery activities, addiction is progressive and can result in disability or
premature death.
Substance Dependence

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),
substance dependence is defined as:

"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. These, along with Substance Abuse are
considered Substance Use Disorders…”

Substance dependence can be diagnosed with physiological dependence, evidence of

tolerance or withdrawal, or without physiological dependence.

Behavioral Addiction

The term addiction is also sometimes applied to compulsions that are not substance-related,
such as compulsive shopping, sex addiction/compulsive sex, overeating, and problem
gambling and computer addiction. In these kinds of common usages, the term addiction is
used to describe a recurring compulsion by an individual to engage in some specific activity,
despite harmful consequences, as deemed by the user himself to his individual health, mental
state, or social life.

Substance Abuse

Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a
substance that is not considered dependent. The term "drug abuse" does not exclude
dependency, but is otherwise used in a similar manner in nonmedical contexts. The terms
have a huge range of definitions related to taking a psychoactive drug or performance
enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a
negative judgment of the drug use in question. Some of the drugs most often associated with
this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine,
methaqualone, and opioids. Use of these drugs may lead to criminal penalty in addition to
possible physical, social, and psychological harm, both strongly depending on local
jurisdiction. Other definitions of drug abuse fall into four main categories: public health
definitions, mass communication and vernacular usage, medical definitions, and political and
criminal justice definitions.

Worldwide, the UN estimates there are more than 50 million regular users of heroin, cocaine
and synthetic drugs.

Substance abuse is a form of substance-related disorder.

Signs and Symptoms

Depending on the actual compound, drug abuse including alcohol may lead to health
problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor
vehicle accidents, homicides, suicides, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and drug abusers. The reasons believed to cause
the increased risk of suicide include the long-term abuse of alcohol and drugs causing
physiological distortion of brain chemistry as well as the social isolation. Another factor is
the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is
also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being
related to alcohol abuse. In the USA approximately 30 percent of suicides are related to
alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal
offences including child abuse, domestic violence, rapes, burglaries and assaults.

Drug abuse, including alcohol and prescription drugs can induce symptomatology which
resembles mental illness. This can occur both in the intoxicated state and also during the
withdrawal state. In some cases these substance induced psychiatric disorders can persist long
after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine
abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for
months after cessation of use. Benzodiazepines are the most notable drug for inducing
prolonged withdrawal effects with symptoms sometimes persisting for years after cessation
of use. Abuse of hallucinogens can trigger delusional and other psychotic phenomena long
after cessation of use and cannabis may trigger panic attacks during intoxication and with use
it may cause a state similar to dysthymia. Severe anxiety and depression are commonly
induced by sustained alcohol abuse which in most cases abates with prolonged abstinence.
Even moderate alcohol sustained use may increase anxiety and depression levels in some
individuals. In most cases these drug induced psychiatric disorders fade away with prolonged
abstinence.

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood,
levels of awareness or perceptions and sensations. Most of these drugs also alter systems
other than the CNS. Some of these are often thought of as being abused. Some drugs appear
to be more likely to lead to uncontrolled use than others.

Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however;
drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally
marketed under the name "ReVia," and now marketed in intramuscular formulation as
"Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of
alcohol dependence. This drug has reached very few patients. This may be due to a number of
factors, including resistance by Addiction Medicine specialists and lack of resources.

The ability to recognize the signs of drug use or the symptoms of drug use in family members
by parents and spouses has been affected significantly by the emergence of home drug test
technology which helps identify recent use of common street and prescription drugs with near
lab quality accuracy.

Prevention

1 in 5 teenagers report having abused a prescription medication and over 2500 teenagers a
day experiment with prescription medications taken from the home. The Massachusetts
legislature just enacted a law that requires all Pharmacy's located within the Commonwealth
to display, and offer for sale, medical lock boxes for home use and to place those products
within 50 feet of the pharmacy counter. Products such as the RxDrugSAFE, a fingerprint
recognition home medical safe, combats unauthorized access to prescription medications at
home, thereby preventing abuse. This new law is the first such law enacted within the United
States.
Treatment

Treatment for binge drinking and other forms of substance abuse is critical for many around
the world. Behavioral interventions and medications exist that have helped many people
reduce, or discontinue, their substance abuse. From the applied behavior analysis literature,
the behavioral psychology literature, and from randomized clinical trials, several evidenced
based interventions have emerged:

 Behavioral Marital Therapy

 Motivational Interviewing
 Community Reinforcement Approach
 Exposure therapy
 Contingency Management
 Pharmacological therapy - A number of medications have been approved for the
treatment of substance abuse. These include replacement therapies such as
buprenorphine and methadone as well as antagonist medications like disulfiram and
naltrexone in either short acting, or the newer long acting form (under the brand name
Vivitrol). Several other medications, often ones originally used in other contexts, have
also been shown to be effective including bupropion (Zyban or Wellbutrin), Modafinil
(Provigil) and more.

It has been suggested that social skills training adjunctive to inpatient treatment of alcohol
dependence is probably efficacious.

Conclusion

Addiction is a condition that can be successfully treated and managed. Relapses, however,
can and do occur. Given this, people with substance use problems need to have information
on how to find treatment, and how to use periods when substance use is not a problem to
preserve their health and avoid relapse. Recovery is a journey, sometimes a long one. It takes
courage and determination to deal with substance use problems, but help is available.