Addiction

by Kristen FescoeMarch 29, 2014

What is Addiction?

An addiction is a mental or physical dependence to a substance or action despite adverse consequences when using this substance or performing the action. While a person can be addicted to almost anything, the most commonly referred to addiction is a dependence upon drugs or alcohol. Addiction occurs when an individual becomes mentally and/or physically reliant upon the drug. Typically, this starts as a mild desire to obtain the drug and leads to a severe craving where much of the addicts life is spent trying to secure drugs. Addiction can occur over a very short period of time in the more potent drugs and it can develop over the course of months or even years.

 

Dependence Versus Addiction

The Fourth Edition of the Diagnostic And Statistical Manual (DSM-IV) outlined the difference between an abuse to drugs and a dependence upon the substance. In order to be formally diagnosed with a drug abuse issue it must be determined that the individual has a primary, chronic, neurobiological disease with genetic, psychosocial and environmental factors that influence its development and manifestations. A true case of drug or alcohol abuse is characterized by behaviors that must include one or more of the following:

  • A complete loss of control over the drug or alcohol use
  • A continued use of the substance despite real or potential physical harm
  • Compulsive and consistent use and craving of the drug or alcohol

In order to meet the DSM-IV-TR criteria for substance abuse an individual must display 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 calendar year:
 

▪Recurrent substance use, resulting in a failure to fulfill major role obligations at work, school, or home

▪Recurrent substance use in situations in which it is physically hazardous

▪Recurrent substance-related legal problems

▪Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

B. The symptoms have never met the criteria for substance dependence for this class of substance. {1}

In order for an individual to be diagnosed with dependence to a drug or alcohol they must display two necessary criteria: tolerance and withdrawal. In order to display tolerance the quantity needed to obtain the same euphoric high must rise over time. While someone might start out using a small amount of a particular drug, over time his or her need will rise. This includes both a higher and higher amount of the drug as well as more occurrences over the course of a day. In order to display withdrawal, an individual will show physical symptoms when they go an extended period of time without using their substance. This could be in the form of mild symptoms like nausea, anxiety, headache and shaking hands. It could also take the form of much more severe side effects like vomiting, fever, disorientation, tremors and even seizures.

The DSM-IV-TR criteria for substance dependence includes a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same calendar year:

 

▪Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve intoxication or markedly diminished effect with continued use of the same amount of the substance.

▪Withdrawal, as manifested by either the characteristic withdrawal syndrome for the substance or the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

▪The substance is often taken in larger amounts or over a longer period than was intended

▪There is a persistent desire or unsuccessful efforts to cut down or control substance use

▪A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

▪Important social, occupational, or recreational activities are given up or reduced because of substance use

▪The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. {1}

 

What is Physical Dependence?

In addition to the distinction made between dependence and addiction, there is a further distinction made between a physical and a psychological dependence. Some drugs are considered to be both physically and psychologically addictive (like alcohol, heroin, cocaine, meth and many others), while some drugs are considered to be more psychologically addictive (like marijuana, ecstasy and “fake pot”). Most substances have qualities of both but the severity varies depending upon the person and the substance.

A physical dependence occurs when neural pathways in the brain become accustomed to the presence of the drug. Once this happens the brain will no longer function in the same way in the absence of the drug. The drug may also alter the naturally occurring neurotransmitters in the brain. If substances like dopamine or serotonin are altered this can lead to depression and anxiety, as these neurotransmitters are responsible for mood.

 

What is Psychological Dependence?

A psychological addiction occurs when a person becomes dependent upon the feeling of euphoria and well being that comes with using the substance. For some people the euphoria is an escape from the harsh reality of their life. By using the drug they can escape feelings of isolation, low self-confidence, loneliness, depression and anxiety. If the drug helps to stave off those negative feelings, it reinforces the use of the drug in the future. Many mental health practitioners call this practice “self medication”.

 

What Causes Addiction?

Addiction can be caused by a few factors. Some researchers argue that addiction is primarily caused by a genetic predisposition to the disease of addiction. This follows the “Disease Model” of addiction. Meaning that addiction is a disease that can be passed down from generation to generation like heart disease or diabetes.  While some people may have the genetic predisposition they may lack the exposure or desire to use drugs or alcohol. For example, if you have a pre-determined genetic likelihood to become addicted to narcotics but are never exposed to them, you may manage to avoid addiction.

Another factor that can play a role in the addiction process is environmental impact. Things like the family in which you grow up, the neighborhood where you are raised, the school you attend and what kind of upbringing you experience, may all increase or decrease your chance to become addicted to drugs or alcohol. If you grew up in a family where addiction was rampant then using drugs or alcohol may have become “normalized” for you. On the other hand, if you were raised in an environment where drugs or alcohol were considered off limits, then you may be less likely to use drugs or alcohol.

In actuality, the cause of addiction probably lies somewhere in the middle of these two scenarios. Whether or not an individual becomes addicted to drugs or alcohol is most likely the result of interplay between your genetic code and your environmental exposure.

 

Can You Overcome an Addiction?

Now that we better understand the process of addiction we can ask the most important question – Can you overcome and addiction? Fortunately, the answer is yes. Years and years of research have shown that addictions can be overcome with the right tools. Finding the right recovery program significantly increases the chances of success. Having a good support system also works to increase the odds of long-term sobriety. Being active in your own recover (attending meetings, therapy, group sessions, etc) is a very strong determinant to success.

For those individuals who want to get better, it can be a reality. The process of recovery takes time and patience but it can lead to a new and sober life. Addiction does not have to be a death sentence.

 

 

1 - http://www.uscourts.gov/uscourts/federalcourts/pps/fedprob/2006-09/accountability_table1.html