Chapter 7
An In-Depth Analysis of Addiction.
In the second chapter we saw several main reasons in general as to why people may develop addictions. Here we shall examine this extremely important subject in greater depth. If you have not already covered the second chapter, it would be good at this point to go through it before continuing to read this chapter. People who do not have good and adaptive systems of combating pain and stress (here we mean more the emotional or psychological and not so much the physical) adopt addictions whether it is drugs or alcohol, gambling and so on. Very often, behind addictions there are hidden (or not) problems of depression and anxiety. People can become addicted to many various substances. These include; alcohol (actually said to be the most powerful addiction), amphetamine, caffeine, cannabis (marijuana), hallucinogens, inhalants, nicotine, opioids, Phenyclidine (PCP), sedatives, hypnotics (for example, sleeping pills), or anxiolytics (which reduce stress and anxiety). Some of these have similar features: alcohol shares features with sedatives, hypnotics, and anxiolytics. Cocaine shares features with amphetamines and amphetamine-like drugs. In many cases there can be an addiction of more than one substance together in combination which is known in psychology as Poly-substance Dependence.
Many prescribed medications as well as medications given without prescription can cause addictions. Symptoms generally occur at high doses of the medication and usually disappear when the dosage is lowered or the medication is stopped. Impairments in cognition or mood are the most common symptoms associated with the intoxication of drugs, although anxiety, hallucinations, delusions, or seizures can also result. Symptoms usually disappear when the individual is no longer taking the substance, but resolution of the symptoms can take weeks or months and may require treatment. Drug addictions can also lead to Psychotic disorder, Mood disorder, Anxiety disorder, sexual dysfunction, and insomnia. The essential feature of drug addiction is a group of cognitive (mental), behavioural, and physiological symptoms indicating that the user continues the use of the drug despite significant drug-related problems. A pattern of repeated use can result in tolerance (needing more and higher doses of a drug because the body has become used to the doses), withdrawal, and compulsive drug-taking behaviour. The symptoms of addiction are similar across various categories of drugs. Craving (a strong drive or urge to use the drug), is experienced by most (if not all) drug users. Tolerance, is the need for greatly increased amounts of the drug to achieve intoxication (or the desired effect) or a diminished effect with continued use of the same amount of the drug. The degree to which tolerance develops varies greatly with the type of drug. Furthermore, for a specific drug, varied degrees of tolerance may develop due to its different central nervous system effects. Individuals with heavy use of opioids and stimulants can develop substantial (for example 10-fold) levels of tolerance, often to a dosage that would be lethal to a non-user. To put this in to a simpler perspective, many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or PCP are generally not aware of having developed tolerance. Tolerance levels are also dependent on each individual's body organism.
Withdrawal is a maladaptive behavioural change, with simultaneous physiological and cognitive effects, that occurs when blood or tissue concentrations of a substance decline in an individual who had been using the substance heavily for a prolonged period of time. After developing unpleasant withdrawal symptoms, the person is likely to take the substance to relieve or avoid those symptoms, usually taking the substance throughout the day beginning soon after they wake up. Withdrawal symptoms (which are generally the opposite of the acute effects of the substance) vary according to what drug is used.
There is a pattern of compulsive drug use that is characteristic of addiction. The individual may take the drug in larger amounts or over a longer period than was originally intended (for example, continuing to use marijuana until dependent on it despite setting a limit of just one smoke). The individual may express a persistent desire to cut down or regulate the use of the drug. Often, an addict has made many unsuccessful efforts to decrease or discontinue use. In many instances of drug addictions, virtually all of the person's daily activities revolve around the drug: obtaining it, using it and recovering from its effects. Important family, social, occupational or recreational activities may be given up or reduced because of drug-use. The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with friends that also use the substances. Despite recognizing that the drug is contributing to a psychological or physical problem (for example, severe depressive symptoms or damage to organs), the person continues to use the drug. The key issue when dealing with drug users is not the existence of the problem per say, but rather the individual's failure to abstain from using the substance despite having evidence of the difficulty and the problems it is causing. Thus, the key question when dealing with drug users when they enquire about or seek therapy is not why do you try drugs? It is why do you continue using them?
