Addiction ED’s purpose is to inform readers concerning the clinical aspects of various types of symptomatic behavior of more common addictions. This is not meant to replace the educational component of addiction care and treatment, but rather to provide information from various experts on each subject presented.
The following are the Addiction ED menu categories:
- Disease Debate: Is Addiction a Disease?
- Role of Family & Genetics
- Withdrawal and Post-Acute Withdrawal (PAWS)
- Alcohol and Drug Addiction
- Other Addictive Behaviors
- Less Obvious Addictions
A skeleton walked into the bar and said to the bartender, “I’ll have a beer and a mop.”
Definition of Addiction
A substance addiction meets two criteria:
- You have difficulty controlling how much you use or how long you use. For example, one drink leads to more drinks, or one line of cocaine leads to more.
- You continue to use even though it has negative consequences to your life. For example, you continue to drink even though it has hurt your relationships, or have suffered financially, or your health has suffered.
Those two criteria define all addictions. They are true for alcohol and drug addiction, but they’re also true for gambling addiction, eating disorders, and sexual addiction.
There are different stages of addictions. The late stage is the non-functioning addict. They’ve lost their job and have to use every day. It’s what people think addiction is like, but that stereotype is rare.
The early stage is the functioning addict. They still have a job and their relationships are intact, but their life is suffering because of their addiction. That is the most common scenario. You don’t have to suffer major losses to have an addiction.
The consequences of addiction get worse over time. Addiction is a progressive disease. It’s never easy to quit. But if you’ve already suffered negative consequences and don’t want them to get worse, there’s never a better time to quit than now.
- Tolerance. Has your use of drugs or alcohol increased over time?
- Withdrawal. When you stop using, have you ever experienced physical or emotional withdrawal? Have you had any of the following symptoms: irritability, anxiety, shakes, sweats, nausea, or vomiting?
- Difficulty controlling your use. Do you sometimes use more or for a longer time than you would like? Do you sometimes drink to get drunk? Do you stop after a few drink usually, or does one drink lead to more drinks?
- Negative consequences. Have you continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family?
- Neglecting or postponing activities. Have you ever put off or reduced social, recreational, work, or household activities because of your use?
- Spending significant time or emotional energy. Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? Have you spend a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?
- Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?
If you answered yes to at least 3 of these questions, then you meet the medical definition of addiction. This definition is based on the of American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10) criteria.(1)
Look at the self-test questionnaire page to see if you have an addiction.
The terms alcohol addiction, alcoholism, and alcohol dependence all mean the same thing. No one term is more serious than the other. Different terms have evolved over the years to overcome the negative stigma of addiction, and to make it easier for people to reach out and ask for help. The same is true for the terms drug addiction and drug dependence. (Reference: www.AddictionsAndRecovery.org)
How Common is Drug and Alcohol Addiction?
Approximately 10% of any population is addicted to drugs or alcohol. Addiction crosses all socio-economic boundaries. 10% of teachers, 10% of plumbers, and 10% of CEOs have an addiction.
Addiction is more common than diabetes, which occurs in approximately 7% of the population.
What Is a Substance Use Disorder?
According to The American Psychiatric Association Substance Use Disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems. The most severe SUDs are sometimes called addictions.
People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain’s structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavioral control.
Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate effects of the substance wears off, or in other words, after the period of intoxication. Intoxication is the intense pleasure, euphoria, calm, increased perception and sense, and other feelings that are caused by the substance. Intoxication symptoms are different for each substance.
When someone has a substance use disorder, they usually build up a tolerance to the substance, meaning they need larger amounts to feel the effects.
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:
- to feel good — feeling of pleasure, “high” or “intoxication”
- to feel better — relieve stress, forget problems, or feel numb
- to do better — improve performance or thinking
- curiosity and peer pressure or experimenting
People with substance use and behavioral addictions may be aware of their problem but not be able to stop even if they want and try to. The addiction may cause physical and psychological problems as well as interpersonal problems such as with family members and friends or at work. Alcohol and drug use is one of the leading causes of preventable illnesses and premature death nationwide.
Symptoms of substance use disorder are grouped into four categories:
- Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
- Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use
- Risky use: substance is used in risky settings; continued use despite known problems
- Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)
Many people experience substance use disorder along with another psychiatric disorder. Oftentimes another psychiatric disorder precedes substance use disorder, or the use of a substance may trigger or worsen another psychiatric disorder.
Consequences of Addiction
People only stop using when they’ve suffered enough negative consequences. When you’ve suffered enough pain and enough regret you’ll be ready to stop. After all, why stop before that? Addiction feels good.
You’re ready to stop your addiction when the two competing qualities of addiction collide. On the one hand, addiction feels good which makes you want to use more. On the other hand, addiction feels so good that you’re willing to sacrifice part of your life to have more, and you’re willing to experience pain in order to continue using. After awhile something has got to give.
The purpose of websites like this is to show you the potential negative consequences of addiction so that you make the move to quit before you’ve lost everything. You don’t have to hit rock bottom. You can try to imagine what it would be like to hit rock bottom. And then that can be enough to motivate you.
The most important consequences of addiction are social, emotional, psychological, and spiritual. People usually think of the physical and economic consequences of addiction. “I don’t have a serious addiction because my health is fine, and I haven’t lost my job.” But your body usually repairs itself quickly. The health consequences of addiction are often the least important.
As far as work is concerned that’s usually the last thing to suffer. You need your work to pay your bills, so that you can continue to use. When your work begins to suffer, you’ve slipped from being a functioning addict to a non-functioning addict.
The damage addiction does to your relationships and self-esteem takes longer to repair. You’ve hurt friends and family. You’ve disappointed yourself. You’ve traded important things in your life so that you could make more time to use. You’ve lived a double life—a lie. You’ve seen the hurt in your family’s eyes, and the disappointment in your children’s faces. Spiritually, you have in some way turned away from God and the core values that have made so much sense to you in the past.
Use this opportunity to examine the patterns of addiction that have led to your struggle. Take the time to recognize that addiction is controlling you but that it doesn’t have to. There is a power at work in the world with the authority to rearrange the processes of your brain and central nervous system because He loves you enough to complete transform your life. It is within your power and control to choose to let Him. Simply open the new door He has provided to you walk through into the new life experience.
Cost of Addiction
When you look at the dollars and cents cost of addiction, the figures are mind boggling.
At least twice as many people die from alcoholism in the US every year as die from motor vehicle accidents.(2)
Alcohol intoxication is associated with 40-50% of traffic fatalities, 25-35% of nonfatal motor vehicle injuries, and 64% of fires. Alcohol is present in nearly 50% of homicides, either in the victim or the perpetrator.(3)
Alcohol intoxication is involved in 31% of fatal injuries, and 23% of completed suicides.(4)
One study found that 86 % of homicide offenders, 37 % of assault offenders, and 57 % of men and 27 % of women involved in marital violence were drinking at the time of their offense.(5)
How Is Substance Use Disorder Treated?
Effective treatments for substance use disorders are available.
The first step is recognition of the problem. The recovery process can be delayed when a person lacks awareness of problematic substance use. Although interventions by concerned friends and family often prompt treatment, self-referrals are always welcome and encouraged.
A medical professional should conduct a formal assessment of symptoms to identify if a substance use disorder is present. All patients can benefit from treatment, regardless of whether the disorder is mild, moderate, or severe. Unfortunately, many people who meet criteria for a substance use disorder and could benefit from treatment don’t receive help.
Because SUDs affect many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s specific situation and any co-occurring medical, psychiatric, and social problems is optimal for leading to sustained recovery.
Medications are used to control drug cravings, relieve symptoms of withdrawal, and to prevent relapses. Psychotherapy can help individuals with SUD better understand their behavior and motivations, develop higher self-esteem, cope with stress, and address other psychiatric problems.
A person’s recovery plan is unique to the person’s specific needs and may include strategies outside of formal treatment. These may include:
- Hospitalization for medical withdrawal management (detoxification)
- Therapeutic communities (highly controlled, drug-free environments) or sober houses
- Outpatient medication management and psychotherapy
- Intensive outpatient programs
- Residential treatment (“rehab”)
- Many people find mutual-aid groups helpful (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery)
- Self-help groups that include family members (Al-Anon or Nar-Anon Family Groups)
13 principles of effective drug addiction treatment
These 13 principles of effective drug addiction treatment were developed based on three decades of scientific research. Research shows that treatment can help drug-addicted individuals stop drug use, avoid relapse and successfully recover their lives.
- Addiction is a complex, but treatable, disease that affects brain function and behavior.
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
- Remaining in treatment for an adequate period of time is critical.
- Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
- An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.
- Many drug-addicted individuals also have other mental disorders.
- Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
- Treatment does not need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
- Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.
Source: National Institute on Drug Abuse. These principles are detailed in NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide.
