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Causes and Symptoms of Addiction, Its Diagnosis and Treatment

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Addiction is an uncontrolled urge to engage in unhealthy or harmful behavior. Human beings can become addicted to many different forms of behaviors such as gambling, eating, sex, or reckless behavior, but the term addiction is most commonly used to refer to a physiological state of dependence caused by the constant use of drugs, alcohol, or other substances. Addiction is portrayed by uncontrollable craving, increased tolerance, and symptoms of withdrawal when deprived of access to the addictive substance, which leads to larger doses. Addictions affect millions of people in the United States every year. Addiction results from an continuous need to fight the negative side effects of a substance or situation by returning to that substance or situation for the initial enhancing effect. The desire for drugs such as heroin, cocaine, or alcohol all result from a need to suppress the low that follows the high. Other forms of addiction occur where seemingly harmless behaviors such as eating, running, or working become the main focus of the addict’s life.

Different Types

There are two different classifications for addiction, chemical (substance) and non-chemical (process). While the dependency on substances that are ingested or injected is more commonly discussed. There are a number of non-chemical addictions that can lead to equally devastating lifestyles. Chemical addiction is the general description for an addiction to a substance that is injected or ingested. Alcohol, opiates, and cocaine are the most common of these chemicals. Even though each of them are addictive, they have many different side effects on the body. Addictions can involve substances or actions without addictive chemicals. Some of these addictions are difficult to define and may seem harmless, but they can actually be very destructive to the lives of those who cannot escape them.

Substance abuse and dependence are disorders that affect all population groups although specific patterns of abuse and dependence vary with age, gender, culture, and socioeconomic status. According to data from the National Longitudinal Alcohol Epidemiologic Survey, 13.3% of a survey group of Americans showed some sort of symptoms of alcohol dependence during their lifetime, and 4.4% showed symptoms of alcohol dependence during the past 12 months.

According to the United States Department of Health and Human Services’ National Survey on Drug Use and Health, in 2005 around 9.1% of the population age 12 or older (about 22.2 million people) were classified as having substance abuse or dependence within just the last year. About 7.7% (18.7 about million people) were classified as having alcohol abuse or dependence.

Although substance dependence can begin at any age, people at the ages of 18 to 25 have been found to have higher substance abuse and dependency rates than other age groups. Individuals who first used drugs or alcohol at a young age are more likely to have drug abuse and dependence problems later in life than those who first used drugs or alcohol at an older age. Gender proportions vary according to the class of drugs, but substance abuse and dependence is about twice as likely to occur in men than in women.

Substance abuse and dependence, refers to medications, drugs of abuse, and toxins. These substances have an intoxicating effect, desired by the user, which can have either stimulating or suppressive effects on the body. Substance dependence and/or abuse can involve any of the following 10 classes of substances: alcoholamphetamines (including “crystal meth,” some medications used in the treatment of attention deficit disorder [ADD], and amphetamine-like substances found in appetite suppressants)cannabis (marijuana and hashish)cocaine (“crack”)hallucinogens (LSD, mescaline, and MDMA [“ecstasy”])inhalants (compounds found in gasoline, glue, and paint thinners)nicotine (including that found in cigarettes and smokeless tobacco) opioids (morphine, heroin, codeine, methadone, oxycodone [Oxycontin (TM)])phencyclidine (PCP, angel dust, ketamine)sedative, hypnotic, and anxiolytic (anti-anxiety) substances (benzodiazepines such as valium, barbiturates, prescription sleeping medications, and most prescription anti-anxiety medications)

Causes and Symptoms

The causes of substance dependence are not well established, but three factors are believed to contribute to substance related disorders, genetic factors, psychopathology, and social learning. In genetic epidemiological studies of alcoholism, the chances of identical twins both exhibiting alcohol dependence was significantly greater than with fraternal twins, suggesting a genetic component in alcoholism. It is unclear, whether the genetic factor is related to alcoholism directly, or whether it is linked to other psychiatric disorders that are known to be connected with substance abuse. For example, there is evidence that alcoholic males from families with depressive disorders seem to have more severe courses of substance dependence than alcoholic men from families without these family histories.

These and many other findings suggest substance abuse may be a way to relieve the symptoms of a psychological disorder. Unless the underlying pathology is treated, attempts to permanently stop substance dependence do not work. Psychopathologies that are associated with substance dependence include antisocial personality disorder, bipolar disorder, depression, anxiety disorder, and schizophrenia.

A third factor related to substance dependence is social environment. Drug-taking is essentially a socially learned behavior. Local social norms determine the likelihood that a person is exposed to the substance and whether continuous use is reinforced. For example, individuals may, by observing family or their peers learn that substance use is a normal way to relieve their daily stresses. External penalties, such as legal or social sanctions, may lower the likelihood of substance abuse. The DSM-5 identifies seven symptoms, at least three of which must be met during a given 12-month period, for the diagnosis of substance dependence: Tolerance, as defined either by the need for increasing amounts of the substance to obtain the desired effect or by experiencing less effect with extended use of the same amount of the substance.

Withdrawal, as exhibited either by experiencing unpleasant mental, physiological, and emotional changes when drug-taking stops or by using the substance as a way to relieve or prevent withdrawal symptoms. Longer duration of taking substance or use in greater quantities than was originally intended. Persistent desire or repeated unsuccessful efforts to stop or decrease substance use. A relatively large amount of time spent in securing and using the substance, or in recovering from the effects of the substance. Important work and social activities reduced because of substance use. Continued substance use despite negative physical and psychological effects of use.

Although not explicitly listed in the DSM-5 criteria, “craving,” or the overwhelming desire to use the substance regardless of countervailing forces, is a universally-reported symptom of substance dependence.

Diagnosis and Treatment

The tools used in the diagnosis of substance dependence include screening questionnaires and patient histories, physical examination, and lab tests. A simple and popular screening tool is the CAGE questionnaire. CAGE refers to the first letters of each word that forms the basis of each of the four questions of the screening exam:

Trying to Cut down on your substance use?

Becoming Annoyed by people trying to talk to you about your substance use?

Begin to feel Guilty about your substance use?

Needing an “Eye opener” (using the substance first thing in the morning) in order to start your day?

If there is a “yes” answer to some these questions it is an indication that the individual should be referred for a more thorough diagnosis for substance dependency or abuse. Continuous use of an addictive substance can produces changes in the body’s chemistry and any treatment must be geared to a gradual reduction in dosage. Initially, only opium and its derivatives (morphine, heroin, codeine) were recognized as addictive, but many other drugs, whether therapeutic (for example, tranquilizers) or recreational (such as cocaine and alcohol), are now known to be addictive. Research points to a genetic predisposition to addiction; although environment and psychological makeup are other important factors and a solely genetic basis for addiction is too simplistic. Although physical addiction always has a psychological element, not all psychological dependence is accompanied by physical dependence.

Addiction of any form is difficult to treat. Many programs instituted to break the grip of addictive substances have had very limited success. The cure depends upon the resolve of the addict, and he or she often struggles with the addiction even after treatment.

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