Addiction
Addiction Overview
In Every human gathering that can be called a society, psychoactive drugs have a seriously pervasive effect on all aspects. Addiction is a complex, changing and evolving disorder. It is a chronic relapsing disorder classified under Substance-related and Addictive disorders in Psychiatry classification.
To understand the problem, it must be framed accurately. So, this is what statistics say about drugs and drug use. Using tobacco which is legal and socially accepted substance is responsible for 8 million deaths per year, being the first preventable cause of death. The evolution of electronic nicotine devices greatly affected the availability of tobacco (nicotine) all over the world, raising the mortality rate more than 60% in the last two decades.
In Egypt hashish and tramadol have been the most commonly used substances as ‘Mapping the Addiction in Egypt’ mentioned. Also, it concluded that the most commonly affected are males, aged 26-30 years old, living in urban areas, being skilled worker, not being religiously committed, and the absence of the father figure. Although higher prevalence in males, yet females constitute a substantial category especially in large cities that are in need for a specialized therapeutic service.
Addiction includes clusters of cognitive, behavioral, bio-physiological signs and symptoms, yet the main characterizing is the repeated impulsive and compulsive behavior seeking getting or administering the drug.
The drug of abuse is what the patient perceives as an incentive. The American association of psychiatrist included gambling to the Substance-related and Addictive disorders in DSM-5 as being the first behavioral addiction disorder to be enlisted.
The substance of abuse is not the core of diagnosing addiction. Daily abusing (even if no craving) is not an accurate criterion for the diagnosis. Actually, practicing periods of abstinence is a part of the denial phenomenon that the patient uses to deceive himself. Irregular abuse is very much like the incubation period of a virus before the full blown picture of the disease, it is him walking from irregular or occasional abuse to the complete dependence on the drug.
That has formed a great portion of the rationale for the APA to include the abuse (harmful use) to the dependence under the name Substance-related and Addictive disorders.
Etiology
Etiology of addiction involve the nature of human genetic makeup with vulnerability (up to 40 to 60%), along with surrounding environment to the patient which having the upper hand in timing appearance of the disease and shaping the patient’s own symptoms and complains as environment determine type of drug, the general social and peer group attitude facilitate places and companies, while personal hobbies and ways to feeling pleasure is the cornerstone to personal resilience to stress.
Addiction is Chronic Organic Disease.
- Addiction is a chronic medical disorder, just the same as other chronic medical disorders e.g. diabetes mellitus, chronic hypertension and other medical disorders, having signs, symptoms, pathophysiological changes, etiology, preventive measures and medical intervening therapeutic treatments.
- Addiction as any organic disease or disorder is diagnosed by subjective symptoms (only patient can feel and describe) and objective signs can be observed or measured by trained doctor (sometimes patient don’t recognize as part of his disease).
- These signs and symptoms are accompanied by alterations in normal structure and functions of the involved part of the body. In addiction alterations in nerve cell structure, neural connections, and amount of neurotransmitters affect the higher brain functions including thinking, memory, judgment, emotions, and all aspects of human behavior.
- Addiction is a chronic long lasting disease, cannot be cured but can be managed and by so avoid complications can be managed by therapeutic intervention alongside with changing habits and life style getting the patient to live a healthy fulfilling life. This declares that once a person becomes an addiction patient, it is not possible for him to reduce, limit or control his use of psychoactive substances. Actually claiming so is a part of the defense mechanism that called denial with characterizes the addict before submitting to therapy.
Stages
A full blown picture of an addict in never out of the blue, it is a process that takes time with early signs usually unnoticed resembling incubation period of a virus in infectious diseases which is rarely symptomatic until the condition deteriorates with overwhelming symptoms and complications that turn the treatment into a challenge. It can be even staged into:
1- Experimental and recreational use.
2- Occasional and circumstantial use
usually for specific reason or certain situation
3- Intensified or regular use
usually to deal with ongoing problems or to maintain level of performance
4- Compulsive or addictive use
the most severe and the most dangerous stage, where the drug take the priority in patient’s life over his health, family, society and his job. His life is all about the drug and how to get it and use it despite any consequences that may happen.
Relapse
The most important single issue in Relapse is ‘It Never Happens Suddenly’, it is a process that takes time in prodromal hiding in patient’s thinking and behavior until it erupts on the surface. This why ‘Relapse is Preventable’ if patient, family, supporter and therapy team pay attention to the alarming signals.
Tailoring a specialized treatment plan for each patient including all biological, physiological, psychological, social, environmental, occupational and alarming signals to relapse is the essence of a successful medical care to any chronic disease, especially in addiction.
Final thoughts
Last but not least, the prototype for the addicted patient as poor and miserable person that can never achieve any a respectable or regular job is obsolete. Any person around us can be vulnerable to addiction we can’t predict, on the edge of harmful use we can’t see, or even a regular user that maintain performance and social obligations. The deepest most common in patient of addiction is that they suffer feeling of inferiority and embrace his helplessness to overwhelming feeling of loneliness and isolation. The behavior of the patient is out of his desperate feel of pain and compulsive act, NOT out of neglect. The addiction is literally and actually hijacked his brain. If the patient is not recovered from inside (even with keeping abstinent), relapsing to drug use is an inevitable.
Tailoring a specialized treatment plan for each patient including all biological, physiological, psychological, social, environmental, occupational and alarming signals to relapse is the essence of a successful medical care to any chronic disease, especially in addiction.
Screening, Diagnosis and where to start?
Screening for addiction is a complementary process, including psychiatric assessment for the presence and severity of addiction through psychiatric interviewing and full history taking, and questionnaires answered by the patient himself to screen for addiction disorder and its severity.
It also includes laboratory investigations, as drug test screening in urine, which screens for the presence and the type of the drug abused, other laboratory investigations include investigations for collateral side effects of substance abuse as HIV, HCV and HBV which are transmitted unsafe practice.
In case of addiction, pleas head for the nearest facility affiliated with Mental Health Secretariat to benefit from different services provided for addiction therapy.