What is Addiction?

The term addiction refers to the uncontrollable use of drugs/substances resulting in various deleterious physical and psychological problems. The drugs usually have a direct effect on the brain. There are two main purposes for which the drugs are primarily used:
To induce an intense state of happiness.
To get rid of the current stressors the person is facing in his or her life.
The individual develops a habit of abusing the drug as it serves as a way of leaving the person in a world free of tensions and full of pleasures. Due to these rewarding effects of drugs on the brain, the individual is compelled to engage in repeated use. Individuals age 18-24 have a greater likelihood to become involved in illicit use of the drug. The following figure gives a pictorial description that how the individuals indulge in the use of a drug and its related effects:

The main symptoms of addiction can be clustered around four domains:

The lack of control over drug usage is one of the most essential features in maintaining addiction. The individual feels helpless and fails to limit the use of drugs.
Most of the time is spent in obtaining the drug.
The individual does face an urge or craving for the drug. This desire to obtain the drug is so strong that the individual fails to think of anything else.

The risky use of drugs involves taking drugs where it is physically hazardous such as before driving or keep using the drug even it is causing physical harm such as repeatedly injecting the drug that is resulting in bruises.
Despite the hazardous effects the individual keep on using it and failed to refrain from using the drug.

The behavioral consequences of drugs are observable in the form of mood changes, problems in thinking, perceiving, attention and judgment.
Disturbances in social functioning are also apparent in the form of repeated relationship problems. The individuals’ work performance, hobbies are also affected. For example, several absentees from schools or college in the case of teens, being late to office in case of adults are reported.
The increased use of drugs makes the individual’s body to develop more tolerance to the drug. Hence, the initial dose that was previously sufficient, fails to satisfy the urge with the passage of time.
Individuals experience withdrawal effects when the body is deprived of drugs or he or she stops taking drugs. The increased dependence on drugs results in these withdrawal effects. Common withdrawal symptoms can include body aches, muscle twitching, sweats, vomiting, diarrhea, and insomnia.
Common Drugs
The following are the drugs that are commonly responsible for resulting in various psychological disorders:
Cannabis (also known as hash or weed)
Caffeine (found in tea, coffee, energy drinks)
Hydrocarbon inhalants (such as found in glues, paints, cigarette lighter fluid, nail polish, etc.)
Hallucinogens (e.g. MDMA or ecstasy)
Stimulants(e.g. cocaine, ice or crystal methamphetamine))
Sedatives or Anxiolytics (such as sleep-inducing and anti-anxiety medications)
Tobacco (found in cigarettes)
Opioids (such as heroin)
Consequences of Addiction to Mental Health
There are numerous mental health consequences of illicit drug addiction. These drugs may serve as a causation factor of various disorders. These drug-induced disorders are usually severe, short term, but sometimes these disorders may persist. The following table gives a brief overview of the drugs that are likely to induce mental disorders:

Drugs/Medications Associated Disorders
Cannabis Psychotic & Anxiety disorders
Alcohol Psychotic disorders, Bipolar disorder, Depression, Anxiety disorders.
Caffeine Anxiety disorders
Hydrocarbon inhalants Psychotic disorders, Depression, Anxiety disorders
Hallucinogens Psychotic disorders, bipolar disorder, depression, anxiety disorders
Sedatives or anxiolytics Psychotic disorders, bipolar disorder, depression, anxiety disorders
Opioids Depression and Anxiety disorders

Factors Responsible for Drug Abuse
The following are the factors that are likely to contribute towards developing a physiological dependency for a substance/ drug.

In genetic factors, studies have shown that relatives of drinkers have higher rates of alcohol abuse. The twin studies have also revealed that genetic factors played a great role in disorders related to substance abuse. Genes by interacting with the environment make the individual more susceptible to addiction as it has been found that alcohol and smoking problems among adolescents were higher among those teens that had a large number of peers who drank.
Among the neurobiological factors, it has been found disturbances in dopamine systems make some individuals susceptible to develop drug dependency. The dopamine system is linked to pleasure and reward, becomes supersensitive not only to the direct effects of drugs but also to the cues associated with drugs (e.g., needles used for injecting drugs or rolling paper, etc.). This oversensitivity to cues induces craving, and the individual does anything to obtain the drug. The transition from liking to intense craving is regulated by dopamine pathways in the brain, which is responsible for maintaining the addiction.
In psychological factors, two main elements are responsible for substance/drug addiction. The first one is mood alteration and the second one is the personality factors. The mood alteration has a maintaining effect on addiction. The individual use drug as a way of enhancing the positive mood and eliminating the negative one. In this way, addiction behavior is reinforced. In regard to personality factors, high levels of negative emotionality, constraint from the environment and conservative moral standards have an important role in substance abuse.
Among the socio-cultural factors, the peers, parents, media, and cultural norms about acceptable behavior played a significant role in an individual’s interest and access towards drugs.

Modules for Treatment
The challenge in the treatment of substance-related disorders is a recurrent relapse. The following are the steps that are followed in the treatment of drug-induced disorders.
The first step in treatment is detoxification. The person is enabled to function without the use of drugs. This detoxification is the pharmacological management of withdrawal from drugs. When the person quits drugs he experiences withdrawals. Sometimes these withdrawals are much disturbing. With the help of medicine, the agony of quitting drugs is managed
The second step involves psychological treatment. Two main goals of this treatment are:

Cognitive Behavior Therapy is frequently being used in the treatment of a drug-induced disorder. Following is the 4-step program of CBT for substance/ drug abusers:

The engagement of the patient is ensured by building a trusting relationship. This is done by adopting a non-judgmental attitude towards the patient. This building of trusting relationships helps in seeing the addiction as a mutual problem.
In cue analysis, the patient is enabled to look for cues under which he or she experiences a craving for the drug.
The problem-solving skills in the case of substance-related disorders are directed towards dealing with the risk of relapse. By the use of problem –solving strategies an individual is enabled to deal with internal and external triggers of drug abuse.
In the fourth step, the beliefs about the use of the substance are elicited and are challenged by providing alternative evidence to the patient.
The behavioral intervention is done by reinforcing the inconsistent behaviors that are inconsistent with drug abuse such as taking the medications, spending time with family, etc.
The relapse prevention in case of drug abuse is of pivotal importance. The individuals are enabled to prevent the relapse by the use of avoiding the high-risk situations (e.g. being around people using drugs) in which an individual is likely to again indulge in drug abuse.

Case study
K.H. 24-year-old male, unmarried plumber, had a previous history of heroin use for the past 3 years. He first tried heroin during his time when he was going to Karachi for the shipment of goods with his fellows. Due to a lack of control over heroin use he was removed from his job a year later. He began to steal money and valuables to fulfill his need for the drug, due to which his father asked him to, leave the house. He then began living on the street and started begging for money to support his habit. Over the years, K. H. had a tremendous weight loss and became quite malnourished. He was 6 feet tall but his weight was only 65 kilograms. Food wasn’t a priority on most days. Looking at his miserable situation he was taken by one of his friends’ to a rehabilitation center, but the doctor asked him to remain free of heroin in order to be admitted. The patient was able to resist his urge for a day or two, but then withdrawal symptoms began in the form of nausea, vomiting and body aches thus making it too difficult to resist. Staying under the strict surveillance of friends he failed to have the drug again and gained admittance to the addiction ward. The medications were given that help in overcoming his discomfort caused due to withdrawal signs. Along with the medications, K.H. started visiting the psychologist for therapeutic that further aided his improvement by the use of cognitive therapy. Now he was hopeful that he would change his habit for the betterment of himself.

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