SUBSTANCE DEPENDENCE also known as DRUG DEPENDENCE is an adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of drug use. A drug addiction , a distinct concept from substance dependence, is defined as compulsive , out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing . ΔFosB , a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral addiction and drug addictions, but not dependence.
Within the framework of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance dependence is redefined as a drug addiction, and can be diagnosed without the occurrence of a withdrawal syndrome. It is now described accordingly: "When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders."
* 1 Withdrawal
* 2 Risk factors
* 2.1 Dependence potential * 2.2 Capture rates
* 3 Biomolecular mechanisms
* 4 Diagnosis
* 4.1 DSM classification
* 5 Management
* 5.1 Residential * 5.2 Behavioral programming * 5.3 Alternative therapies
* 6 Treatment and Issues
* 8 Society and culture
* 8.1 Legislation
* 9 See also * 10 References * 11 External links
ADDICTION AND DEPENDENCE GLOSSARY
• ADDICTION – a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences
• ADDICTIVE BEHAVIOR – a behavior that is both rewarding and reinforcing
• ADDICTIVE DRUG – a drug that is both rewarding and reinforcing
• DEPENDENCE – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
• DRUG SENSITIZATION or REVERSE TOLERANCE – the escalating effect of a drug resulting from repeated administration at a given dose
• DRUG WITHDRAWAL – symptoms that occur upon cessation of repeated drug use
• PHYSICAL DEPENDENCE – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens )
• PSYCHOLOGICAL DEPENDENCE – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia )
• REINFORCING STIMULI – stimuli that increase the probability of repeating behaviors paired with them
• REWARDING STIMULI – stimuli that the brain interprets as intrinsically positive and desirable or as something to be approached
• SENSITIZATION – an amplified response to a stimulus resulting from repeated exposure to it
• SUBSTANCE USE DISORDER - a condition in which the use of substances leads to clinically and functionally significant impairment or distress
• TOLERANCE – the diminishing effect of a drug resulting from repeated administration at a given dose
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Withdrawal is the body's reaction to abstaining from a substance upon
which a person has developed a dependence syndrome. When dependence
has developed, cessation of substance use produces an unpleasant
state, which promotes continued drug use through negative
reinforcement ; i.e., the drug is used to escape or avoid re-entering
the associated withdrawal state. The withdrawal state may include
physical-somatic symptoms (physical dependence ),
emotional-motivational symptoms (psychological dependence ), or both.
Chemical and hormonal imbalances may arise if the substance is not
The dependence potential of a drug varies from substance to substance, and from individual to individual. Dose, frequency, pharmacokinetics of a particular substance, route of administration, and time are critical factors for developing a drug dependence.
An article in
DRUG MEAN PLEASURE PSYCHOLOGICAL DEPENDENCE PHYSICAL DEPENDENCE
Barbiturates 2.01 2.0 2.2 1.8
Ecstasy 1.13 1.5 1.2 0.7
Capture rates enumerate the percentage of users who reported that they had become dependent to their respective drug at some point.
DRUG % OF USERS
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Two factors have been identified as playing pivotal roles in
psychological dependence : the neuropeptide "corticotropin-releasing
factor " (CRF) and the gene transcription factor "cAMP response
element binding protein " (CREB). The nucleus accumbens (NAcc) is one
brain structure that has been implicated in the psychological
component of drug dependence . In the NAcc,
In addition to CREB, it is hypothesized that stress mechanisms play a role in dependence. Boob and Kreek have hypothesized that during drug use, CRF activates the hypothalamic–pituitary–adrenal axis (HPA axis) and other stress systems in the extended amygdala . This activation influences the dysregulated emotional state associated with psychological dependence. They found that as drug use escalates, so does the presence of CRF in human cerebrospinal fluid . In rat models, the separate use of CRF inhibitors and CRF receptor antagonists both decreased self-administration of the drug of study. Other studies in this review showed dysregulation of other neuropeptides that affect the HPA axis, including enkephalin which is an endogenous opioid peptide that regulates pain. It also appears that µ-opioid receptors , which enkephalin acts upon, is influential in the reward system and can regulate the expression of stress hormones .
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Upregulation of the cAMP signal transduction pathway in the locus
"Substance dependence", as defined in the DSM, can be diagnosed with physiological dependence , evidence of tolerance or withdrawal, or without physiological dependence. DSM-5 substance dependencies include:
Sedative , hypnotic , or anxiolytic dependence (including
benzodiazepine dependence and barbiturate dependence )
Treatments for addiction vary widely according to the types of drugs involved, amount of drugs used, duration of the drug addiction, medical complications and the social needs of the individual. Determining the best type of recovery program for an addicted person depends on a number of factors, including: personality, drugs of choice, concept of spirituality or religion, mental or physical illness, and local availability and affordability of programs.
Many different ideas circulate regarding what is considered a successful outcome in the recovery from addiction. Programs that emphasize controlled drinking exist for alcohol addiction. Opiate replacement therapy has been a medical standard of treatment for opioid addiction for many years.
Treatments and attitudes toward addiction vary widely among different
countries. In the US and developing countries, the goal of
commissioners of treatment for drug dependence is generally total
abstinence from all drugs. Other countries, particularly in Europe,
argue the aims of treatment for drug dependence are more complex, with
treatment aims including reduction in use to the point that drug use
no longer interferes with normal activities such as work and family
commitments; shifting the addict away from more dangerous routes of
drug administration such as injecting to safer routes such as oral
administration; reduction in crime committed by drug addicts; and
treatment of other comorbid conditions such as
Residential drug treatment can be broadly divided into two camps: 12-step programs and therapeutic communities. Twelve-step programs are a nonclinical support-group and faith-based approach to treating addiction. Therapy typically involves the use of cognitive-behavioral therapy , an approach that looks at the relationship between thoughts, feelings and behaviors, addressing the root cause of maladaptive behavior. Cognitive-behavioral therapy treats addiction as a behavior rather than a disease, and so is subsequently curable, or rather, unlearnable. Cognitive-behavioral therapy programs recognize that, for some individuals, controlled use is a more realistic possibility.
One of many recovery methods are 12-step recovery programs , with
prominent examples including
In a survey of treatment providers from three separate institutions,
the National Association of
Behavioral programming is considered critical in helping those with addictions achieve abstinence. From the applied behavior analysis literature and the behavioral psychology literature, several evidence based intervention programs have emerged: (1) behavioral marital therapy ; (2) community reinforcement approach ; (3) cue exposure therapy; and (4) contingency management strategies. In addition, the same author suggest that Social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious. Community reinforcement has both efficacy and effectiveness data. In addition, behavioral treatment such as community reinforcement and family training (CRAFT) have helped family members to get their loved ones into treatment. Motivational Intervention has also shown to be an effective treatment for substance dependence.
Alternative therapies, such as acupuncture , are used by some practitioners to alleviate the symptoms of drug addiction. In 1997, the American Medical Association (AMA) adopted as policy the following statement after a report on a number of alternative therapies including acupuncture:
There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.
Important phases in treating substance dependence include establishing coping mechanisms to deal with the hardships of withdrawal symptoms. With the correct approaches, the patient can live a healthier life.
Online websites have been a resource to aid in helping people to overcome addictions. These websites act as ways for struggling addicts, family members of addicts, and people who are in the recovery stage to confide in each other (anonymously if they so choose). They provide an alternative way for these people to seek help, support and information. Sites typically include chat rooms, forums, and blogs for members to interact.
TREATMENT AND ISSUES
Psychologists need to use many techniques and approaches to implement the right application to fix substance related disorders. Psychodynamic approach is one of the techniques that psychologist use to solve the addictions problems. In the Psychodynamic therapy, psychologists need to understand the conflicts and the needs of the addict persons, and also need to locate the defects of their ego and defense mechanisms. Using this approach alone by itself is proved to be ineffective in solving addiction problems. Psychology is not only defined by conscious as believed in structuralism ideology, is also defined by cognition and behavior. Therefore, cognitive and behavioral techniques should be integrated with psychodynamic approaches to achieve effective treatment to substance related disorders (Comer, 2013; Cornish et al., 1995; Lightdale et al., 2011, 2008). Cognitive treatment required psychologist to think deep in what is happening in the brain of addict persons. Cognitive psychologists should zoom in to neural functions of the brain and understand that drugs have been manipulating the dopamine rewarding center of the brain. To put it in other words, Drugs have become the only rewarding pleasurable resource of daily life. From this particular state of thinking Cognitive psychologist need to find ways to change the thought process of addict persons (Comer, 2013; de Wit and Phan, 2010).
There are two routes that should be applied to cognitively fix substance abuse persons; track the thoughts that pulled them to addictions and track the thoughts that prevent them from relapsing. Nevertheless, psychologist should also add the principle of functionalism in the equation of treating substance related disorder. As matter of fact behavioral techniques have the largest wide share of application in treating substance related disorders. Behavioral psychologists would use the techniques of “aversion therapy”. This sort of therapy is based on the principles of classical conditioning of Ivan Pavlov. It is when pairing substance abuse with unpleasant stimulus or condition, for example, pairing pain, electrical shock, or nausea with alcohol consumption. The latter required using some nausea-induced medications (Comer, 2013; Owen-Howard, 2010; Welsh one approach is to reduce regularly the dosages intake of the harmful substances.
The other approach is to use medicines that contain chemicals that
interfere with the functions of the drugs in the brain. The third
approach is when substituting addiction drugs with other addiction
drugs. The next paragraph would explain how this approach is
problematic and involve in the debate of ethical concerns. Those three
conditions of biological interventions have aimed on the process of
detoxification within the substance abuse individuals, especially the
ones whose drugs become the center of their life. Psychologists need
to think of the consequences when understanding how the process of
detoxification is a difficult stage and might throw individuals with
addiction problems into unpleasant conditions and painful experience.
Moreover, Psychologist needs to realize that by using biological
interventions they are purposely and intentionally throwing drug
abusive people into unwanted withdrawal symptoms. This might inflict
pain and dangerous consequences on the addict persons. Therefore,
biological intervention should be combined with Humanistic approaches
and other therapeutic techniques. Self-
The examples and perspective in this section MAY NOT REPRESENT A WORLDWIDE VIEW OF THE SUBJECT. You may improve this article , discuss the issue on the talk page , or create a new article , as appropriate. (February 2014) (Learn how and when to remove this template message )
The phenomenon of drug addiction has occurred to some degree
throughout recorded history (see "
For the entirety of US history, drugs have been used by some members of the population. In the country's early years, most drug use by the settlers was of alcohol or tobacco.
The nineteenth century saw opium usage in the US become much more
common and popular.
Many soldiers in the Vietnam War were introduced to heroin and many developed a dependency to the substance which survived even when they returned to the US. Technological advances in travel meant that this increased demand for heroin in the US could now be met. Furthermore, as technology advanced, more drugs were synthesized and discovered, opening up new avenues to substance dependency.
SOCIETY AND CULTURE
This section DOES NOT CITE ANY SOURCES . Please help improve this section by adding citations to reliable sources . Unsourced material may be challenged and removed . (October 2014) (Learn how and when to remove this template message )
Depending on the jurisdiction , addictive drugs may be legal, legal only as part of a government sponsored study, illegal to use for any purpose, illegal to sell, or even illegal to merely possess.
Most countries have legislation which brings various drugs and drug-like substances under the control of licensing systems. Typically this legislation covers any or all of the opiates, amphetamines, cannabinoids, cocaine, barbiturates, benzodiazepines, anesthetics, hallucinogenics, derivatives and a variety of more modern synthetic drugs. Unlicensed production, supply or possession is a criminal offence .
Usually, however, drug classification under such legislation is not related simply to addictiveness. The substances covered often have very different addictive properties. Some are highly prone to cause physical dependency, while others rarely cause any form of compulsive need whatsoever. Also, under legislation specifically about drugs, alcohol and nicotine are not usually included.
Although the legislation may be justifiable on moral or public health grounds, it can make addiction or dependency a much more serious issue for the individual: reliable supplies of a drug become difficult to secure, and the individual becomes vulnerable to both criminal abuse and legal punishment.
It is unclear whether laws against illegal drug use do anything to stem usage and dependency. In jurisdictions where addictive drugs are illegal, they are generally supplied by drug dealers , who are often involved with organized crime . Even though the cost of producing most illegal addictive substances is very low, their illegality combined with the addict's need permits the seller to command a premium price, often hundreds of times the production cost. As a result, addicts sometimes turn to crime to support their habit.
Drug and Alcohol Dependence (journal)
Risk factors in pregnancy
* ^ A B C Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15:
The official diagnosis of drug addiction by the Diagnostic and
Statistic Manual of Mental Disorders (2000), which makes distinctions
between drug use, abuse, and substance dependence, is flawed. First,
diagnosis of drug use versus abuse can be arbitrary and reflect
cultural norms, not medical phenomena. Second, the term substance
dependence implies that dependence is the primary pharmacologic
phenomenon underlying addiction, which is likely not true, as
tolerance, sensitization, and learning and memory also play central
roles. It is ironic and unfortunate that the Manual avoids use of the
term addiction, which provides the best description of the clinical
syndrome. * ^ A B "Substance use disorder". Pubmed Health. National
Institutes of Health. Retrieved 12 September 2014.
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Substance-use disorder: A diagnostic term in the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
referring to recurrent use of alcohol or other drugs that causes
clinically and functionally significant impairment, such as health
problems, disability, and failure to meet major responsibilities at
work, school, or home. Depending on the level of severity, this
disorder is classified as mild, moderate, or severe.
Addiction: A term used to indicate the most severe, chronic stage of
substance-use disorder, in which there is a substantial loss of
self-control, as indicated by compulsive drug taking despite the
desire to stop taking the drug. In the DSM-5, the term addiction is
synonymous with the classification of severe substance-use disorder.
* ^ Nutt King, Saulsbury, Blakemore (2007). "Development of a
rational scale to assess the harm of drugs of potential misuse".
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