Describing addiction & risk factors

• Defining addiction

  Addiction was initially defined as:

  ‘Periodic or chronic intoxication produced by repeated consumption of drugs, natural or synthetic’

  WHO - this explains Addiction-as-Disease (AAD)

  Alternate and more modern definitions are a little more varied:

  “Anything that you can become obsessed with, and you do so much that you can’t do the things you need to do with family, friends, school, job – that can be an addiction. And texting absolutely can qualify” - Dale Archer (2010)
• Defining addiction

  The DSM IV defines addiction under the category of a substance use disorder (SUD) and this generically refers to:

  ‘Patterns of symptoms caused by using a substance than an individual continue taking despite its negative effects’

  There’s lots of criteria used to establish whether a behaviour is an addiction but the three most important are:

  • Dependence 
  • Tolerance
  • Withdrawal symptoms
• Dependence 

  ‘A state of physical or psychological inability to stop the use of a substance’

  Dependence comes in two forms:

  • Psychological dependence 
  • Physical dependence
• Psychological dependence

  Psychological dependence refers to the compulsion to experience the effects of a substance, usually in terms of an increase in pleasure or decrease in discomfort. In both instances however, use of the substance is followed by a reward. 

  A consequence of psychological dependence is that the person will keep taking the substance / doing the behaviour until is becomes habitual, despite harmful consequences
• Physical dependence

  Physical dependence is defined in terms of withdrawal. 

  It is only possible to determine that someone is physically dependent on a substance when they abstain from it and experience withdrawal syndrome
• Withdrawal syndrome

  A withdrawal syndrome is a collection of symptoms associated with abstaining from or reducing the use of an addictive substance. 

  The specific collection of symptoms is unique to each category of substance and are predictable. The symptoms are almost always the opposite of the ones created by the substance.
• Withdrawal syndrome

  The existence of withdrawal indicates that a physical dependence has developed. 

  Symptoms of withdrawal occur every time the person cannot get the substance, meaning they occur relatively often. 

  There symptoms are often unpleasant and cause discomfort so motivation for continuing to take the substance is partly to avoid the withdrawal symptoms 

  This therefore becomes a secondary form of psychological dependence
• Withdrawal typically has two phases:

  • Acute withdrawal phase - begins within hours of abstaining and features intense cravings for a substance. Usually diminish gradually over a few days

  Prolonged withdrawal phase - symptoms that continue for weeks, months etc. The person becomes highly sensitive to cues they associate with the substance. This sensitivity is why relapse is so common
• Tolerance

  Tolerance occurs when an individual’s response to a given amount of a substance is reduced. This means they need ever greater doses to produce the same effect. Tolerance is created by repeated exposure to the effects of a substance. 
• Tolerance

  One type of tolerance is behavioural tolerance - this occurs when the individual learns through experience to adjust their behaviour to compensate for the effects of a substance. 

  A rarer type of tolerance is cross-tolerance - this is when the developed tolerance of one substance reduces the sensitivity to another substance i.e. alcoholics who have become tolerant to the sleep-inducing effects of alcohol tend to require more anesthesia.
• Risk factors in addiction

  A risk factor is anything that increases the chances that someone will form an addiction or engage in addictive behaviour. The term ‘risk factor’ may also be used when explaining why a person increases their current level of use
• Additional research support

  Genetics: Kendler et al. (2012) - used data from the National Swedish Adoption Study and found that adopted children with one addicted biological parent were at significantly greater risk of developing an addiction than adopted children with no addicted parents. (+) This research illustrates the importance of genetics as a risk factor in the development of addiction