Addiction Disorders
Addiction is a complex condition. While addiction begins with a voluntary behavior, over time the addicted individual loses the ability to control that behavior. The reasons for this loss of control involve biological vulnerabilities such as genetics and brain chemistry, as well as psychological factors such as personal experience, environment, relationships, and emotions. Drugs themselves also alter neurochemistry in ways that affect brain functioning. Understanding the underpinnings of addiction is important because they inform the pathway to recovery.
Symptoms
Addiction disorders are usually defined by some combination of physical and psychological dependence:
Physical dependence: Physical dependence is characterized by tolerance to the drug's effects, whereby more and more of a substance must be used to achieve the same effect, and withdrawal, whereby cessation of drug use leads to a profoundly unpleasant emotional and physical reaction. Heroin and alcohol are two substances that produce a strong physical dependence that often leads to abuse.
Psychological dependence: Psychological dependence occurs when there is an overwhelming desire to experience the effects of the substance and to avoid the consequences of not having the substance. Cocaine, marijuana, amphetamines, and hallucinogens may cause substantial psychological dependence, with mild to no physical dependence.
Causes and Risk Factors
It is not well understood how or why a person progresses from substance experimentation to more frequent use with a greater tolerance to physical dependency on the substance. Peer pressure, personality characteristics, life history, developmental experiences, and emotional distress that is relieved by the drug's specific effects all play a role. In addition, there is strong evidence for a genetic basis to addiction and neuroscientists have elucidated many neurobehavioral pathways that appear to be involved in the condition. These neurobiological characteristics serve as targets for novel treatments to help people suffering from addiction disorders.
Drugs that produce dependence act on the central nervous system with one or more of these effects:
- Elation, euphoria or other pleasurable mood changes
- Feelings of increased mental and physical ability
- Reduced anxiety and tension
- Altered sensory perceptions
- Behavior changes
- Changes in thinking patterns and thought processes
Diagnosis
Before a diagnosis can be made, a comprehensive psychiatric evaluation should be completed to elucidate the biological, psychological, and social contributors to addiction.
Treatment
Treatment will vary depending on the nature of the drug causing the addiction, how severe the addiction is, how long the person has been addicted, what their emotional state is, how motivated they are to recover, and what, if any, medical complications may be associated with the addiction.
The first step in treatment is usually supervision and assistance to help the person stop using the drug. Often counseling, group therapy and participation in an appropriate type of 12-step program are also beneficial. In addition, there are specific medications that have been developed and approved for treatment of substance use disorders.
Recovery
Recovery is a state of wellness and balance. It is characterized by physical and emotional well-being, a capacity for enduring relationships, an ability to derive pleasure from healthy activities, and the ability to engage in desired educational or occupational pursuits. Effective treatment for addiction extends beyond medical stabilization of the ¿addicted behavior,¿ and actually seeks to improve life coping skills, develop personal insight, promote healthy relationships, and facilitate long-term lifestyle modification.
Does Treatment Help?
Treatment often works. A body of evidence conclusively demonstrates that specific forms of treatment are effective. Many people with addiction become demoralized by past unsuccessful efforts to quit. However, recovery remains possible, and in fact, it has been shown that recovery rates for addiction are better than many other medical conditions. Often treatment is too short and, after stabilization, what is needed is an extended period of outpatient support services.
Resources at Cedars-Sinai
- Department of Psychiatry & Behavioral Neurosciences
- Addiction Psychiatry Program
- Alcoholism Research at Thalian's Mental Health Center
- Outpatient Services at the Department of Psychiatry and Behavioral Neurosciences
