Addiction is the state of being enslaved to a habit or practice, or to a substance which is psychologically or physically habit-forming, such as alcohol or narcotics, to such an extent that its cessation causes severe symptoms of withdrawal.
Addiction initially starts with the trial of a substance. As the individual tries the substance for the first time, he or she may develop a liking for it. They therefore try it again and again until they reach a point where they cannot function without it, thus crossing over from ‘using’ to addiction.
The Model of addiction:
The model is called the ‘brain diseased’ model and is widely accepted amongst the scientific community.
It says that, when there are transitions in the brain, due to the use of a substance which gives reward to the person, the limbic system rewards the individual for this behavior by releasing a chemical called dopamine in the brain. This release of dopamine can be anywhere up to 10 times the amount which our brain releases normally, giving the user the feeling of a ‘rush’ or ‘high’.
This is a learned behavior, where the individuals learn from the reward provided to them by the limbic system. This learning is affected by structures within the brain (e.g. the amygdala, the hippocampus and the prefrontal cortex). These structures communicate directly between themselves and with the nucleus accumbens, serving to regulate its output. The individual thus learns to abuse a substance in a similar way to that whereby he or she has previously learned to eat or exercise where, again, dopamine had been released. In the case of substance abuse, the dopamine levels are much higher so, consequently, the learning process is much faster. In addition, since the amount of dopamine released is abnormal, the brain struggles to regain its normal chemical balance after the substance wears off. This produces a ‘hangover’, or withdrawal, which can manifest in physical pain, depression and even dangerous behavior.
Conversely, prolonged use of alcohol can lead the brain to stop producing as much dopamine as it does naturally. This creates further withdrawal, leading to a physical dependency. The addict needs to drink more and more alcohol, just to feel normal, creating a vicious cycle which can be difficult to break.
Substances such as alcohol, cocaine, amphetamines and opiates block the transmission of certain signals in the central nervous system by binding to specialized receptors in the brain. These drugs block the function of naturally occurring chemicals and, since many substances actually replace these naturally occurring chemicals, they also cause the body to stop producing them. Thus, when the drug leaves the body, there are no natural chemicals to compensate. The body therefore reacts with potentially severe withdrawal symptoms, such pain, nausea, shakes and physical cravings, until the production of the naturally occurring chemicals is re-established. This readjustment can take anywhere from several days to several months, but is usually a relatively quick process.
In a review published in 2007, Yucel and colleagues stated that individuals with long-term abuse consistently demonstrate neuropsychological impairments of executive (inhibitory) control, working memory and decision making, together with neurobiological abnormalities involving frontotemporal and basal ganglia circuits. In some instances these deficits are dose dependent, implying that they are a direct consequence of prolonged drug exposure. However, co-morbid behavioral, personality and mental health problems are common among drug-using populations and are associated with similar neuropsychological deficits.
Treatment Approaches and Rehabilitation:
A variety of treatment approaches exist, each of which is appropriate for some individuals but less so for others. They include behavior modifications and support groups, as well as pharmacological treatment. Some treatment has total abstinence from alcohol as its primary goal, whilst other approaches seek to change the pattern of drinking to one that is moderate and compatible with a healthy and balanced lifestyle. Whatever the final aim, most treatment comprises three stages: detoxification to minimize withdrawal, rehabilitation and maintenance
Self-help or mutual help groups aspire to total abstinence from alcohol. They include Alcoholics Anonymous (AA), developed in the United States, in which an individual submits to a higher power in the process of ‘recovery’. AA members make a fresh resolve each day not to drink.
Early identification and brief intervention emphasizes that it is possible for individuals to modify their problematic drinking patterns. It is possible for individuals to learn to drink responsibly, especially if they are diagnosed early and before problems have become severe.
Motivational interviewing centers on the idea that individuals with problematic drinking patterns may recognize the negative aspects of their behavior, but need assistance in making the decision to change. This is achieved through motivational techniques to encourage the patient to set realistic and attainable goals, using positive feedback to encourage and sustain progress and change.
The community reinforcement approach includes behavioral techniques designed to support the individual in overcoming dependence. In general, it is most appropriate for those who are alcohol-dependent or have severe problems. The approach identifies high-risk situations which encourage and contribute to the individual’s problematic drinking and endows the patient with skills aimed at problem solving and at avoiding such situations. Skills include vocational training, recreational activities, marriage counseling, and avoiding situations where the risk for drinking and drunkenness is high. The patient is also taught skills to avoid relapse.
Psychological therapy and aversion therapy are also used to reduce problematic drinking. Aversion therapy relies on associating alcohol with highly negative contexts (e.g. nausea induced by various medications, such as the drug Antabuse) or other negative cues. Other methods include teaching social skills to deal with stressors and to facilitate problem solving, or developing skills aimed at reducing or controlling drinking (e.g. refusing or just sipping drinks). Psychotherapy is employed as an approach for general drinking problems and also for alcohol dependence.
Behavioral treatments and other psychosocial interventions (such as AA or other 12-step programs) are essential in helping people recovering from substance dependence to learn new, effective coping skills to deal with stress, in order to stop their drug and alcohol abuse. These new healthy coping skills enable them to function without alcohol or drugs, to handle cravings, to avoid alcohol/drugs and situations that could lead to drug use and to handle a relapse, should it occur. Behavioral approaches such as individual, group or family counseling, contingency management and cognitive-behavioral therapies, also help patients improve their interpersonal relationships and their ability to function at work and in the community.
Simultaneously, new anti-addiction medication treatments, many of which have only been developed in the last few years, can be used to counter brain injury from past drug use, to relieve withdrawal symptoms and to help overcome cravings.
Rehabilitation is required both on the psychosocial aspect and the neuro-cognitive aspect.
Psychosocially, the patient is helped to restore psychosocial functioning. The goal of psychosocial rehabilitation is to help individuals with persistent and serious mental illness to develop the emotional, social and intellectual skills needed to live, learn and work in the community with the least amount of professional support.
Neuro-cognitive rehabilitation on the other hand, is designed to improve the brain functions of the individual. Improvement is reflected in attention, memory and executive functions. Brain rehabilitation strategies such as brain training games have been found to be helpful for this rehabilitation.
Alcohol addiction is a brain disease. It becomes learned in the brain, when rewarding chemicals such as dopamine are released. For that reason it causes problems in brain due to the blockage of essential neurotransmitters, due to which withdrawal symptoms occur and the craving for intake increases. This may lead to less inhibited or disinherited behavior due to impairments in executive control, working memory and decision making. Treatment and rehabilitation go hand and hand in achieving improvement in the patient’s overall behavior. Brain training is one way of neurocognitive rehabilitation.
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