ADDICTION - Watsons Health

ADDICTION

An addiction is a chronic dysfunction of the brain system that involves reward, motivation, and memory. It’s about the way your body craves a substance or behavior, especially if it causes a compulsive or obsessive pursuit of “reward” and lack of concern over consequences.

There are two main types of addiction.

1. Behavioral addiction refers to several mental health conditions in which a person engages in a particular behavior repeatedly, even if the behavior causes them harm. It may seem as if people with behavioral addictions simply cannot resist engaging in the behavior. Common behavioral addictions include gambling addiction, shopping addiction, hoarding, and kleptomania (impulsive stealing).

 All behavioral addictions have common traits. These include:

  • Preoccupation with the behavior.
  • Diminished ability to control the behavior.
  • Building up a tolerance to the behavior so the behavior is needed more often or in greater intensity to get the desired gratification.
  • Experiencing withdrawal if the behavior is avoided or resisted.
  • Experiencing adverse psychological consequences, such as depression or anxiety symptoms, when the behavior is avoided or resisted.

2. Drug addiction, also called substance use disorder, is a dependence on a legal or illegal drug or medication, such as cigarettes/tobacco, alcohol, illegal drugs and prescription drugs. Alcohol and nicotine (in cigarettes) are legal substances, but are also considered drugs. When you’re addicted, you’re not able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can’t do it on their own. Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment, and the law.

Drug addiction symptoms or behaviors include, among others:

  • Feeling that you have to use the drug regularly — this can be daily or even several times a day
  • Having intense urges for the drug
  • Over time, needing more of the drug to get the same effect
  • Making certain that you maintain a supply of the drug
  • Spending money on the drug, even though you can’t afford it
  • Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
  • Doing things to get the drug that you normally wouldn’t do, such as stealing
  • Driving or doing other risky activities when you’re under the influence of the drug
  • Focusing more and more time and energy on getting and using the drug
  • Failing in your attempts to stop using the drug
  • Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing drug abuse in family members

Sometimes it’s difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager or other family member is using drugs include:

  • Problems at school or work – frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
  • Physical health issues – lack of energy and motivation
  • Neglected appearance – lack of interest in clothing, grooming or looks
  • Changes in behavior – exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
  • Spending money – sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they’re being sold to support drug use

DIAGNOSIS

To assess whether you might have a behavioral addiction, your treatment provider will explore issues such as:

  • Whether the behavior has caused you to lose something of value or compromises your health, such as when a sex addiction causes you to lose a relationship or contract an STD.
  • Harming loved ones because of the addiction, such as when a gambling addiction drives your family into debt.
  • Doing or saying harmful things because of the addiction, such as picking a fight with your wife so you have an excuse to go gamble.
  • Whether you want to continue engaging in the behavior or are only doing it because you feel like you can’t stop.

Diagnosing drug addiction (also called substance use disorder) requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they’re not a diagnostic test for addiction. These tests may be used for monitoring treatment and recovery.

For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.

DSM-5 criteria for substance use disorder include a behavior pattern of drug use that causes significant problems and distress, regardless of what drug is used.

You may have a substance use disorder if at least two of these issues occur within a 12-month period:

  • You often take larger amounts of the drug over a longer period of time than you intended
  • You want to cut down or quit, but haven’t been successful
  • You spend a good deal of time getting the drug, using the drug or recovering from the effects of the drug
  • You have intense urges for the drug that block out any other thoughts
  • You aren’t meeting obligations and responsibilities because of your substance use
  • You keep using the drug, even though you know it’s causing problems in your life
  • You give up or cut back important social, occupational or recreational activities because of your substance use
  • You use the substance in situations that may be unsafe, such as when driving or operating machinery
  • You use the substance even though you know it’s causing you physical or psychological harm
  • You develop tolerance, which means that the drug has less and less effect on you and you need more of the drug to get the same effect
  • You have physical or psychological withdrawal symptoms when you stop taking the drug, or you take the drug (or a similar drug) to avoid withdrawal symptoms

 

TREATMENT

Behavioral addiction

Behavioral addiction treatment and rehabilitation presents a challenge in many cases because, unlike treatment for drugs or alcohol, abstinence can be impossible. For example, a person who is addicted to overeating cannot cut food out of their life. For this reason, some types of behavioral addiction treatment programs focus primarily on rehabilitation and recovery rather than detoxification or abstinence.

Behavioral addiction residential treatment programs address the underlying psychological issues that led you to develop the process addiction. These programs often follow the same structure as substance abuse treatment programs, including 12-step programs, motivational enhancement, and cognitive behavioral therapies that have proven successful at treating behavioral addictions.1 These treatment programs focus on helping you develop healthier ways of dealing with life and daily stressors.

In addition to residential programs, outpatient behavioral addiction treatment is another option for those struggling with these conditions. Outpatient therapy involves visiting a treatment facility or medical professional on a daily or weekly basis during the beginning stages of treatment. As you begin to feel more control over your behavioral addiction, treatment may become less frequent. Outpatient treatment usually involves a maintenance period in which you visit twice monthly or once per month to receive supportive ongoing care.

During individual or one-on-one counseling, you meet privately with a behavioral health counselor who is trained in behavioral addiction therapy. Sessions focus on identifying the emotional issues and underlying causes of the behavioral addiction, which can include trauma therapy, if applicable. One-on-one counseling offers you a chance to privately voice concerns that may otherwise be uncomfortable to talk about with others in a group setting.

In many behavioral addiction treatment programs, therapy is based on the cognitive behavioral therapy (CBT) model. CBT focuses on eliminating unhealthy or negative behaviors by replacing them with positive, healthier options. This form of treatment teaches new behavioral patterns as well, but the focus is usually on the motivations behind the behavior rather than the physical actions themselves. One of the main goals of CBT is to change or modify the thought processes that led to the behavioral addiction.

Another treatment option is group therapy in which you attend a session that at least two other patients and one behavioral health counselor are present. Group therapy allows you to share common experiences and understand that you are not alone in the addiction and recovery process. During group therapy sessions, the therapist may lead your group in a focused topic or leave the topic of discussion up to the group members. Common topics in group sessions include denial, legal problems, relationship problems, work problems, health issues, financial struggles, identity crises, and stress.

Similar to group therapy, 12-step recovery programs provide a structured framework for working through behavioral addiction problems while having the support of others who have gone through similar experiences. Some 12-step programs have religious undertones and require participants to admit that they do not have control over their addictions. Non-12-step programs follow a similar structured framework, but exclude any religious affiliation and emphasize taking personal accountability for one’s addiction. Non-12-step, 12-step, and group therapy programs are excellent options for long-term recovery because they offer built-in support from people who understand how hard overcoming addiction can be.

The type of behavioral addiction treatment program you need will depend on your specific addiction. For example, a gambling addiction requires abstinence as part of the treatment program, while overeating requires relearning behaviors so that you can modify negative patterns and engage in healthy eating. The staff at the facility you choose will assess your situation and your addiction, and then determine the most effective behavioral addiction treatment for your unique circumstances.

Some treatment facilities specialize in one particular kind of addiction (such as gambling addiction), while others offer various programs or an all-inclusive program to treat people with a variety of different addiction struggles. You can also choose from inpatient and outpatient programs, or a sequential combination of both.

Ideally, people suffering from behavioral addiction will receive multiple forms of treatment. For example, in an inpatient setting, you participate in one-on-one therapy sessions, group therapy, skills building activities, and coping skills development. This diverse therapeutic approach offers the greatest chance of success in beating a behavioral addiction.

Drug addiction

The treatment options explained below can help you overcome an addiction and stay drug-free.

Chemical dependence treatment programs

Treatment programs usually offer:

  • Individual, group or family therapy sessions
  • A focus on understanding the nature of addiction and preventing relapse
  • Levels of care and settings that vary depending on your needs, such as outpatient, residential and inpatient programs

Detoxification

The goal of detoxification, also called “detox” or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center.

Withdrawal from different categories of drugs — such as depressants, stimulants or opioids — produces different side effects and requires different approaches. Detoxification may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, buprenorphine, or a combination of buprenorphine and naloxone.

Counseling

As part of a drug treatment program, counseling — also called talk therapy or psychotherapy — can be done by a psychologist, psychiatrist, or licensed alcohol and drug counselor with an individual, family or group. The therapist or counselor can:

  • Help you develop ways to cope with your drug cravings
  • Suggest strategies to avoid drugs and prevent relapse
  • Offer suggestions on how to deal with a relapse if it occurs
  • Talk about issues regarding your job, legal problems, and relationships with family and friends
  • Include family members to help them develop better communication skills and be supportive

Self-help groups

Many, though not all, self-help support groups use the 12-step model first developed by Alcoholics Anonymous. Self-help groups, such as Narcotics Anonymous, help people who are addicted to drugs.

The self-help support group message is that addiction is a chronic disorder with a danger of relapse. Self-help support groups can decrease the sense of shame and isolation that can lead to relapse.

Your therapist or counselor can help you locate a self-help group. You may also find support groups in your community or on the Internet.

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