Individuals are addicted to drugs for many reasons mainly for pleasurable effects. Substances alter mental status, improve performance, relieve boredom, and to self medicate a mental disorder.
Addiction is a chronic relapsing and treatable medical condition. It is most prevalent in all mental conditions. Addiction is a disease of the brain and not a judgment on character.
It is often neglected and undertreated in Canadian society because it is often legal and by choice. Unfortunately, there is stigma and judgment in regards to addiction and substance abuse. This can lead to individuals not seeking the help and support they need.
Neurobiology of Addiction
Addiction is when an addictive substance is taken in excess. It causes direct activation of the brain reward pathway. Increased levels of dopamine release a high. The brain requires higher levels to gain normal function and the same dopamine-related effects.
Some people are born with certain temperaments causing them to be more susceptible to addiction. In other words, they have a more addictive personality. These temperaments are not the cause of addiction. There are also many social and environmental predisposing factors in people early lives that may make a person more vulnerable to addiction. Children whose mothers experienced stress during pregnancy may contribute to vulnerability to addiction.
Goals of Treatment
There are three goals for treatment for addiction. To stabilize the person’s condition, to alter the course of the disorder, and to alter the persons overall functioning.
It is vital to build a bond between health care providers and individuals based on mutual respect, trust, and empathy. Therapeutic alliance between the two is necessary.
Substance Use Disorder
Substance use disorder is substance-specific involving many different addictive substances such as; alcohol, sugar, gambling, drugs, medications, and many more. This causes impaired control and social impairment which affects school and work. This involves risky use which is when they know it can impair them they still do it. It also pharmacologic pattern, they have increased tolerance so they need more to achieve the same effect. This is measured on a continuum. If they score greater than a six, they are considered to have substance use disorder.
Adolescents constitute the greatest vulnerability because their bodies are still changing and growing. The substances will affect their body and minds more than an adult. Substance users often have mood or anxiety disorders. Substance use is strongly associated with other mental health disorders.
Some more classes of substances include hallucinogens, inhalants, opioids, hypnotics, sedatives, and tobacco.
Substance-induced disorder of intoxication is reversible behavioral changes due to the effect of the substance on the Central Nervous System. This results in maladaptive behavior. Withdrawl creates a negative psychological and physical reactions when the substance is reduced or removed such as hangover.
Greater than 80% of the Canadian population consume alcohol. Canadians consume a rate more than 50% above the world average. 47% of men and 24% of women do heavy drinking. Women are more likely to do drugs and men are more likely to abuse drugs and alcohol.
Alcohol is a central nervous system depressant that is absorbed through the stomach, colon, and small intestine. It can cross the placenta. Physiological effects depend on the amount taken, the level of tolerance, gender, body mass, and metabolic rate. Years of alcohol abuse causes cerebellar degeneration from increased levels of acetaldehyde (a toxic byproduct of alcohol metabolism) It causes impaired coordination, unsteady gait, and fine tremors.
First alcohol affects the forebrain, motor coordination, and decision making. Then alcohol knocks out the midbrain, you lose control over emotions and increases chances of a blackout. Finally alcohol batters the brainstem and affects heart rate, body temperature, appetite, and consciousness, a dangerous and potentially fatal condition.
Warnick’s Syndrome is an alcohol-induced cognitive disorder result of thiamine deficiency. It causes oculomotor dysfunction, ataxia, and confusion.
C.A.G.E. questionnaire is used to assess alcohol abuse. C- Have you ever cut down on your drinking or drug use? A-Have you ever been angry about being confronted about drugs or alcohol. G- do you or have you felt guilty about drinking or drug use? E-eye opener.
Alcohol withdrawal occurs when alcohol is reduced or when abstaining. There are three stages of withdrawal. Minor withdrawal appears 6-12 hours after the last drink, it causes tachycardia, hypertension, and anxiety. Intermediate withdrawal appears 12-72 hours after the last drink, and can cause seizures, hallucinations, and dysthymia. Major withdrawal is the most severe. It can cause hypertension, hallucinations, fever, changes in alertness and consciousness, and even sudden death may occur. It also causes agitation and delirium tremors which is vomiting, sweating, shaking, increase temperature and increase BP. People who want to get help and treatment from alcohol should be hospitalized or go to rehab for these reasons.
Opioids are used for severe pain. It causes CNS depression, sleep/stupor, and analgesia. May cause tolerance and physical dependence. Common physical effects include sweating, nausea, constipation, pain relief, fatigue, confusion, and respiration depression. It causes pleasurable rewards which makes it addicting.
Cocaine is a Central Nervous System stimulant that has a high potential for abuse. Initially causes a sense of euphoria and a cocaine rush (energy and alertness). Its followed by an intense depressive phase called the cocaine crash (powerful cravings). Long term use depletes norepinephrine. Withdrawal occurs in a few hours to a few days and may become depressive with suicidal ideation.
Intervention And Interviewing
Interventions require a safe environment. A quite low stimulating environment. Plenty of water, rest, food is needed along with lots of support.
Motivational interviewing principles include avoid arguing, express empathy, develop discrepancy, roll with resistance, and support self-efficiency.
Stages of Change
Quitting is not a single event. It is a back and forth process. The five stages of change include Precontemplation, contemplation, preparation, action, and maintenance.
Precontemplation considers the benefits and the risks of no intent on quitting. Contemplation is where the individual is aware of a problem that exists but has not made a plan to stop. Preparation is where they have a plan on how to quit in the next thirty days. Action they see how they are doing, they have quit in the last 6 months. Maintenance is a follow up after 6 months about temptations. A person may float through these stages until eventually, they are successful.
Therapy and Reduction
Cognitive Behavioural therapy addresses the interaction between how we think, feel, and behave. It helps identify cognitive patterns and emotions that are linked to these behaviors.
Harm Reduction reduces the risk of adverse consequences arising from substance use while recognizing that abstinence is ideal. Harm reduction works well with people who have no intention of reducing use ex.) food in a bar helps absorb some of the alcohol.
Alcoholics or Gamblers Anonymous has a 12 step program. Its a peer self-help group. Each member is assigned to a support person who has obtained sobriety. The focus is on abstinence and loss of control over the ability to drink or gamble. This is a life long commitment.
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