Addiction
Addiction is a brain disease. Addiction is a chronic relapsing disorder. Addiction involves the chronic pharmacological actions of substances in the brain. Some Individuals may be more vulnerable to addiction than others. There are also ‘non-substance’ behavioural addictions (e.g., gambling).
Various Substance and behavioural addictions
Substance addictions
a) Alcohol
b) Tobacco
c) Cannabis (marijuana)
d) Prescription drugs (sedatives, sleeping pill)
e) Cocaine
f) Opioids (like heroin)
g) Amphetamines (like methamphetamine, known as crystal meth)
h) Hallucinogens (LSD, PCP, Magic Mushrooms, Ketamine)
i) Inhalants
Behavioural addictions
a) Gambling
b) Shopping
c) Sex
d) Internet
Features of Addiction (Dependent use)
1. A strong desire or sense of compulsion to take the substance
2. Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use.
3. Emergence of withdrawal symptoms when substance use is reduced or stopped. Eg:- Tremors or shaking of body when alcohol use is reduced.
4. Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses.
5. Progressive neglect of alternative pleasures or interests because of psychoactive substance use.
6. Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning.
Neurobiological processes in addiction
Addiction involves many dysfunctional changes in Brain circuits, Neurotransmitters & Neurobiological processes. They are
1. Reward Circuitry: Dopamine neurons in the Ventral tegmental area (VTA) via the mesolimbic pathway project to ventral striatum (VS). This is the reward circuitry or the pleasure circuitry because Dopamine induces a feeling of pleasure. Substances of addiction (e.g. alcohol) induce surges in the release of Dopamine in VS. These surges in dopamine release resemble and can greatly surpass the physiological increases triggered by natural rewards (e.g. food, water), thus causing more ‘liking’ to these substances of addiction, the first step in addiction process.
2. Motivation and drive: OFC (Orbito-Frontal Cortex) & related pathways are involved in Motivation & drive for rewards. The more activity in these pathways brought about by the substance of addiction causes increased motivation & drive to procure and use these substances- increased ‘wanting’.
3. Learning & Memory: Repeated substance use will cause changes in the brainestablish new conditioned functional neuronal connections between brain regions involved in reward dependent dopamine surge, leading to consolidation of substance use & related memory, which can be later triggered by cues related to substance use in turn leading to relapse in substance use.
4. Cognitive control: Repeated substance use will weaken the ‘inhibitory control’ of prefrontal cortex over the substance use. Also, cognitive flexibility, working memory, planning, concentration etc are also affected, leading to unrestrained substance use & substance addiction.
Major ill effects of some common substances of abuse
1. Alcohol
Liver: It can damage the liver causing hepatitis & cirrhosis leading to coughing out of blood. It can also cause liver cancer.
Brain: Damage the brain leading to memory loss, Seizures & Delirium. Alcohol causes various psychiatric disorders like depression, anxiety & psychosis.
Stomach: Ulcers & Cancer
Reproductive system: loss of libido, hormonal changes, erectile dysfunction.
2. Nicotine
Signs and symptoms of nicotine toxicity include nausea, vomiting, salivation, weakness, abdominal pain, diarrhoea, dizziness, headache, increased blood pressure, palpitations, tremor, cold sweats, inability to concentrate, confusion, and sensory disturbances.
Mouth & oesophagus: Cancer
Lungs: Cancer, COPD & breathing difficulty
Peripheral vascular diseases: Claudication & Gangrene
3. Cannabis
Cannabis intake causes red eyes, palpitations, increased appetite, confusion, uncontrollable anger & irritability.
Cannabis can cause various psychiatric disorders like Psychosis, Schizophrenia,
Depression, Anxiety, sleep disorders.
Cognitive impairment: impairment in memory, attention & organization
Amotivational syndrome: Cannabis can cause amotivational syndrome- lack of motivation & purpose of life.
Treatment
Treatment involves both Psychotherapy (Counseling) & Pharmacotherapy (treating with the help of drugs)
Psychotherapy
It is therapy by psychological means. Here the therapist empathetically listens to the patient & tries to know the patient’s problems. Evaluates if the client has any other psychological or psychiatric issues other than substance addiction. The therapist through motivational interviewing motivates the client to stop substances. Once the client stops the substance use, further sessions are conducted to help maintain the abstinence.
Pharmacotherapy
It is the treatment with the help of medicines.
1. Detoxification treatment (Substitution therapy)
In most of the cases of addiction, it is difficult or impossible for the client to stop addiction by mere will power or counselling. So here medicines are given to help the client stop substance use.
2. Maintenance therapy (anti craving therapy)
Because substance addiction involves neurobiological changes (already discussed above) in the brain, medicines are needed to correct those changes & damages & correct the neurobiological vulnerabilities for responsible craving & relapse.
Reference :
1. Oxford Textbook of Psychiatry
2. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry
3. The ICD-10: Classification of Mental and Behavioural Disorders
4. Diagnostic and Statistical Manual of Mental Disorders (DSM–5)
5. https://www.ncbi.nlm.nih.gov/pmc/
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