What is addiction?

What is addiction?

-Written By Dylan Kerr 2015-2017

 

Addiction has had many descriptions over a number of years:

  • Learnt behavior
  • Health behavior problem
  • Substance use disorder
  • Chemical dependency
  • Disease

Addiction is word that is fairly commonplace in everyday language, people often use the word addicted to describe things they are passionate about. You may hear people say they are addicted to things like exercise, running and football. However those things generally speaking are healthy activities. When we talk about addiction in the setting of a drug and alcohol rehab we mean substance use disorder.

Substance use disorder?

In the field of psychiatry, doctors and other practitioners use a manual known as the DMS-5, which is the Diagnostic and Statistical Manual of Mental Disorders.  This gives classification of all know mental disorders and addiction is classified amongst them.

In the DSM-5 addiction is referred to as:

Substance Use Disorder

And

Addictive Disorders

So what’s the difference?

 

Substance Use Disorder

 

What makes a substance use disorder?

 

Addictive Disorder

 

What is an addictive disorder?

 

 

 

 

 

 

Why call it a disease?

Medically speaking if you have disorders in the structure or chemistry of the brain it can be classified as a “neurological disorder” which is a brain disease.

  • Alcohol and drugs have a temporary effect to brain chemistry
  • When drugs and alcohol are used over a long time they can change both the chemistry and structure of the brain

Viewing addiction as disease was first coined by a Scottish Doctor Tomas Trotter, whom had treated alcoholics 200 years ago. He couldn’t understand how some of his patients with great insight of their problems would fall back into patterns of alcoholism again, despite abstinence and awareness around the issue.

Viewing addiction as a disease has become a popular stance and widespread viewpoint.

The American Society for Addiction Medicine (ASAM), defines addiction as a disease. In their 2011 definition of addiction they stated it was a disease which had symptoms with“bio-psycho-social-spiritual” manifestations.  What is interesting in this definition of addiction is the inclusion of spiritual manifestations.

Let’s think about addiction as a disease,  what are the symptoms that you have noticed personally?

Bio (physical health)

Ability to focus, withdrawals when not drinking, shaking when withdrawing

 

 

Psycho (mental well-being)

Suicidal thoughts, paranoia, lack of sleep, aggression

 

 

Social

All my friends are drug addicts, I lost touch with my family, I can’t have a normal life

 

 

Spiritual

Complete lack of drive towards anything, loss of humor, no vision of the future

 

 

 

The literature and “program” of Narcotics Anonymous and Alcoholics Anonymous refers to the nature of addiction as being “the disease of addiction”. There is encouragement from being in the program to indentify as an alcoholic or addict at all stages of recovery – no matter the length of abstinence.  Many self-report that they feel they had “the disease of addiction” before using substances.

Addict before substances?

If you think about addiction as being a “neurological disorder”, then that implies there is something abnormal about brain chemistry or structure.  Being an addict before substance use would imply there is something preset in the makeup of the brain that would make you prone to becoming an addict.

Many people have tried to draw conclusions from this:

  • low frontal lobe stimulation
  • low dopamine levels (the feel good chemistry of the brain)
  • low serotonin levels (the other happy chemistry of the brain thought to be linked to depression)

An interesting study was carried out in the late 90’s on the co-existence of criminal behavior and drug addiction. Up until this point it was widely considered that the expense and habitual nature of drugs drove people to commit crime. However upon reviewing the lives of thousands of people in custody who were drug addicts it was discovered that the average age of first criminal offence was 13 and the average age of first drug use was 16.

However that could also possible indicate that are environmental factors to nature of addiction and these most certainly cannot be dismissed.

There has never been any real conclusive evidence to suggest that people are born an addicts but there may very well be pre-cursors into ushering people into substance use disorders.

Critics

Critics to the idea of the disease model believe that although it is a useful metaphor that can help people control their lifestyle it isn’t exactly true and by viewing it as a disease they are in fact not really addressing root causes of the issue – For example, mental health issues, depression and childhood trauma.

Environments and events

A lot of people self-disclose significant events that shifted what could be considered a normal pattern of drink or drug use to abnormal levels.  Some people say stress, depression, work, relationships or sometimes a particular type of drug created their addiction issues.

“I was fine drinking and doing ecstasy on the weekends, but then I tried crystal meth and that brought me to my knees within months!”

“I just drank on the weekend, I would never dream of drinking during the week when I was working. Then I lost my job and I found myself drinking all the time.”

Addiction remains to this day a very much a chicken and egg scenario. There is no definitive answer despite numerous claims from even very prestigious bodies. But this is okay; everyone arrives at their addiction in different ways.  What all can agree on is that there is a now a very unhealthy relationship with substances and something ought to be done to not only remedy the situation but also prevent it from happening again.

 

There are many routes into addiction.  People report the lack of connectivity with others, depression, dependency, anxiety, low self esteem, stress, insomnia, poor sexual function, child-abuse, bullying, lack of self worth…etc.  All these can be reasons why people become addicts.  These are the things that have shaped our thinking

Substances like alcohol, methamphetamine, heroin, diazepam, cannabis and cocaine all work by stimulating the reward pathways in our brain. No matter if they make you feel awake or sedated there is a sense of reward.

One part of the brain which is associated with pleasure and reward is the ventral tegmental area (VTA). When taking a substance this part of the brain is engorged with blood and chemistry, the feel good chemistry dopamine.  This is along with serotonin is essentially what makes you feel happy. It is the part of the brain associated with survival and is stimulated by activities such as sex, eating, drinking and drug use.

 

Brain Pathways?

 

I’m sure you’ve something like the picture before.   A simple pathway has formed across a field of grass by people regularly walking or driving across it. You can see sometimes patches of grass where people have frequently taken short-cuts.   This is why we often see signs saying “don’t step on the grass”. Because although our actions, no matter how innocent they may seem, if imprinted on the grass thousands of times they will leave a clear impression. A pathway.

Once a pathway is formed across a field it will remain there for some time, regardless of you walking on it.

This is a useful metaphor to consider when thinking about the nature of addiction. Most of the effects from drugs and alcohol for the vast majority of people are temporary.   They do not impress much on how our brain and pathways form.

But after repeated amounts they begin to create significant pathways.

The traditional view of drug addiction was if you keep repeating certain actions those chemical changes and physical changes impress upon the brain permanently and as a result of this if drink or use drugs again they will quickly relapse back into addictive patterns of use.

Whilst this is true to some extent, there are actually a lot of people who are exposed to regular and vast amounts of drugs and alcohol who don’t seem form an addiction. In fact, those who form an addiction to drugs and alcohol are in the minority.

This tells us there is more to drugs and alcohol than just the substances involved. We have to accept at some level there is a change to the brain.

Some neurology (study of the nervous system, brain, spine, nerves) -scientists have done experiments looking at how the brain has changed for addicts.

Using scanning equipment (PET – Positron emission tomography) they inject a radio-active dye into the brain of an addict that shows an illuminated image of cell-to-cell communication. The radio-active dye acts as tracer that shows dopamine pathways within the brain.

This method has been used in some popular studies around chronic methamphetamine abuse, whereby scientists have now been able to observe structural and chemical changes within the brain of addicts even beyond the use of drugs.

Studies have shown that even in abstinence individuals obtain less than normal amounts of pleasure from ordinary activities and accomplishments(Volkow et al 1996-2001).

What is clear from these studies is that the more severe the abuse the longer it takes to recover back to a level of “normality”.  However recovery is real and will happen providing drug and alcohol abuse is kerbed off for a good period of time.

Many recovering addicts chose to remain abstinent for their life, citing that any amount of drink or drugs that affects their mind will resort in them going back into addictive patterns of usage. This is backed up by clinical observations of relapses, that addiction can be a chronic life-long issue for many people.

-Written by Dylan Kerr

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