Chapter 12.docx

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Chapter 12:
Addiction Disorders
Individual lifestyle and personality features are thought to play a role in the development of addictive
disorders and are central themes in some types of treatment
Addictive behaviour is defined as behaviour based on the pathological need for a substance or activity
and may involve the abuse of the substance
The most commonly used problem substances are those that affect mental functioning, or psychoactive
drugs which include alcohol, nicotine, barbiturates, tranquillizers, amphetamines, heroin, ecstasy and
marijuana
For diagnostic purposed, addiction or substance-related disorders are divided into two major
categories: conditions that involve organic impairment resulting from the prolonged and excessive
ingestion of psychoactive substances; and comprises substance-induced organic mental disorders and
syndromes
(both these conditions stem from toxicity or from physiological changes in the brain due to vitamin
deficiency), and the majority of addiction disorders fall into the second category which focuses on
maladaptive behaviour resulting from regular and consistent use of a substance
Substance abuse involves a pathological use of a substance resulting in a potentially hazardous
behaviour such as driving while intoxicated or continued use despite a persistent social, psychological,
occupational or health problem
Substance dependence includes more severe forms of substance-use disorders and usually involved
a marked physiological need for increasing amounts of a substance to achieve the desired effects
Dependence to these disorders means that an individual will show a tolerance for a drug and/or
experience withdrawal symptoms when the drug is unavailable
Tolerance refers to the need for increased amounts of a substance to achieve the desired effects,
resulting from biochemical changes in the body that affect the rate of metabolism and of eliminations
of the substance from the body
Withdrawal symptoms are physical symptoms such as sweating, tremors and tension that accompany
abstinence from the drug
Alcohol Abuse and Dependency:
Alcoholism (preferred term alcohol dependence syndrome) is defined as a psychic and usually
also physical state, resulting from taking alcohol, characterized by behavioural and other responses
that always include a compulsion to take alcohol on a continuous or periodic basis in order to
experience it psychic effect, and sometimes to avoid the discomfort of its absence, tolerance may
or may not be presented
Many ancient cultures, including the Egyptian, Greek and roman make extensive and often
excessive use of alcohol (Cambyses, the kind of Persia in the sixteenth century BCE is known to
be one of the first alcohol abusers on record)
Alcohol abuse and dependence are major problems in the Western world and are among the
most destructive of the psychiatric disorders
The life span of the average person with alcohol dependence is about 12 years shorter than that
of the average person without the disorder, and was estimated that in 1995 over 6500 Canadians
lost their lives as a result of alcohol consumption, with motor vehicle accidents, liver cirrhosis, and
suicide being the leading causes
Alcohol significantly lowers performance on cognitive tasks such as problem solving and the more
complex task, the greater the impairments and can also lead to brain shrinkage
Over 37% of alcohol abusers suffer from at least one coexisting mental disorder which is not surprising
given that alcohol is a depressant, depression and personality disorders are most common
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Alcohol abuse is also associated with about 40-50% of all murders, 40% of all assaults and over
50% of all rapes
In North America, alcohol abuse and dependency cuts across all age, educational, occupational
and socioeconomic boundaries, as well alcohol misuse is a serious problem in the industry, in the
professions as well as the military
Men become problem drinkers at about five times the frequency of women
Problem drinking may develop during any life period from childhood to old age, although marriage
and higher levels of education are associated with a lower incidence of alcoholism (different cultural
groups have varying rates of the disorder across diverse cultural samples)
At lower levels, alcohol stimulates certain brain cells and activates the pleasure centers of the
brain, yet at higher levels, alcohol depressed brain functioning, inhibiting one of the brains excitatory
neurotransmitters: glutamine which in turn slows down activity in the parts of the brain
In the state of intoxication, the world is pleasant and worries are left behind, as well feelings of
self-esteem and adequacy rise, yet varies for different, yet the effects of alcohol differ from drinker
to drinker and is dependent on the physical condition, the amount of food in their stomach and
the duration of their drinking (over time a tolerance can increase)
Alcohol that is taken in must be assimilated (done by the liver, and can cause irreversible damage if
overworked) by the body, except for about 5-10% that is eliminated through breath, urine and
perspiration
Fetal alcohol syndrome occurs when an expectant mother drinks heavily during the early days
of pregnancy (affects 1 in 100 babies), the newborn infant may have physical and behavioural
abnormalities, as well as experience symptoms of alcohol withdrawal, growth deficiencies and
irregularities and damage to the central nervous system (fetal alcohol syndrome us also associated
with the development of mental disorder in adults)
An excessive drinker usually suffers from chronic fatigue, oversensitivity and depression, behaviour
becomes course and inappropriate, loses pride and responsibility and neglects others around the
drinker
Several acute psychotic reactions fir the diagnostic classification of substance induced disorders and
are often referred to as 1) alcoholic psychoses because they are marked by a temporary loss of
contact with reality, as well a reaction called alcohol withdrawal delirium may occur where slight
noises or student moving objects may cause considerable excitement and agitation, 2) alcohol
amnesic disorder which is a memory defect (particularly with regard to recent events), which is
sometimes accompanied by falsification of events (confabulation), where faces, rooms, pictures or
objects may not be recognized, although they feel familiar this the memory gaps are filled with
reminiscences and fanciful tales
The effects vary due to the active areas of the brain as well as the persons biological makeup
(genetic and environmental influences that differ in each person), the development of an alcohol
addiction is a complex process involving many elements: constitutional vulnerability and environmental
encouragement as well as the unique biochemical properties of certain psychoactive substances
Drugs differ in their biochemical properties as well as in how rapidly they enter the brain, central
to the neurochemical process underlying addiction is the role the drug plays in activating the pleasure
pathways
Mesocorticolimbic dopamine pathway (MCLP) is the center of psychoactive drug activation in
the brain, alcohol may stimulate the mesolimbic dopamine pathway directly or it may act indirectly by
decreasing the activity of GABA neurons (which normally inhibit dopamine neurons)
The exposure of the brain to an addictive drug alters its neurochemical structure and results in a
number of behavioural effects, with continued use of the drug, neuroadaptation or tolerance to and
dependence on the substance develop
There is strong evidence for the inheritance of alcoholism as well as the importance of genetic
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