ABC of Addictions

Addiction is a plague that affects individuals and society in an adverse manner. It is a very costly illness that has worldwide prevalence. A study conducted in Australia found that $437m was lost in 2001 due to alcohol related absenteeism (Pidd, Berry & Roche, 2006). In the United Kingdom, a study conducted in 2001 found that alcohol related work absenteeism had an economic cost of an average £1.5bn per year (Institute of Alcohol Studies, 2009).

There are many forms of addiction. The most commonly recognised addictions include alcoholism, cigarette smoking, marijuana smoking and illicit drug use. Research has shown that other forms of addictions have become problematic including gambling, workaholism, exercise, viewing pornography and other sexual behaviours. These are commonly referred to as behavioural addictions (Martin, Weinberg & Bealer, 2007; DiClemente, 2006).

Prevalence
 
The National Drug Strategy Household Survey (NDSHS) conducted in 2007 recruited 25,000 Australians aged 14 years and older as participants to investigate drug use trends in Australia. The study found that 38.1% of Australians aged 14 years and older had used illicit drugs at some point in their lives and 13.4% of Australians reported they had used drugs in the last12 months. The most commonly used drugs were Marijuana (9.1%) and ecstasy (3.5%). The study also reported an increase in cocaine use between 2004 and 2007. 8.1% reported daily use of alcohol (Australian Institute of Health and Welfare, 2008).
 
The National Survey on Drug Use and Health (NSDUH) conducted in 2007, surveyed over 67, 000 Americans who were 12 years and older. This study found that 8% of the population were illicit drug users with marijuana being the most commonly used drug. 6.9% of the population reported to be heavy drinkers while 23% of the population reported participating in binge drinking (Substance Abuse and Mental Health Services Administration [SAMHSA], 2008).
 
The 2007 United Kingdom Focal Point report, covering 16 to 59 year olds from England and Wales found that, 35.4% used drugs in their lifetime (ever); 10.2% used drugs in the last year (recent use); and 6 % used drugs in the last month (current use). The latest findings from the 2007-2008 British Crime Survey found that 9.3% of 16 to 59 year olds used drugs in the last year and 5.3 % used drugs in the last month.
 
Like Australia and the USA, Cannabis/Marijuana was the most commonly used drug across all recall periods in the UK followed by cocaine for recent and current use (REITOX National Focal Point, 2008).
 
Definition of Addiction
 
Addiction refers to persistent, repetitive and often irresistible self destructive activity that, at its beginning, is perceived as rewarding. It involves addictive behaviour that once learnt it becomes difficult to get rid of despite its negative consequences on the individual and their environment. The term addiction is often used to refer to physiological dependence on the substance (DiClemente, 2003; Martin, Weinberg & Bealer, 2007).
 
All addictions are said to be disorders that result in uncontrolled repetitive behaviours and in most cases addicts may not recognize the harmful effects of their behaviours until the behaviour progressively disrupts their lives (Martin, Weinberg & Bealer, 2007). Addiction is viewed as a chronically relapsing disorder characterised by compulsion to take the substance, loss of control and emergence of negative emotional stages of dysphoria (Koob & Simon, 2009).
 
Drug use along with other potentially addictive activities such as gambling or sex causes the brain to release dopamine, a chemical involved in experiencing pleasure (Phillips & Crabble, 2005). This surge in dopamine can be so powerful that it compels users to keep taking the drug. With prolonged use, however, drugs can alter the brain so that experiencing pleasure without the drug is nearly impossible.
 
At this point, drug use does not raise dopamine levels or produce a “high”, instead, the user keeps taking the drug to manage painful withdrawal symptoms such as fever, cramps, violent nausea, and depression (Robbins & Everitt, 1999). Based on research of how drugs affect the brain, scientists have theorised that people who are deficient in dopamine may be more likely than others to become addicted (Robbins & Everitt, 1999). The two contrasting perspectives on addiction, biological versus behavioural influences, is an ongoing debate over the appropriate way to treat drug addictions and alcoholism.
 
Psychological Factors
 
Almost all substance use affects the “reward mechanism” in the brain. The main chemical messenger involved in the brain’s reward mechanism is dopamine. Each time the person uses a substance they will tend to feel ‘good’, which makes them want to use the substance again. Over time, changes in the brain occur (e.g. less dopamine is produced), which lessens the pleasurable effects of the substance and therefore larger amounts are needed to get the same affect.
 
The early stages of addiction are actually associated with both positive and negative reinforcements. Reinforcement refers to a process in which the substance use behaviour is strengthened due to previous consequences experienced by the user as a result of the substance use behaviour.
 
Positive reinforcement refers to a situation where there is a rewarding experience obtained from the using behaviour (for example, feeling calm and relaxed after smoking cannabis or feeling sociable after drinking alcohol). The rewarding experience increases the probability of the using behaviour occurring again, in order for the user to have the rewarding experience again.

For example: if a person feels relaxed after drinking alcohol, they are more likely to use alcohol to obtain that same relaxed feeling again.

Negative reinforcement refers to a situation where there is a negative experience avoided as a result of the using behaviour (for example, a person may be able to avoid the feelings of anxiety by smoking cannabis or avoid social anxiety by drinking alcohol).
 
The successful avoidance of the negative experience through the using behaviour increases the likelihood of the behaviour occurring again in order to avoid the same negative experience again (Koob & Simon, 2009; Gilpin & Koob, 2008).
 
It is common for individuals to get caught up in the addictive use and abuse of substances in order to eliminate negative emotions such as stress, depression, anxiety and irritability. After repeated use, an individual will come to realise that they don’t experience these emotions when they use the desired substance.
 
This operates as a motivator for continued use, not only to avoid such negative reinforcers but also to manage withdrawal symptoms that they may have experienced following cessation of the substance at various times (McMullin, 2000; Gilpin & Koob, 2008).
 
In this sense addicted individuals do not only use substances to avoid negative emotions and chemically induce more positive side effects, the motivation for continued use is also fuelled by the physiological and psychological need to manage withdrawal symptoms that develop with their dependency (Gilpin & Koob, 2008; McMullin, 2000).
 
Biological Factors
 
There is compelling research to suggest that the development of addiction, particularly with alcohol and drugs, is influenced by genetic factors. For example, numerous twin studies have shown that having more substance abusers in the immediate family increases the probability that others in the immediate family will become a substance abuser even if raised in a different environment (Phillips & Crabbe, 2005). Specifically, twin and adoption studies have convincingly demonstrated that genes contribute to the development of alcohol dependence and other illicit drugs, with heritability estimates ranging from 50 to 60 percent for both men and women.
 
Data from the Virginia Twin Registry found that a common genetic factor seemed to contribute to the total variance in alcohol dependence, illicit drug abuse and dependence, conduct disorder, and adult antisocial behaviour (Dick & Agrawal, 2008). In their study, Nielsen, Ji, Yuferov, Ho, Chen, Leveran, Ott and Kreek (2008) claimed to have identified a specific genotype and other genes that are associated with heroin addiction. Although there is increasing evidence of a relationship between genetic makeup and addiction, further research is needed to ascertain the specific genes involved in substance dependency.
 
Social Factors
 
The role of society, peers, and family systems has all been found to be associated with the adoption and maintenance of addiction. For example, conformity to some social norms have been said to contribute to the onset of addiction (DiClemente, 2006). It has also been suggested by some authors that social policies attempting to control the use of drugs, by making them illegal, have perpetuated addiction by increasing a preoccupation with the drugs in some individuals (Martin, Weinberg & Bealer, 2007; DiClemente, 2006).
 
Changing social trends whereby the use of alcohol and illicit drugs is more readily acceptable and in some cases associated with a certain status, is also viewed as a contributing factor. (E.g. cocaine use is associated with the rich and famous). Glamorising of substance use, particularly drugs by celebrities, has also been implicated in the development of addiction among young adults.
 
Family influences have also been implicated in the development of addictive behaviours (DiClemete, 2006). Advocates of family systems ideas hold problematic parental modelling of adult roles as a key contributing factor. Excessive substance abuse on the part of the parent is seen to influence undesirable behaviour in children that can result in them experimenting with and continuing to use substances, making them more susceptible to addiction (DiClemete, 2006).
 
Social relationship influences commonly referred to as ‘peer pressure’ has also been seen to contribute to an individual’s vulnerability to developing substance addiction. Attitudes of favoured friends regarding substance use can prompt substance use which can ultimately lead to addiction (Beck, Arria, Caldeira, Vincent, O’Grady & Wish, 2008; Martin, Weinberg & Bealer, 2007). It is clear that social and environmental factors also make a significant contribution to both acquisition and maintenance of addictions.
 
Source: www.mentalhealthacademy.com.au