Addiction

Addiction is a term used to describe a strong compulsion to repeat a behavior regardless of its negative consequences. A person who is addicted is sometimes called an addict.

Many drugs or behaviors can precipitate a pattern of conditions recognized as addiction, which include a craving for more of the drug or behavior, increased tolerance to increased exposure, and withdrawal symptoms of pain or discomfort in the absence of the addictive stimulus. Most drugs and behaviors that have the potential to provide both pleasure and relief from pain pose a risk of dependency.

Table of contents

1 Diverse addictions
2 Methods of care
3 Diverse explanations
4 Physiological basis
5 Casual addiction
6 See also

Diverse addictions

Not all medical practitioners agree on what comprises addiction or dependency. Researchers, medical professionals and popular literature has discussed addictions of several sorts, including those to:

Eating disorders are also widely treated as addictions; they are often characterised by strong elements of addictive behaviour. Many people experience withdrawal or withdrawal-like symptoms if they alter their diet suddenly, suggesting that some common food substances - especially chocolate, artificial sweeteners, and sugar - may have the potential for addiction. But eating disorders are also sometimes related to other disfunctions outside the "pleasure centers" of the brain most commonly related to addiction.

The medical community usually distinguishes between physical and psychological addictions. Physical dependency leads to physical symptoms in the absence of the addictive substance whereas psychological dependency is related to psychological discomfort. The distinction does not necessarily mean that psychological addictions are easier to break than physical ones. Addictions often appear to have both physical and psychological components. Breaking any addiction can be difficult, otherwise it wouldn't be an addiction.

The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, and the individual. Some alcoholics say that they drank in an alcoholic way from the moment of first intoxication, while other people drink socially without ever becoming addicted. Nicotine is considered by many to be among the most most addictive substance in common use.

Methods of care

Early editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders described addiction as a physical dependancy on a substance that resulted in withdrawal symptoms in the absence of the substance. Recent editions, including DSM-IV, have moved toward a diagnostic instrument that classifies such conditions as dependency, rather than addiction. The American Society of Addiction Medicine recommends treatments for people with chemical dependancy based on patient placement criteria (currently listed in PPC-2), which attempt to match levels of care according to clinical assessments in six areas, including:

Acute intoxication and/or withdrawal potential
Biomedical conditions or complications
Emotional/behavioral conditions or complications
Treatment acceptance/resistance
Relapse potential
Recovery environment

Some medical systems, including those of at least 15 states of the United States, refer to an Addiction Severity Index to assess the severity of problems related to substance use. The index asesses problems in six areas: medical, employment/support, alcohol and other drug use, legal, family/social, and psychiatric.

While addiction or dependency is related to seemingly uncontrollable urges, and may have roots in genetic predispositions, treatment of dependency is always classified as behavioral medicine. Early treatment of acute withdrawal often includes medical detoxification, which can include doses of anxiolitics to reduce symptoms of withdrawal. In chronic opiate addiction, a surrogate drug, such as methadone is sometimes offered as a form of opiate replacement therapy. But treatment approaches universally focus on the individual's ultimate choice to pursue an alternate course of action.

Therapists often classify patients with chemical dependencies as either interested in changing or not interested in change. Treatments usually involve planning for specific ways to avoid the addictive stimulus, and therapeutic interventions intended to help a client learn healthier ways to find satisfaction. Clinical leaders in recent years have attempted to tailor intervention approaches to specific influences that affect addictive behavior, using therapeutic interviews in an effort to discover factors that led a person to embrace unhealthy, addictive sources of pleasure or relief from pain.

Treatment Modality Matrix

Behavioral Pattern Intervention Goals
Low self esteem, anxiety, verbal hostility Relationship therapy, client centered approach Increase self esteem, reduce hostility and anxiety

Defective personal constructs, ignorance of interpersonal means Cognitive restructuring including directive and group therapies Insight

Focal anxiety such as fear of crowds Desensitization Change response to same cue

Undesirable behaviors, lacking appropriate behaviors Aversive conditioning, operant conditioning, counter conditioning Eliminate or replace behavior

Lack of information Provide information Have client act on information

Difficult social circumstances Organizational intervention, environmental manipulation, family counseling Remove cause of social difficulty

Poor social performance, rigid interpersonal behavior Sensitivity training, communication training, group therapy Increase interpersonal repetoire, desensitization to group functioning

Grossly bizarre behavior Medical referral Protect from society, prepare for further treatment

_{Adapted from: Essentials of Clinical Dependency Counseling, Aspen Publishers}

Treatment Modality Matrix
*Behavioral Pattern*	*Intervention*	*Goals*
Low self esteem, anxiety, verbal hostility	Relationship therapy, client centered approach	Increase self esteem, reduce hostility and anxiety
Defective personal constructs, ignorance of interpersonal means	Cognitive restructuring including directive and group therapies	Insight
Focal anxiety such as fear of crowds	Desensitization	Change response to same cue
Undesirable behaviors, lacking appropriate behaviors	Aversive conditioning, operant conditioning, counter conditioning	Eliminate or replace behavior
Lack of information	Provide information	Have client act on information
Difficult social circumstances	Organizational intervention, environmental manipulation, family counseling	Remove cause of social difficulty
Poor social performance, rigid interpersonal behavior	Sensitivity training, communication training, group therapy	Increase interpersonal repetoire, desensitization to group functioning
Grossly bizarre behavior	Medical referral	Protect from society, prepare for further treatment
_{Adapted from: Essentials of Clinical Dependency Counseling, Aspen Publishers}

Diverse explanations

Several explanations (or "models") have been presented to explain addiction:

The moral model states that addictions are the result of human weakness, and are defects of character. Those who advance this model do not accept that there is any biological basis for addiction. They often have scant sympathy for people with serious addictions, believing either that a person with greater moral strength could have the force of will to break an addiction, or that the addict demonstrated a great moral failure in the first place by starting the addiction. The moral model is widely applied to dependency on illegal substances, perhaps for purely social or political reasons, but is no longer widely considered to have any therapeutic value. Elements of the moral model, especially a focus on individual choices, have found enduring roles in other approaches to treatment of dependencies.
The disease model holds that addiction is an illness, and comes about as a result of the impairment of healthy neurochemical or behavioral processes. While there is some dispute among clinicians as to the reliability of this model, it is widely employed in therapeutic settings. Most treatment approaches involve recognition that dependencies are behavioral disfunctions, and thus involve some element of physical or mental disease.
The genetic model posits a genetic predisposition to certain behaviors. It is frequently noted that certain addictions "run in the family," and while researcers continue to explore the extent of genetic influence, there is strong evidence that genetic predisposition is often a factor in dependency. Researchers have had difficulty assessing differences, however, between social causes of dependency learned in family settings and genetic factors related to family.
The cultural model recognises that the influence of culture is a strong determinant on whether or not individuals fall prey to certain addictions. For example, alcohol addictions are rare among Saudi Arabians, where obtaining alcohol is difficult and using alcohol is prohibited. In North America, on the other hand, the incidence of gambling addictions soared in the last two decades of the 20th century, mirroring the growth of a gaming industry. Half of all patients diagnosed as alcoholic are born into families where alcohol is used heavily, suggesting a role for either family culure or genetic factors or more likely, for both.
The blended model attempts to consider elements of all other models in developing a therapeutic approach to dependency. It holds that the mechanism of dependency is different for different individuals, and that each case must be considered on its own merits.
The social norms model is often employed in educational efforts intended to demonstrate, especially to student populations, that self-administration of psychoactive substances is not a normative behavior. Educators often employ the social norms model in attempts to demonstrate that those who frequently use alcohol or other psycho-active substances in ways that pose the threat of physical harm are a minority, and that the majority of a social group approaches the use of potentially harmful substances with caution and moderation.

Physiological basis

Although the term addiction is sometimes often used loosely rather than as a medical classification, there are some physiological conditions related to everyday behaviors that are also related to the more commonly recognized mechanisms associated with addiction. Pleasurable activities cause the release of endorphins, and this endorphin-rush can conceivably become 'addictive'. This process of attentuating pleasure pathways is part of the brain's natural system for ensuring that humans develop abiding interests; since human societies depend on this, such addictions are not necessarily a problem. The pathways oriented to endorphins, sometimes called pleasure centers originated in small organisms such as insects, which rely on the neurological system to help them find familiar sources of food.

In general terms, endorphins stimulate activity of the neurotransmitter dopamine. Increased dopamine activity is often met by an increase in the number of receptors sensitive to dopamine. This process is called upregulation. The increased number of receptors tends to result in reduced electrical activity along post-synaptic nerve pathways, unless some behavior or substance causes a continued high level of dopaminergic stimulation. The absence of a pleasurable sensation in conditions that were formally sufficient can cause a mild feeling of let-down after neurons have been upregulated. The increased requirement for dopamine to maintain electrical activity is the basis of both tolerance and withdrawal associated with addiction.

In cases of physical dependency on depressants of the central nervous system such as opiates, barbiturates, or alcohol, the absence of the substance leads to symptoms of sometimes severe physical discomfort. In these cases, a body has become so dependant on a chemical that it has stopped producing the necessary neurotransmitters required to maintain a comfortable status.

Opiates present extreme risks of physical dependency because they are chemically similar to endorphins, causing an upregulation of dopaminergic receptors without stimulation of the endorphin systems. Cocaine and amphetamines also pose risks associated with physical attenuation, cocaine for its chemical similarity with dopamine, and amphetamines by their similarity with norepinephrine which acts indirectly to stimulate dopaminergic pathways in the brain.

Casual addiction

The word addiction is also sometimes used colloquially to refer to something a person has a passion for. Such "addicts" include:

Biblioholics

Chocoholicss
Wikiholics
Genealogists