Addiction, substance abuse and dependence
What is substance abuse?
Substance abuse refers to ‘the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.’ Many will experience substance abuse at some point, like with binge drinking, but it can become very problematic when it occurs on a regular basis. For example, it can lead to drug dependence which is the body’s physical need, or addiction, to a specific agent. Addiction severely places a burden on society due to its repercussions on healthcare and crime rates.
Addiction is a complex disease, but it is treatable. However, we cannot use the ‘one size fits all approach,’ no single treatment is universally successful in treating the disease. Instead treatment must be tailored to meet the needs of each individual, as no case is the same. When someone is addicted, treatment needs to be immediate and should be easily accessible. This is why there are rehabilitation centres. For treatment to be effective, we cannot just look at what drug they are using, we need to look at all aspects of their lives. As there are multiple aspects to consider, it is important that the treatment is carried out for a suitable period of time. Most commonly, counselling and behavioural therapies are used, alongside medication. Medications are highly important for detoxification, but are more effective when combined with behavioural therapies. Detoxification is only the first stage. Treatment plans must be monitored and adjusted when necessary, during treatment the patient’s needs may change. If required, mental disorders should be addressed and supported. Patients should be monitored to see their current drug use. Patients should be offered tests for HIV, hepatitis B and C, tuberculosis and other infectious diseases. Education for patients is vital as we want to avoid a relapse and we want the patients to feel safe and optimistic about a new future.
Pharmacological approaches to treating drug dependence
For opioid addiction, we can alleviate withdrawal symptoms using methadone, which is a long term substitution, as well as buprenorphine, or legal heroin. Patients that were given methadone had 33% fewer opioid-positive drug tests than those not, and were 4.44 times more likely to stay in treatment compared to controls. We can use drugs to block the effects of opioids, such as naltrexone. For alcohol addiction, aversive therapies can be used such as disulfiram to induce an unpleasant response to ethanol. Disulfiram causes an accumulation of acetaldehyde which can cause a variety of symptoms, such as: orthostatic syncope, hypotension, hot flushed face, nausea, sweating, vomiting, pulsatile headache, confusion, and blurred vision. So as you can see, very unpleasant! Benzodiazepines can be used to treat anxiety as a result of alcohol abstinence.
With cocaine addiction, reward pathways become less sensitive to natural reinforcers, as addicts get used to an increased dopamine release. Stress circuits become quite sensitive, leading to increased feelings of displeasure and bad moods when not taking the drug. Addiction can lead to poor decision making, where they choose to seek the drug instead of normal pleasures such as relationships or food.