Since addiction refers to more than just substance abuse and affects people across all age groups it is important to understand its causes, how to diagnose it and how it can be treated successfully.
There is no simple explanation for what can give rise to addiction as there can often be more than one cause. Addiction has been linked to genetic and other biological factors, but many social, psychological and environmental factors can contribute. Even though addiction has been linked to some characteristics such as an inability to tolerate stressful situations and other anxious disorders, there is still no one type of personality that can be associated with addiction.
When most people hear the word addiction they think of leisure drug abuse, but nicotine, inhalants, alcohol, opioids and many other substances can be addictive. Gambling is a typical example of behavior addiction.
Addictive substances and behaviors share the same neurobiological feature. Researchers have shown how addiction activates brain pathways of reward and reinforcement, with the neurotransmitter dopamine involved in many of these.
There is an increased likelihood that addiction will be accompanied by mental health conditions such as anxiety, depression and others. Addiction and compulsivity both engage many of the same brain mechanisms, while they also respond to most of the same approaches when treated.
The cravings that results from any addiction cause disruptions in all spheres of everyday activities and end up harming the relationships and other obligations of the individual, who continues the activity, despite the psychological or physical impairment of the addiction. As the body adapts to the presence of the substance, so does the tolerance to it increase.
Addicts are often not aware that their behavior is becoming problematic, not only to those around them but even to themselves, since their brain’s executive functions become affected. Increasingly, the pursuit of getting the pleasurable effects of the addiction will dominate the thoughts and activities of the individual.
Risk Factors Leading to Addiction:
Many elements combine to create a risk factor for addiction – with one of the most important been the exposure to the addictive agent. According to research we cannot predict exactly which individuals will develop a compulsive substance use or behaviors.
Risk factors include:
- Genes, according to scientists make up for half the risk for developing addiction. This is caused by a variation in the gene that determines the makeup of brain receptors for the neurotransmitter dopamine. The body’s hormonal response to stress is another contributor.
- Physiological factors like liver enzyme variations, which usually influences alcoholism.
- Gender does play a role too. Males are more likely to develop substance abuse to females.
- Personality plays a role, as those with addiction seem to seek impulsivity and sensation. Impulsivity though, seems to be related to the risk of relapse.
- Trauma and abuse add to the burden of stress, and early exposure to both seems to contribute to the development of substance use.
- Mental health conditions such as depression, anxiety, attention deficit disorder and post traumatic stress disorder (PTSD) all increase the risk of addiction.
- Difficulties managing strong emotions are also linked to substance abuse.
- Family relationships can protect or sometimes can contribute to addiction risks. If a parent or sibling with an addictive disorder is present then the chances increase. Parental supervision and support reduces the risk while troubled parent-children relations and divorce add to it. Sexual, physical and emotional abuses contribute to a higher risk factor. Marriage and raising children has been shown to also increase the risk.
- Accessibility to substances such as alcohol, drugs and gambling within the community, home or school environment increases the risk of repeated use.
- Peer pressure increases the risk considerably. Humans are social animals and seek approval from those around them and the need to conform often leads to the adoption of like behavior. This is prevalent in the adolescent years and positive social relationships have proven to protect against substance abuse.
- Education and employment provide financial and psychological rewards, which in turn offer stability. These rewards protect against the need to seek addiction.
Chronic pain, sleep disruptions and mood swings are some of the symptoms plaguing the average adult in the US today. When physicians are faced with patients who are complaining about any one of these symptoms and they realize that they need help to cope with their work and family commitments they often prescribe one of the many medications available to help alleviate the symptoms.
The prescribing of opioids has continued over many decades now, even though there is limited evidence that they are even effective for chronic pain. They have also proven to be highly addictive with patients needing higher doses over time to get the same relief. Opioids have serious side effects, which include depression, constipation, chances of overdosing and death. When patients try to stop taking them they suffer severe withdrawal symptoms, which include irritability.
The problem with opioids is that they mask pain enabling patients to go about their daily lives. Unfortunately, they do not address the root cause of the pain.
The Opioid Crisis
The statistics from a 2018 US Department of Health and Human Services Report are alarming, 116 deaths each day caused by opioid overdosing. These figures refer to the opioid related death rates for 2016 and these 42,249 deaths were the largest number ever recorded. A third of these deaths – 15,469 – were due to heroin use. The opiod epidemic is proving costly in lives and money- $504 billion in 2016 alone.
In 2017, the Centers for Disease Control and Prevention issued a pain management guideline that discouraged the prescription of opioids as the choice of treatment for chronic pain. This and other attempts to reduce opioid use as a treatment for chronic paint are not working. Chronic pain sufferers desperately seek alternative opioids like heroin, or see multiple doctors in order to get their hands on more prescribed medication to cover their needs.
The Centers for Disease Control and Prevention have identified three distinctive waves in opioid overdose deaths.
- Increased opioid prescribing began in the 1990s and the first noticeable increase of deaths began in 1999. The deaths were attributed to natural, semi-synthetic opioids and methadone.
- A second wave of increased overdose deaths took place in 2010, with increased heroin overdose deaths.
- Significant increases in overdose deaths involving synthetic opiods constituted the third wave in 2013. These synthetic opiods are illicitly manufactured fantanyl (IMF). The heroin market continuously changes and provides users with IMF in various combinations of heroin with counterfeit pills and cocaine.
As we read the statistics above, we start to realize that the opiod crisis does not only relate to prescribed medication, but is also associated with illicitly supplied, potentially harmful synthetic opiods, manufactured in inregulated conditions. It is obvious that other methods for reducing pain need to be explored if this opioid crisis is to be resolved.
What Constitutes an Opioid Use Disorder?
Opioid drugs include prescription pain-relieving medications such as oxycodone, codeine, morphine and fentanyl. They also include the illegal and also highly addictive drug heroin and all of its available by products.
According to the American Society of Addiction Medicine, in 2015, 2 million people in the US were misusing prescribed pain killers and 591,000 had a substance misuse disorder involving heroin.
The leading cause of deaths in the US for the under 50 years of age population group is from opioid related overdoses. The initial source of the addiction appears to be from prescribed opioids.
As with all addictions there are often innocent victims. They are victims because of a shortage of money or care due to the addiction, or because of their exposure to the harmful effects of substance abuse.
In cases of opioid addiction there has been a stark increase in infants exposed to opioids from before their birth. The 2017 Substance Abuse and Mental Health Services Administration report noted, that between 2000 and 2009 there was an increase from 1.19 per 1000 to 5.63 of hospitalized women using opioids during their pregnancy.
This has resulted in a dramatic increase of NAS (neonatal abstinence syndrome) among newborns. The 2009 figure shows 3.39 hospital births per 1000, and taking the increased opioid addiction statistics into account it must be far higher by now.
Babies born to opioid users will typically start showing withdrawal symptoms within a period of between ten days of their birth. The symptoms of NAS include tremors, seizures, excessive crying, vomiting and sweating. These can last for up to six months and can come with many potentially dangerous complications.
Studies have shown that children born to opioid dependent mothers have an increased possibility to develop Attention Deficit Hyperactivity Disorder (ADHD) and aggressive behaviors. They are also likely to be exposed to a difficult social environment that may have a negative impact on future social behavior.
Since the social environment plays a major role in shaping future behaviors there is concern that crime is a learned behavior. For more than forty years research literature has explored and consistently supported the social learning theory.
A much debated issue concerns the rights of a mother who uses opioids to keep her child after birth, as she has knowingly been abusing her unborn child. There are many difficulties arising out of an issue like this. Firstly, most states in the US do not criminalize a mother’s drug use during pregnancy and even those states that can prosecute don’t require health care workers to report a mother’s drug abuse. Most states do not require health workers to conduct a drug test during pregnancy either.
The opioid crisis cannot be ignored in general, but the rising number of incidences involving NAS is creating innocent victims, born to suffer the physical and social consequences from their mother’s substance abuse.
Since more than half of all people dealing with chronic pain consult their family doctor first, it is always a good idea to start off there. It is important to diagnose the source of the pain so that the correct treatment can be applied. If all else fails and pain continues to remain uncontrolled there are alternatives:
- Non- drug approaches include guided imagery, meditation and other relaxation which have shown positive results. Changing the thinking around pain has proved to be effective with the use of techniques such as biofeedback, cognitive behavioral therapy and yoga.
- Medication management professionals can assist in the reduction or stopping of opioid use. The patient is encouraged to keep a record of pain, treatment and non-medical approaches used to assist in this endeavor.
- Effective and accessible non-drug options for pain management are also available and CBD oil has shown promising results.
Addiction can be recognized in an individual when their behavior leads to harm or distress and at least two of the following features will be present:
- Larger amounts of the substance are used than required and over a longer period of time than was prescribed.
- Even though there is a desire to cut down the efforts are usually unsuccessful.
- The use of the substance or attempts to stop consumes a significant amount of time, affecting work, school or home life.
- There are continuous cravings to use the substance.
- Despite the problems caused by the addiction, no efforts are made to stop.
- Refusal to or decreased participation in important work, social or recreational activities.
- Use occurs even in potentially dangerous situations and even when physical and psychological problems occur.
- Greater tolerance to the substance diminishes its effect and increased amounts are required to achieve the desired effect.
- Withdrawal is manifested with physiological symptoms and the need of another substance to prevent these symptoms.
Complete remission from substance abuse is possible. However, recovery is often a long process and may involve various treatment methods. Relapses are regarded as part of the treatment process which should also include prevention regimens and management of recurrent use.
There are also programs available for those that feel that they are not ready to give up, but need to manage their substance abuse.
Success is not instant and all signs of improvement are considered to be positive. The best treatments focus on all aspects, in order to assist the individual to establish a productive role in society, including family life, work skills and mental well being.
The best treatment programs have a combination of components and regularly monitor and evaluate the progress of the individual. Each phase during the treatment could involve different components
- The first and most important stage of treatment may involve detoxification under medical supervision.
- Medications might be prescribed to reduce or counter the effects of stopping the substance.
- Any anxiety or stress caused by the withdrawal or by the treatment may be treated with medication.
- Motivational counseling assists in resolving any ambivalence about the treatment and to assist with incentives that will assist in continuing with the program.
- Cognitive Behavior Therapy (CBT) helps the individual recognize what could trigger a relapse and how to cope.
- Group therapy and peer support offer the sharing of similar experiences and how to prevent a recurrence.
- Family Therapy supports the establishment of new supportive family roles, correcting previous damage done by the addiction.
- Life skills training will help the individual find a purpose and employability skills.
Besides the various elements within a treatment, there are also a variety of settings where an individual can choose to undergo the treatment. Commitment to treatment has proven to be more important than the treatment program, or place where it is carried out.
Researchers have identified certain features that make some programs more effective than others, and it doesn’t seem to matter if they take place in a doctor’s office, outpatient clinic or long- term treatment facility.
- Comprehensive medical and psychiatric screening of patients
- Individual needs are addressed and treatment of co-occurring conditions must be included. In an opioid addiction there is likely to be issues with chronic pain, but there could be anxiety and hepatitis too.
- Family involvement has proven to be essential.
- Continuity of care, for each stage of the recovery, through linked resources.
- A respectful environment.
- Evidence-based treatments and best practices should be the principles of the treatment program.
- Licensed and certified staff members for each of the disciplines which they practice in the facility.
- The program must be accredited by a nationally recognized agency.
- Monitoring of patient response to all treatments should be accompanied with the outcome data showing the results.
Currently, the medical world defines 10 separate substance use disorders and they are defined according to the class of drugs abused. All of them, opioid addiction included, share the defining features of addiction – they directly and intensely involve reward and reinforcement systems of the brain, leading to compulsive use that then typically leads to neglect of normal activities with harm other spheres of their life. Opiod addiction needs to be addressed sooner rather than later. There is no doubt that since the introduction of the New Farm Bill signed by president Trump, CBD cannabidiol will be able to act as a counter measure to harmful and addictive medicine – read more here about academic research on CBD.