Addiction can by defined as a chronic, relapsing disorder characterised by compulsive substance seeking and use despite adverse consequences.
Key indicators of a substance use disorder (SUD) are as follows (as per the DSM-5 diagnostic criteria for SUD)
1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use it, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.
For the individual experiencing addiction, use of a substance can be a desperate attempt to cope with an underlying health issue. Alternatively, a person may begin using a substance for another reason such as experimentation, and through continued use before long they find themselves physiologically dependent. In this case, the individual may be compelled to continue using the substance because the effects of withdrawal are too significant if they attempt to cease their use. In either scenario, the individual in addiction is often stuck in an uncomfortable ambivalence - on one hand they feel compelled to use the substance out of a need to cope, but on the other hand they recognize negative consequences on their use (such as impacts on health).
An individual looking to overcome their addiction is faced with several key hurdles across areas of functioning impacted by addiction including the physical, psychological, emotional, and behavioral. One of the biggest challenges faced here by the person wanting recovery is rewiring of the brain that occurs through prolonged use of a substance.
In short, when a person uses a substance, an amount of the neurotransmitter dopamine (D2) is released in the lower limbic region of the brain giving the person a sense of euphoria (and hence alleviating discomfort). The problem is, the brain remembers this positive sensation, and remembers the situation, event, person, or emotion (trigger) that the person used in response to and in turn received the pleasurable release of D2 and alleviation of discomfort.
This is a process of classical conditioning leading to the automatic pre-activation of D2 in the brain of the user when confronted with a trigger (event, situation, person, emotion) that they typically use a substance in response to. The resultant challenge for the individual is an experience of cravings and urges in response to the trigger. Cravings are defined as a thought about using, whereas urges are the physiological desire to use reinforced by the pre-activation of D2 before the person has even actually used the substance.
The commencement of recovery from addiction begins with developing insight and awareness into this underlying process, building motivation to change, and developing skills for management of triggers, cravings, and urges.
Comments