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Understanding Addiction
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ADDICTION
Addiction is most commonly thought of in the context of alcohol and illicit
substances (e.g., Cocaine, Heroin, Cannabis) but addiction in its truest sense can
relate to many wide and varied substances, processes, behaviours, and pursuits.
It is ultimately the point at which one goes from doing something and being able to
stop, to not being able to stop.
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THE ADDICTION PROCESS
The bump is a protective internal mechanism in-between the normal and problematic
section that shows a preference for control, and indeed well-being.
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Control
Generally speaking, one pass over to the problematic side (excessive drinking for
example) and be able to return to normal drinking again (Binge). Yet some are not
so fortunate.
Nonetheless as one repeatedly passes over this bump, and with greater frequency,
they simply tend to wear it down.
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Once addiction is established; the bump is damaged as it were, there is a core
compromising of control, and this can be difficult for everyone to understand and accept.
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Control
Sometimes people in such a situation may say to themselves "sure one drink won't do
me any harm". This of course is absolutely true and difficult to internally challenge.
However of course the comment ignores the fact that the bump is gone and thus will
most certainly lead to problematic use (abuse) and it is that which will cause the harm,
not the first drink. Often others around the person will, failing to recognise the
problem (the loss of the bump as theirs is intact), suggest control measures.
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Common-sense statements such as the following are often offered:
• "Just drink beer"
• "Only use the tablets when you have a headache"
• "Only do it on weekends"
• "Just do it slower"
• “Don’t drink on an empty stomach”
• Only have a drink when I’m with you”
How much a person emotionally invests in the behaviour itself also determines the speed
and frequency with which one crosses that centre point
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Emotional Investments
Examples of emotional investments in such behaviour may be as follows: (Switching off
from a difficult situation)
▪ Managing stress
▪ Aiding sleep
▪ Blocking out difficult memories
▪ Compensating for various insecurities
▪ Managing interpersonal/social anxiety
▪ Blocking out unpleasant psychological processes (e.g., psychoses/neuroses)
▪ Managing fear
▪ Dealing with phobias
▪ Dealing with boredom
▪ Dealing with guilt/shame
▪ Coping with trauma A.Tassi/BAU/FHS/HESC001 10
Are You Addicted?
Therefore, in truth the fastest way to discover if you are addicted or not, is to simply
try to stop for a defined period and see what happens.
If it was relatively easy and felt more like just breaking a habit then you are probably not
addicted.
Think of something that you would find it difficult to cease. Think of something you do
regularly that you love and may find it difficult to arrest. This may be exercise, sugar
intake, caffeine, TV, video games, internet use, and technology.
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Are You Addicted?
If you find that you convinced yourself through ANY means that you don't need to try this
right now, having previously committed to doing so, or that you should do it at a different
time, then you are probably engaging in the dualistic internal struggle and debate
synonymous with addiction.
But perhaps the consequences are comparatively non-severe and thus one does not
consider stopping. Yet it may still be interesting to try.
Is one injecting drugs everyday to keep the withdrawals and sickness away? Or could one
simply not do without something sweet today?
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Is addiction a
DISEASE or a CHOICE?
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The Current Understanding of Addiction
In clinical texts and articles, addiction is introduced as a “chronic illness” that
should be classified with diseases like asthma and diabetes
“Addiction Is a Brain Disease”
“A Disease of Young People”
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Is punishing drug use is the right approach?
If treating addiction is the right approach, then punishing addicts for drug use
has to be at least somewhat ineffective, if not counterproductive.
Conversely, if punishing drug use is the right approach, then treatment
programs are likely to be less effective than they could be.
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Is punishing drug use is the right approach?
If people are choosing to harm themselves and their activity also
harms others, then they are getting what they deserve and the damage to
society calls for a righting of the scales of justice and retribution.
The core assumption in this viewpoint is that there are but two possible
responses to addiction: medical treatment or punishment.
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The Current Understanding of Addiction
If addiction is a disease, then science will soon find an effective treatment for
it, as has been the case for many other diseases, but that if addiction is a
matter of choice, then the appropriate response is punishment.
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Is punishing drug use is the right approach?
There are many people who believe that addicted individuals do not deserve
treatment.”
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The Current Understanding of Addiction
What needs to be pointed out is that medical treatment and punishment do
not exhaust the possible responses to human problems.
We teach, offer advice, arrange contingencies, and in general have a wide
array of techniques for improving social relations and the behavior of others.
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The Current Understanding of Addiction
Many programs are considered among the most effective approaches for
getting addicts off drugs. They fit neither a medical nor penal model of
rehabilitation.
Rather, they are the most logical treatment approach if addiction is not a
compulsive disorder but one in which voluntary behavior is self-destructive
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Genetics and Addiction
Do genes also influence voluntary
activities?
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Religiosity and Addiction
✓ Spiritual values, and adherence to traditional social roles are correlated
✓ Religion play a role in times of stress
✓ Religiosity and drug use were negatively correlated.
(Gartner et al., 1991; Newcomb et al., 1999; Galaif et al., 2007; Galaif & Newcomb, 1999)
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Social Environment
Studies reveal that one of the most important etiological factors in addiction is
the immediate social environment.
Social environment as well as nationwide cultural trends influenced the
prevalence of illicit drug use and the likelihood that drug use became drug
abuse.
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Does drug use in addicts remains voluntary?
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Individuals always choose the better option
Voluntary addiction does not mean someone chooses to be an addict. The
view that addicts are voluntary drug users is sometimes rejected on the
grounds that “no one would choose to be an addict.” No one would choose
the miseries usually associated with heavy drug use. However, The addict
chooses is to use the drug one more time.
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The Current Understanding of Addiction
The point is that one day of heroin does not mean addiction, just as eating
dessert once does not make one fat.
Of course as the days accumulate, the characteristics of addiction emerge,
and as the desserts accumulate, fat cells get bigger.
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Conclusion
❑Voluntary behavior does not necessarily lead to the best outcome
❑Choice can produce the worst possible outcome
❑Local choice can drive overall welfare to its lowest possible level
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Is addiction a
DISEASE or a CHOICE?
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The Current Understanding of Addiction
Voluntary behavior involves pitfalls and that choosing what is best can
actually lead to the worst overall possible outcome
ADDICTION IS A DISORDER OF CHOICE
GENE M. HEYMAN, 2009. Addiction : A Disorder of Choice
H A R VA R D U N I V E R S I T Y P R E S S
Cambridge, Massachusetts, and London, England
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Addiction Concepts
D e p e n d e n c e , To l e r a n c e & A d d i c t i o n
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ADDICTION
Addiction is most commonly thought of in the context of alcohol and illicit
substances (e.g., Cocaine, Heroin, Cannabis) but addiction in its truest sense can
relate to many wide and varied substances, processes, behaviours, and pursuits.
It is ultimately the point at which one goes from doing something and being able to
stop, to not being able to stop.
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Dependence, Tolerance & Addiction
With regular use of a substance over time, a user needs
Tolerance more and more to get the same effect. Chasing the high.
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Dependence, Tolerance & Addiction
Dependence Is an emotional or physical need for a drug for the mind/body to
function. It is characterized by the emergence of withdrawal
symptoms upon abrupt discontinuation or substantial decrease of
the opioid drug.
Addiction Is when the body or brain dependence on a drug (substance) or
activity (exercise or gambling) become a habit, person relies on it
to function from day to day despite knowing that it might be
harmful to self andA.Tassi/BAU/FHS/HESC001
others. 46
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Dependence, Tolerance & Addiction
With regular substance use, user needs more and more to get the same
effect → TOLERANCE. As Tolerance increases a point is reached where the body
cannot produce enough natural opioids to sustain a feeling of normality and the
body feels discomfort → WITHDRAWAL. The body becomes dependent on the
external opioid supplement to feel normal → PHYSICAL DEPENDENCE A person
relies on it despite knowing that it might be harmful to self and others →
ADDICTION
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What is Addiction?
“Addiction is a chronic, relapsing brain disease that is characterized by
compulsive drug seeking and use, despite harmful consequences.
It is considered a brain disease because drugs change the brain—they
change its structure and how it works. These changes can be long-
lasting, and can lead to the harmful behaviors seen in drug abusers.”
National Institute on Drug Abuse (NIDA)
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What is Addiction?
Addiction:
- Continuous uncontrollable cravings which result in compulsive
substance use
- Addiction is a disorder and affects different parts of the brain than
physical dependence.
- People who are addicted to opioids are both physically dependent
and addicted, but it is the addiction part which is the disorder.
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Addiction is a Chronic Brain Disease
• Drug addiction is a chronic illness with relapse rates similar to those of
hypertension, diabetes, and asthma
• Frequently co-occurs with other mental health conditions
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Addiction is a Chronic Brain Disease
• Has many features in common with medical conditions such as diabetes,
hypertension, and obesity
–Chronic
–Potential for recurrence and recovery
–Influenced by genetic, epigenetic, developmental, and environmental
factors
–Requires a comprehensive approach to treatment
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Three “C’s” of Addiction
Control
–Early social & recreational use
Eventual loss of emotional & behavioral control
–Cognitive distortions (denial & minimization)
–Tolerance & Withdrawal= Strictly defined CD
Compulsion
–Drug-seeking activities & Craving Addiction
–Continued use despite adverse consequences
Chronicity
–Natural history of multiple relapses preceding stable recovery
–Possible relapse after years of sobriety
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Behavior Pathways
A rewarding behavior becomes routine
“Subconscious” control of the behavior
It is hard to extinguish the behavior:
“I am not always aware when it is starts”
The person resists change
It is a Habit
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Increase in Tolerance Over Time
DAY
Withdrawal
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How Addiction Changes Your Brain (CNN)
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Epidemiology
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Addiction is a Developmental Disease: It Starts Early
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Overdose Death Rates
1999 2015
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Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System
Opioid morphine milligram Fentanyl-Related Deaths Surpassed Heroin
equivalents (MME) dispensed fell by or Rx Opioids in 2016
over 15% from 2010-2015
300 266 260 253 242 234
250 222
OPIOID MME IN
200
BILLIONS
150
100
50
0
2010 2011 2012 2013 2014 2015
IMS Health, U.S. Outpatient Retail Setting
Estimate of
Total U.S.
Drug Deaths
in 2016
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Graphs from NY Times Article based on CDC MMWR Report 2017
Hospitalizations for Opioid Overdoses with/without Alcohol
Source: Nationwide Inpatient Sample (NIS), unpublished
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Common Characteristics of People Who are
Addicted
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Characteristics of Addiction
Some defining characteristics of addiction:
1. Loss of control over limiting substances intake
2. Preoccupation with substance
3. Continued use despite consequences
4. Denial
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Common Characteristics of People Who are
Addicted
• Unemployed or employed
• Multiple or no criminal justice contacts
• Difficulty coping with stress or anger
• Highly influenced by social peer group or a loner
• Difficulty handling high-risk relapse situations or craves
excitement
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More Common Characteristics…
• Emotional and psychological immaturity
• Difficulty relating to family
• Difficulty sustaining long-term relationships
• Educational and vocational deficits
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Violence
➢Alcohol disinhibits aggressivity
➢Stimulants produce dose-dependent paranoia
➢Opiate-seeking, but not opiates, produces violence
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Myths About Addiction
MYTH
➢ “Addiction is just a lack of self control”
➢ “If I only use a drug occasionally then I can’t be addicted.”
➢ “It’s always easy to tell when someone is addicted to a drug.”
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Risk Factors
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Addiction Risk Factors
• Genetics
• Earlier Age of Onset
• Childhood Trauma (violent, sexual)
• Learning Disorders & ADD/ADHD
• Mental Illness Predating Use
– Depression
– Bipolar Disorder
– Psychosis
– ADHD A.Tassi/BAU/FHS/HESC001 73
What Are The Risks Of Becoming Addicted?
➢ Genetic predisposition
➢ A younger age for beginning use
➢ Childhood trauma (violent, sexual)
➢ Learning disorders &/or ADD/ADHD
➢ Mental illness
➢Depression
➢Bipolar disorder
➢Psychosis
➢Personality disorder
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PROBLEM USE INDICATORS
• Problems with money
• Drop in school grades & attendance
• Problems at home
• Loss of interest in past activities
• Change in physical appearance
• Change in friends
• Personality changes
• Negative peer group
• Mood changes
• Relationship problems
• Legal problems • Depression/Anxiety
• Only thinking about alcohol / other drugs
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Co-Occurring Disorders = COD
• Mood Disorder+: 24-40% have a co-occurring substance
abuse disorder
• Alcoholism+: 65% of females and 44% of male alcoholics
have co-occurring mental health disorder(s)
– THE MAJOR ONE = DEPRESSION
19% of female alcoholics, 4x the rate for men
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Co-Occurring Disorders = COD
• Addiction+: 30-59% of women in treatment have PTSD,
2-3 times the rate for men
• Prescriptions: 1:7 women >64 years old take
medication for a mental health disorder
• Don’t Forget Physical Effects: body/brain breakdown
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Treating Addiction
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Relapse Rates Are Similar for Drug
Addiction & Other Chronic Illnesses
100
90
Percent of Patients Who Relapse
80
70
60
50
40
50 to 70%
50 to 70%
40 to 60%
30 to 50%
30
20
10
0
Drug Type I Hypertension Asthma
Addiction Diabetes
McLellan et al., JAMA, 2000.
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Vulnerability
Why do some people become easily
addicted while others do not?
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Why Can’t Addicts Just Quit?
Non-Addicted Brain Addicted Brain
Control
Control
Saliency Drive NO Saliency Drive GO
GO
Memory Memory
Because Addiction Changes Brain Circuits
Source: Adapted from Volkow et al., Neuropharmacology, 2004.
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In Treating Addiction…
We Need to Keep Our Eye on
the Real Target
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Treatment Can Work
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Addiction
Treatment
1. Detoxification:
2. Behavioural & cognitive therapies
3. Drugs to treat cravings & prevent relapse
Victorian-era treatments for alcoholism were often both ineffective & inhumane
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Addiction treatment
1. Detoxification: To avoid withdrawal symptoms, medication given → addict feel similar to being on the
addictive drug & gradually reduce dose over time →stabilizes the person's brain long enough to get
through the detoxification process.
₋ Methadone for opiate withdrawal
₋ Nicotine replacement therapies
2. Behavioural & cognitive therapies (support groups): addicts must learn new ways of thinking &
behaving.
3. Drugs to treat cravings & prevent relapse: Naltrexone (alcohol & opiates) Blocks opiate receptors →
the addict no longer receives pleasure from the drug → cravings diminish.
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Remember Drugs of abuse can kill
• The drugs of abuse may give the user a feeling of pleasure, but
they are toxic substances.
• Even a single use of a drug can kill → Overdose .
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For More Information
NIDA Public Information:
www.nida.nih.gov
www.drugabuse.gov
NIDA International Program:
www.international.drugabuse.gov
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www.drugabuse.gov
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