Medical Code: SGM-FS-001
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Condition: Addiction

Layman’s Definition:  physical changes to the body in response to repeated drug use which causes the person to feel bad when they stop taking the drug.

Prevalence: 4 million (at least)

Typical Age of Symptom Onset: Over 18 years (difficult to define use versus addiction)

Primary Symptoms: Continued use of a chemical or engaging in stimulating behaviors (such as illicit sex or gambling) when the drug or behavior is having a negative effect on one’s life, putting job, health, and/or important personal relationships at risk. Ceasing to take the drug may cause a range of unpleasant physical symptoms (withdrawal), depending on the drug. The individual is no longer taking the drug or engaging in the activity because they enjoy it, but simply in order not to feel bad.

It can be very difficult to define when a user of a substance or a gambler, for example, becomes an addict. The amount and frequency of use tends to increase in those who are addicted, but a functional alcoholic, drug addict, or addictive gambler may be able to confine their addictive behaviors to time periods when it does not directly interfere with making a living or carrying out other essential activities. The key distinction between a user and an addict is that the addict will not cease being a user when it is clear to everyone who cares about them that it would be in their best interest to stop.

Secondary Symptoms: The drug itself may produce harmful health effects. Likewise, prioritizing drug use over food/shelter and healthy behaviors may cause an overall decline in the individual’s health. Specific symptoms will depend on the drug being abused. The person who has become addicted may lie and/or engage in criminal behavior in order to obtain money to buy drugs or alcohol or to continue to gamble. Individuals may also hide drug use, gambling, and other addictive behavior in order to avoid punishment or the pressure to stop. Addicts are also likely to become defensive and hostile when their drug use or addictive behavior is challenged. Individuals addicted to a substance may respond to an attack on their drug use as though it were an attack on their person.

Drugs of addiction can also cause mild damage to the parts of the brain that help individuals unlearn behaviors that are no longer producing the desired effect. Thus, addicts tend to have more difficulty breaking other bad habits. Addicted persons may continue to do other self-destructive things, such as driving under the influence, even after they have been caught more than once and face serious penalties for repeat offenses.     

If drugs were taken initially to mask or suppress symptoms of depression, the depression will tend to worsen as the body adapts to the presence of the drug. For example, mild depression may become more severe.

Cause(s)/ Risk Factor(s): Addiction is the negative side of the brain’s ability to adapt and change in response to stimulation. Prolonged exposure to chemicals that mimic certain neurotransmitters or alter nerve functioning causes neurons to reduce the number of neurotransmitter receptors or otherwise change the way that they work in order to try to continue to function effectively and survive in a toxic environment. Over-stimulation of neurons with chemicals that mimic neurotransmitters but are many times more stimulating can result in neuronal cell death (excitotoxicity). The body’s adaptations to the presence of the drug and/or cell loss mean that the nervous system can no longer function effectively when the chemical is not present. This adaptation to the presence of the drug can result in withdrawal symptoms if drug use is stopped abruptly. Addictive behaviors, such as gambling, have similar but somewhat milder over-stimulating effects.

The main risk factors for addiction are genetic factors, which affect how long a drug will stay in the body and/or how quickly and extensively the body adapts to its presence. Physical and/or emotional pain also increases the risk of addiction. Abused drugs can mask or numb this pain, which makes using them more attractive. Individuals with post-traumatic stress disorder (PTSD) and/or who have taken prescription pain medication for a long period of time are particularly prone to addiction, especially if there is a family history of drug or alcohol abuse.

Standard Treatment(s): The first step in treating addiction is to keep the addictive chemical out of the body long enough for the body to readapt to functioning without it. This detoxification phase may take several days or weeks, depending on the abused drug and how long the person has been using it. Medication may be prescribed in order to ease withdrawal symptoms. Withdrawal symptoms may be fatal if left untreated.

For some patients, ongoing treatment with a drug that is chemically similar to the abused drug may be prescribed in order to maintain effective nervous system functioning after neurons have been lost to excitotoxicity. (Methadone replacement treatment and nicotine patches are two examples of such treatments.) Cognitive therapy and group support are generally recommended to help individuals define their reasons for stopping using and to develop strategies for avoiding backsliding into drug use or negative behaviors.

If possible, individuals are advised to avoid triggers (people and places associated with drug use or addictive behaviors), as this tends to remind the individual of the pleasure they felt when they started using and can cause a strong urge to use the drug again or repeat the addictive behavior. Individuals struggling with addiction are generally advised to develop new routines and habits in order to avoid falling into old bad behavior and to associate as much as possible with people who are not using drugs or alcohol or gambling and who support their efforts to stay clean. Family members are generally encouraged to help by refraining from drug/alcohol/gambling themselves, even if they have no addictive tendencies towards these substances or activities. Voluntary lifestyle changes made by loved ones can help keep individuals struggling with addiction from feeling isolated and/or resentful of the restrictions that they must impose on themselves. Drug cravings may never be completely eliminated, but individuals can learn to override that urge if they feel that they have a strong enough reason for remaining clean and sober.

For more a complete discussion of this topic, see also: Addiction: When you can’t just say no

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