Addictions

Addictions. What they are?

An addiction disorder is a complex condition involving uncontrolled substance use despite harmful consequences. Learn more about addiction, its symptoms, management, and treatment options.

An addiction disorder occurs when someone loses control over their use of substances like drugs, medication, alcohol, or tobacco, causing harm to themselves or others. These substances trigger the brain’s reward system, creating pleasurable feelings and intense cravings.

Main Types of Addictions

The diagnosis of addiction disorders is based on the primary substance being abused. The two main types of addiction disorders are:

Alcohol Use Disorder

Alcohol is one of the most commonly used intoxicating substances. When someone abuses alcohol (often called alcoholism), they lose control over how much they drink. Those affected may also experience withdrawal symptoms when not drinking. Alcoholism can cause severe health problems and damage organs like the liver, heart, or brain. Alcohol use disorder can also lead to destructive behaviours and unintended consequences, such as family disputes, violence, accidents, unprotected sex, loss of personal items (wallet, phone, money), drunk driving, and absenteeism from work or school.

Addictions to Drugs

Often called drug addiction, this is a chronic condition that’s hard to control. Drug addicts cannot resist the urge to use drugs, no matter the harm. Drug addiction can involve illegal drugs, prescription medications, or both. Highly addictive substances like cocaine, heroin, methamphetamines, benzodiazepines, steroids, and inhalants can quickly lead to addiction. Drug addiction causes brain changes over time, making it very difficult to resist the intense craving for drugs. This is why addicts often relapse when trying to quit. Drug use disorder can devastate a person’s life, leading to relationship issues, poor work or school performance, neglect of personal care, increased impulsiveness, risk-taking, and loss of interest in hobbies or activities.

Frequency of Addictions

According to the World Health Organisation, alcohol consumption causes three million deaths worldwide annually. Alcohol accounts for 5.1% of the global disease burden. It is the leading risk factor for premature death and disability in people aged 15-49, responsible for 10% of all deaths in this age group.

The World Health Organisation (WHO) also reports that around 270 million people (or about 5.5% of the world population aged 15 to 64) used psychoactive substances in the past year, with approximately 35 million people suffering from drug use disorders. It’s estimated that drug use causes about half a million deaths annually, including 350,000 male and 150,000 female deaths.

Symptoms of Addictions

Symptoms of addiction vary by person and type of addiction. There are several common signs of addiction across different types, including:

Behavioural and social changes:

Secretive or dishonest behavior

• Lack of motivation or apathy
• Changes in eating or sleeping habits
• Loss of interest in hobbies or activities
• Withdrawal from friends and family
• Poor work performance or absenteeism
• Substance use in dangerous situations (e.g., driving)
• Excuses for substance use (e.g., to relax or celebrate)
• Neglecting responsibilities at home or work
• Borrowing or stealing money
• Unpredictable behavior

Psychological changes:

• Sudden mood swings
• Personality changes, irritability, or anger
• Hyperactivity or agitation
• Anxiety, fear, or paranoia without clear cause
• Difficulty concentrating
• Defensiveness
• Poor judgment
• Low self-esteem
• Feelings of hopelessness
• Worsening of mental health issues like anxiety or depression

Physical changes:

• Sudden weight loss or gain
• Bloodshot eyes
• Dilated pupils
• Facial swelling
• Unusual skin color
• Bad breath
• Tremors or shaking
• Deterioration of physical appearance
• Injection marks (in cases of drug abuse)

Stages of Addictions

People who become dependent on substances like alcohol or drugs typically go through four stages of abuse. Understanding these phases can help individuals recognise if they have a problem and need help before addiction occurs. There are four main stages of addiction.

Experimentation:

Substance abuse starts with experimentation or voluntary use. Teenagers and young adults often try substances with friends, usually due to peer pressure. Older adults may use substances for self-medication in response to life issues, like divorce, grief, or job loss. Substance use is rare in this phase.

Regular to Risky Use:

This phase involves frequent use, which may follow a predictable pattern (e.g., every weekend) or specific situations (e.g., boredom, loneliness, or stress). Risky use occurs when consumption leads to emotional, physical, or social problems, such as work issues, accidents, or drunk driving.

Dependence:

In the dependence phase, the person continues regular use despite physical, social, or emotional harm. Many dependent people can still maintain jobs and relationships, but they struggle to see the effects of their substance use on others. Signs of dependence include:

• Failing to meet responsibilities
• Repeated use in dangerous situations (e.g., driving)
• Tolerance, needing more to feel the same effects
• Withdrawal symptoms

Addiction:

When someone is addicted, their use is out of control. Addiction symptoms include uncontrollable cravings, constantly seeking alcohol or drugs, and continuing use despite severe consequences. Addiction is progressive and worsens if left untreated.

Early Signs of Addictions

Recognising early signs of addiction is crucial to getting help quickly.

Early signs of alcohol abuse include:

Blackouts during drinking episodes

• Repeated conflicts with family, friends, or coworkers
• Mood swings
• Using alcohol to relax, cope, sleep, or boost mood
• Headaches, stomach issues, anxiety, or insomnia when not drinking
• Trembling hands
• Reddish skin and broken capillaries on the face
• Bloodshot eyes
• Sudden weight loss or gain
• Neglect of personal grooming
• Slurred speech

Early signs of drug abuse include:

Neglecting family, work, or school responsibilities

• Relationship issues
• Using drugs in dangerous situations like driving or operating machinery
• Engaging in risky behaviour, like using dirty needles or unprotected sex
• Legal problems (e.g., theft to buy drugs or antisocial behaviour)
• Dilated pupils
• Nosebleeds
• Sudden weight loss or gain
• Neglect of personal hygiene
• Incoherent speech
• Shaking or trembling

Diagnosis of Addictions

Although some people self-report when seeking help, a doctor’s assessment is typically the proper way to diagnose addiction and later treat addictions.

How are addictions diagnosed?

A substance use disorder is diagnosed through a thorough examination, typically including an assessment by a mental health professional. Blood or urine tests may confirm substance use, but they don’t indicate addiction.

Tests for diagnosing addictions

Various psychometric tests are used by mental health professionals to assess problematic alcohol and substance use. These include the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), developed for the World Health Organisation to help early detection of addiction; the Alcohol Use Disorders Identification Test (AUDIT), which identifies early signs of harmful drinking or mild dependence; the Drug Use Disorders Identification Test for self-assessment of drug problems; and the CRAFFT Screening Test, designed for evaluating substance-related risks in adolescents.

Causes of Addictions

The exact cause of addiction is unknown, but many factors may contribute, including:

• Environment: Family issues, conflicts about beliefs, values, or peer group influence can promote substance use.
• Mental health: Emotional distress, anxiety, depression, PTSD, low self-esteem, or other psychological problems can be contributing factors.
• Genetics: Addiction can sometimes run in families.

Are addictions hereditary?

Addiction heritability is moderate to high. If someone has a blood relative, like a parent or sibling, with alcohol or drug addiction, their risk of developing an addiction increases. Genetic traits can speed up or slow the disease’s progression.

Who develops addiction?

People of any age, gender, background, or economic status can become addicted to alcohol or drugs. However, addiction is more common in those exposed to environmental, psychological, or genetic risk factors.

How long can you live with an addiction?

Living with addiction is possible, but it increases the risk of premature death. These deaths can result from diseases and injuries, including suicide, liver disease, hepatitis, cancer, and HIV caused by excessive substance use.

Globally, drug abuse is directly and indirectly responsible for over 585,000 premature deaths annually, with 42% occurring in people under 50.

It’s estimated that 2.84 million people die prematurely each year from alcohol consumption. Europe has the highest rate of diseases and premature deaths due to alcohol. In Eastern Europe, nearly one-third of deaths are attributed to alcohol use.

Globally, nearly three-quarters of those who die prematurely from alcohol are under 70, and 28% are younger than 50.

Treating Addictions with Medications

• Opioids: Some opioids, like methadone, are used to withdraw from opioids and later to substitute for those who are still not capable of staying clean. Others, like naltrexone, block opioid effects at brain receptor sites, reducing the cravings. Naltrexone can be used for opioid or alcohol addiction.
• Alcohol antagonists: medications like disulfiram discourage drinking by causing unpleasant effects, such as headaches, vomiting, chest pain, blurred vision, breathing difficulties, and anxiety, when even small amounts of alcohol are consumed.
• Sulfonic acids: Certain sulfonic acid medications are used to treat alcoholism by restoring the brain’s natural chemical balance. This helps prevent drinking and improves overall alcohol abstinence.
• Smoking cessation aids: These medications block nicotine’s pleasurable effects on the brain, preventing people from enjoying smoking.

Psychotherapy for Addictions

Various behavioural and talk therapies can help patients with addiction change their attitudes and behaviours towards substance use, build healthier lifestyles, and continue other treatments. These therapies include:

• Cognitive Behavioural Therapy (CBT): CBT helps people cope with problems by changing their thinking and behaviour. It teaches individuals to recognise, avoid, or handle situations where they would typically use drugs.
• Motivational Interviewing or Incentives: Therapists use positive reinforcement to encourage behaviour changes by helping patients recognise their own desires for change, motivating them to make positive decisions.
• Counselling: Counselling can be offered in group or individual settings, focusing on finding new ways to cope with addiction and addressing underlying causes of drug use.

Inpatient treatment is also available for addiction, including short-term stays focused on detox in a community setting, longer-term therapeutic communities, or supervised housing to transition from inpatient care to independent living.

Substance users can also join support groups like Alcoholics Anonymous or Narcotics Anonymous, where peers support each other in recovery and maintaining sobriety.

Addiction Recovery and Relapse Prevention

The primary goal of addiction prevention is to delay the initial use of drugs or alcohol during adolescence.

It’s essential to address risk factors in different areas of a teen’s life, like peer pressure, while strengthening protective factors, such as school support, to help resist trying drugs or alcohol.

Prevention is also necessary to stop individuals already using some drugs from progressing to others, preventing occasional users from increasing their consumption.

The international classification of prevention measures, used in the United Nations Office on Drugs and Crime standards, includes the following strategies:

• Universal: Universal prevention targets large groups or the entire population (e.g., through TV ads or school programs) to prevent or delay substance use.
• Selective: Selective prevention is aimed at specific subpopulations known to have a higher-than-average risk of substance abuse, especially youth.
• Indicated: Indicated prevention targets people who already use substances and may show signs of future problematic use.

Post-Acute Withdrawal Syndrom (PAWS)

Targeting each population group with relevant resources and messages can help prevent the start or escalation of substance use and its associated problems.

Discussing recovery from addiction and relapse prevention wouldn’t be possible without the scientific research of Dr. Terence Gorski, who created the treatment model for Relapse Prevention and Post-Acute Withdrawal Syndrom (PAWS).

He says dependency is a disease that affects the bio-psycho-social functioning. He asserts that treatment must include ways to address the biological damage caused by addiction, specifically brain dysfunction. The treatment’s objective is to enhance psychological well-being and social relationships.

Relapse is framed as the “relapse syndrome.” This indicates that there are a number of symptoms and warning signs preceding a relapse. The most notable is the presence of untreated post-acute withdrawal syndrome (PAWS). These are symptoms that occur after a person has gone through acute withdrawal, or detoxification.

Initially, the post-acute withdrawal symptoms can be triggered by stress, but also the substance craving enhances the stress level, creating a vicious circle. “This personal distress, caused by the compromised ability to handle thoughts, emotions, and behaviours, is the precipitating cause of a relapse.

Psychologists working with prevention and addiction recovery and post-acute withdrawal symptoms expect symptoms reduction. However, there are some who will experience ongoing stable post-withdrawal symptoms. There will also be some who will experience more such symptoms over time. It is this last category of people in recovery that have the highest relapse rates.

Gorski adheres to the 12-Step wisdom, and the therapeutic underpinning is cognitive-behavioural with a focus on lifestyle changes to foster long-term recovery.

Gorski identifies 3 types of chemically dependent people:

1. Recovery-prone

2. Transitionally relapse-prone

3. Chronically relapse-prone

a) Unmotivated to change

b) Motivated to change

This relapse prevention for dependency model is designed especially for motivated relapse-prone individuals (Gordon, 2003).

Symptoms of Post-Acute Withdrawal Syndrom (PAWS)

Inability to think clearly: inability to concentrate for more than a few minutes; impairment of abstract reasoning; rigid and repetitive thinking/going around and round.

• Memory problems: short- and long-term memory is affected
• Emotional overreactions or numbness
• Sleep disturbances: Short-term or life-long
• Physical coordination problems: Dizziness, balance problems, hand-eye coordination problems, and slow reflexes
• Stress sensitivity: Difficulty managing stress and inability to assess stress realistically (Ibid.)

Stages of recovery from Post-Acute Withdrawal Syndrome

There are 6 developmental periods that clients pass through in which certain recovery tasks are completed:

Gordon and Miller (1985) describe CENAPS as a developmental model of recovery (DMR). There are 6 developmental periods that clients pass through in which certain recovery tasks are completed:

• Pre-treatment: recognising addiction. Learning by the consequences that you cannot safely use addictive chemicals.
• Stabilisation: withdrawal and crisis management. Regaining control of thought processes, emotional processes, memory, judgement and behavior
• Early recovery: Acceptance of the disease and learning to function without drugs and alcohol
• Middle recovery: developing a normal, balanced lifestyle. Resisting substitute addictions.
• Late recovery: personality change. Development of healthy self-esteem, spiritual growth, healthy intimacy, and meaningful living
• Maintenance: growth and development. Staying sober and living productively

As a person progresses through the recovery stages, the CENAPS model proposes to use a number of skills learnt during dependency treatment to alleviate stress and manage PAWS should they occur.

Relapse Prevention Road Map

Counselling is crucial in relapse recovery, showing patients how they will benefit from having a relapse road map. Here patients can apply cognitive-behavioural analysis to a situation. They will see available choices to cope with or avoid these situations and their consequences. This approach also assists in finding AIDs so that people can make choices and decisions from which they benefit (Larimer et al., 1999).

Relapse treatment

Psychologists studied this relapse prevention model and found data show the effectiveness of treatment strategies. Psychologists have applied this RP model to various addictive behaviours. They found it was most successful with alcoholism. There is an idea that in the future modifications be made to this RP model, showing changes about the assessment of risky situations and the conceptualisation of covert and immediate antecedents of relapse. Significant research shows the effectiveness of RP for alcoholism and, to a lesser degree, nicotine or other chemical dependency. Psychologists also noted that people’s self-efficacy might not necessarily rise if they handle a high-risk situation well. Lastly, research findings show that RP plus medication treatment appears to have an enhanced effect on abstention rates (Gordon, 2003).

A review of relapse prevention therapy (RPT) and information on how to work with clients can be found in the Clinical Guidelines for Implementing Relapse Prevention Therapy by Marlatt, Parks, and Witkiewitz. It is a source of information that shows how to work with dependency. These downloadable guidelines also contain information on various assessment tools and other valuable resources (Marlatt et al., 2002).

Ballancing Nutrition in People with Addiction

People with addiction often suffer from nutrient deficiencies, as they tend to consume nutrient-poor foods. Additionally, their bodies have a reduced capacity to absorb nutrients due to drug or alcohol use.

During recovery, substance users should increase nutrient intake to maintain organ health and prevent infections. They are advised to follow regular meal schedules, eat low-fat meals, and consume more protein, complex carbs, and fibre while reducing caffeine and quitting smoking if possible. Dehydration is common during recovery, so it’s important to drink plenty of fluids during and between meals.

Improving and maintaining healthy eating habits is crucial, as people in recovery may confuse hunger with cravings, increasing the risk of relapse.

Physical Activity

People with addiction may find physical activity helpful as a distraction from cravings. Additionally, exercise can help those who use drugs by introducing healthier lifestyles and enhancing both physical and mental health.

Moderate to intense aerobic exercises like brisk walking, tennis, running, or jumping, along with mind-body exercises like yoga, can be an effective part of a combined treatment plan for addiction.

Exercise programs can also provide daily structure and help individuals build positive social connections, enhancing recovery and overall well-being.