Dependence
Dependence, often referred to as addiction, is a complex condition characterized by the compulsive use of substances such as drugs or alcohol, despite negative consequences. It typically arises from a combination of genetic, environmental, and psychological factors, including inherited predispositions and underlying mental health disorders. When individuals repeatedly use a substance, they may develop a tolerance, requiring larger amounts to achieve the desired effects, and experience withdrawal symptoms when they stop.
The symptoms of dependence can be classified into physical dependence, risky behavior, social issues, and impaired control over usage. Diagnosis often involves screenings like urine or blood tests to detect substance presence. Treatment can be challenging, as many individuals may deny their need for help; however, empathetic approaches can facilitate acknowledgment and recovery.
Treatment options include detoxification, therapy (both individual and group), and support programs such as Alcoholics Anonymous. Prevention strategies focus on education, stress management, and addressing mental health, emphasizing the importance of a supportive environment to reduce the risk of developing dependence. Understanding the multifaceted nature of dependence is crucial for developing effective interventions and support systems for those affected.
Dependence
ALSO KNOWN AS: Addiction
DEFINITION: Chemical dependence is a primary, progressive, and potentially fatal condition resulting from the chronic use of certain substances such as drugs or alcohol. Repetitive use of a substance leads to a higher tolerance so that more of the drug is needed for the person to feel its effects. Once chemical dependence has developed, suddenly stopping the substance use will produce withdrawal symptoms such as anxiety and other unpleasant physical symptoms.
Causes
Substance abuse is caused by a combination of factors, including inherited genetics, environmental stressors, and, often, an underlying or preexisting mental health issue, such as depression or anxiety. Social factors, such as peer pressure to experiment, also come into play. Environmental stress, whether at work or at home, is also a significant contributor to cravings that drive a person to abuse substances.
Physiologically, addictive substances flood the brain’s reward circuit, primarily with the hormone dopamine. When these reward pathways are continually overstimulated, the brain produces less of its own hormones and dopamine receptors. Dependence occurs when the user's brain neurons adapt to chronic drug exposure and can function normally only in the presence of the drug. Without the drug, the person experiences several withdrawal symptoms, including agitation, anxiety, and insomnia. The person progressively takes greater amounts of the substance to overcome tolerance, which leads to profound chemical changes in neurons and brain circuits that compromise the long-term functioning and health of the brain.
Risk Factors
Aside from genetics, risk factors for developing a pharmacological dependence include surviving a disaster or experiencing psychic trauma. Disaster and trauma survivors are prone to stress-related disorders such as post-traumatic stress disorder and depression. Such persons may self-medicate with alcohol or other drugs to relieve unbearable symptoms. People who suffer from drug dependence are about twice as likely to suffer from mood disorders than the general population.
Social factors may also play a role in drug abuse and addiction. The attitudes and beliefs of one's family members, peers, and friends about drug use are a significant factor in initial drug use. Once an individual has begun using a drug, the development of dependence is thought to depend upon that person's genetic traits, and some people may be particularly susceptible to developing dependence. Other risk factors include the age of initiation to the drug, mental health disorders, behavior traits, home environment, and socioeconomic status.
Symptoms
According to the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published in 2022, there are eleven diagnostic criteria for substance use disorder organized into four categories: physical dependence, risky use, social problems, and impaired control. According to the DSM-5-TR, physical dependence is characterized by tolerance to the effects of a substance and symptoms of withdrawal when discontinuing or decreasing the use of the substance. The World Health Organization describes dependence syndrome as "a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value." Behavioral symptoms of dependence include neglect of other interests and obligations due to substance use, including the time spent attaining the drug and recovering from its use, and repeated substance use despite negative consequences.
Screening and Diagnosis
Toxicology screens, known as drug tests, can be used to determine whether substances are present in the body. The sensitivity of these tests depends on the drug itself, when it was taken, and whether the test is done on blood or urine. Blood tests are more successful at detecting toxic substances, but urine tests are used more often, partly because they can be done at home and are cheaper and less invasive than drawing blood samples. Tests can also be run on hair follicles, which are highly accurate and can determine substance use over a longer period of time. Although, they are costly, take longer, may be influenced by hair color, and struggle to detect low-level use.
Treatment and Therapy
It can be challenging to convince a person with a drug dependence that they need treatment. Denial, a common indicator of addiction, is less of a hurdle when the person is approached and treated with empathy and respect.
Once a problem has been acknowledged, treatment involves stopping the substance use either gradually or abruptly (with a period of detoxification) and providing support for the person to remain drug-free. Dependence is characterized by relapse, as withdrawal from the substance can cause uncomfortable withdrawal symptoms, and many people who want to quit have to try several times. Even after long periods of sobriety, relapses are possible. Relapse, however, can be an essential part of recovery.
The term detoxification refers to a controlled environment where people may be monitored as their bodily systems return to normal. Medications may be used to control withdrawal symptoms, especially with heavy alcohol use, because suddenly stopping the substance can lead to death in extreme cases of alcohol abuse. Attention should also be paid to patients detoxing from benzodiazepines, as withdrawal can cause seizures. These patients should taper down their use. Medications are available for treating dependence to nicotine, alcohol, and opiates, but they are not for stimulants or marijuana.
Treatment programs exist as in-patient or out-patient services. They should be evaluated based on the type of drug abused, the duration of dependence, and whether the goal is to quit entirely or to minimize a habit’s harmful effects. Twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous provide networks of support for total abstinence through reliance on a higher power; some people, however, do not respond to the spiritual underpinnings of these programs.
Individual and group therapies that employ cognitive-behavioral therapy focus on changing negative thought patterns to alter behaviors, often to reduce the habit’s impact on work and family. Rehabilitation (or rehab) centers exist to separate more seriously dependent patients.
Prevention
Education on drug dependence is important for prevention, as are strategies for coping with stress. These strategies can include meditation, yoga, cognitive-behavioral strategies, physical exercise, and progressive relaxation techniques. For those who are recovering from dependence, relapse prevention involves avoiding places frequented by people using drugs and developing a new social network that supports the recovering individual in leading a drug-free lifestyle. Understanding and addressing past traumas and mental health issues is also key to preventing drug dependence.
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