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Addiction Explained

Addiction is defined variably as the continued use of a substance (or continued participation in a behaviour), even when it is clear that the substance or behaviour is causing the individual harm.

Addiction and dependency are often interchangeable. People whose lives centre around the acquisition and use of a substance are addicted. The development of "tolerance", or requirement of increasing amounts of adrug to obtain the same effect, is characteristic of an addictive substance. The development of adverse psychological or physical symptoms (shakes, pain, mental confusion, nausea, hallucinations, nervousness) when a substance is withheld or withdrawn from an individual, is another sign of addiction.

Addicts typically have very strong denial systems. Denial is the ability to believe that you don’t have a problem when you do. This is characteristic of all addicts independent of their chosen substance or behaviour (alcohol, marijuana, tobacco, cocaine, gambling etc). Denial leads to lying (addicts are Oscar award winning liars) and secretive use (using drugs/alcohol and behaviours when they are alone).

Addicts also have a strong tendency to blame other people, things or the world at large for their problems. This ability to blame others provides them with a ready excuse to use their substance or behaviour at any time. They frequently make statements like, "If you had my problems, you would drink too". "She doesn’t understand me at all", etc. You may also see loss of interest in activities that were previously important to them, change in friends, withdrawal and poor academic performance.

There are many factors that may contribute to the onset of addiction. However, it is comfortable for many people to think of drug/alcohol abuse and addiction as a problem that affects people who are morally weak, come from abnormal social or family situations, or have criminal tendencies. They believe that drug/alcohol abusers and addicts should be able to stop taking drugs/alcohol if they are willing to change their behaviour. The problem is that we do not have any test to determine who is likely to become addicted to a substance. Put simply, some people will become addicted and some will not. A comparison to Russian Roulette is not far short of the mark! There is some good research on the genetic and biologic factors for alcoholism. We also know that it is more likely for a child to become addicted if there is a family history of drug and/or alcohol addiction, and/or home exposure to drugs or alcohol.

The neurobiology of addiction involves two types of interactions with the brain and neural pathways. The first involves a cellular target, or receptor. Almost all addictive drugs have an identified receptor site in the brain which responds to the drugs active ingredient. This is true for tobacco (nicotine), marijuana (THC), heroin (morphine, opiate), cocaine (direct effect). The second effect on the brain is through the reward pathway involving the ventral tegmental area (VTA), the nucleus accumbens and the prefrontal cortex. The VTA is connected to both the nucleus accumbens and the prefrontal cortex via this pathway and it sends information to these structures via its neurons. Stimulation of the VTA causes a release of a chemical (neurotransmitter) called dopamine. This further stimulates the nucleus accumbens and the prefrontal cortex. The end result is a pleasurable sensation or reward. Electrical stimulation of this area of the brain in rats causes them to seek repeated electrical shocks to the brain in order to receive this "reward" sensation. Food, water, sex and nurturing cause natural stimulation of this part of the brain. Addictive drugs also cause a similar activation of the VTA, thus giving the user a reward. Addiction occurs when the user begins to seek this reward compulsively, and without regard for the negative effects and consequences the drug is having on their body, and on their life. The stereotyping of those with drug-related problems effect not only the user, but the families of addicts, their communities, and the health care professionals who work with them. The truth is that no family, community, religious or ethnic group is immune from drug use, abuse and addiction. Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences.

Addiction does not happen when someone makes a conscious choice to use drugs. Addiction is not simply defined as "a lot of drug or alcohol use." Addiction is a chronic relapsing illness characterised by both short term alterations in normal brain functioning creating feelings of pleasure or relief of discomfort, and by long-term effects on brain metabolism and activity creating drug craving and often painful drug withdrawal symptoms. For some this alteration in brain function occurs within the first few uses of a drug, in others it may take months or years of use.

The World Health Organisations definition of addiction:

Repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means. Typically, tolerance is prominent and a withdrawal syndrome frequently occurs when substance use is interrupted. The life of the addict may be dominated by substance use to the virtual exclusion of all other activities and responsibilities. The term addiction also conveys the sense that such substance use has a detrimental effect on society, as well as on the individual; when applied to the use of alcohol, it is equivalent to alcoholism. Addiction is a term of long-standing and variable usage. It is regarded by many as a discrete disease entity, a debilitating disorder rooted in the pharmacological effects of the drug, which is remorselessly progressive. From the 1920s to the 1960s attempts were made to differentiate between addiction ; and "habituation", a less severe form of psychological adaptation. In the 1960s, the World Health Organisation recommended that both terms be abandoned in favour of dependence, which can exist in various degrees of severity.

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