What is addiction?

To begin with, I’ll be providing an introduction of addiction and looking specifically at addiction and what this actually entails. So addiction is complex in nature, and it can take many different forms. This includes physiologic addiction, where we’re looking at chemical dependence, substance misuse and also things such as alcohol misuse and smoking. We also have psychological addiction, which is interesting. We’re looking here at things such as pathological, pathological gaming and gambling. What recent research has illustrated is that parts of the brain that are affected by dependence and by addiction appear to be the same, whether we’re looking at physiological or psychological.

So it appears that addiction, regardless of whether it’s physiological or psychological in nature, is having the same impact on the human brain. There are also three stages of addiction that are important to consider. Initially, we have exposure. So this is obviously exposure to the substance or to the health compromising behaviour itself. Then we have compulsion, which is the compulsion to take the substance and followed by a loss in control over that behaviour. In other words, this translates to a lot of craving behaviour and patients find it difficult to exert control over their compulsive drug seeking or pleasure seeking behaviour.

What we tend to see is that, as mentioned previously, addiction can actually exert certain structural changes to the brain, and that translates to the functional changes and the changes in behaviour that we tend to see over time. Importantly, to consider is that addiction has an impact on functioning. By this, we mean occupational functioning, so people find it more difficult to hold down jobs. Social, it has an impact on their social relationships, on marriages and so forth. And in addition, it has an array of influences on physical and psychological well-being as well. So psychological well-being affected through low mood, craving of the substances, anxiety when the substances are not present.

But in addition, we also see a reduction in life expectancy as a result to the physiological impact of of this kind of dependency. We also see that addiction puts a significant financial strain on our national health service because it doesn’t happen in isolation. Addiction tends to have an impact on a number of different conditions as well. And health compromising behaviours don’t tend to occur in isolation either. So the key symptoms that we tend to look out for in this regard, and this is looking at both the ICD 11 and the DSM 5, both of our diagnostic criteria here agree that these disorders tend to be due to substance use and addictive behaviours. As mentioned previously, physiological and psychological dependency.

And what we tend to find is that a key criterion here is that there is a strong desire to perform the behaviour or to take that specific substance and there’s difficulty in controlling that substance taking behaviour. In addition, physiological withdrawal in the absence of the substance or in the absence of that behaviour tends to be quite profound. And what we tend to find is that when individuals take certain amounts of the substance, they increase their tolerance to the substance. So they need to take more and more and more in order to reach that high that they would initially have reached without taking that amount of a particular substance. So we have increase in tolerance levels.

And when they’re not taking as much of the substance as is required for it to have an effect over a period of time, we see that they experience withdrawal symptoms. We also see that there is progressive neglect of certain interests that they once held, as well as professional and personal responsibility being neglected. And finally, we also see that continued substance misuse and for instance, psychological addiction as well tends to have harmful consequences, not just on their psychological well-being, but on their physical, physiological well-being and social well-being as well. So what causes addiction and substance misuse? So it’s a fine line when we’re looking at substance use and substance misuse.

Obviously, not everyone who drinks will go on to develop an alcohol problem. But it’s important to consider what are the contributing factors to substance misuse. So we know that there are certain environmental factors that are key to keep in mind. So we know that individuals who tend to have experienced early life traumas, adverse early life experiences or even adversity at present, tend to perhaps be predisposed in some sense to acquiring these health compromising behaviours which help in alleviating some of the distress that they experience on a frequent basis.

We also know now through some of the more recent research, that there is a prominent genetic component potentially to addiction and that there may be certain genes that could potentially predispose certain individuals to addictive behaviours. And then there are also psychological factors. So we know that there are certain personality traits that could predispose individuals to such addictive behaviours, as well as the presence of anxiety and or depression, which as mentioned previously, when we’re looking at certain adverse experiences, including the presence of other psychiatric conditions, that tends to lead to an increase at times in health compromising behaviours, because these behaviours make us feel very good temporarily.

They remove something unpleasant in the short term, but in the long term, they just tend to complicate the picture because we’re dealing with a potentially dangerous cocktail of a lot of things going on all at once. So diagnosis, what happens after we’ve actually suspected that there may be a case of addiction present where the patient may have exhibited the key signs and symptoms, is that you or the patient will book an appointment with the GP. In most cases it will probably be a loved one or someone who the patient may trust. Patients rarely tend to seek help, at least in the first instance, on their own.

So the GP would be the first point of call and then the GP will have some questions that she or he will ask regarding the concerns the family and the patient may have. And then the GP will go on to assess things such as frequency of use or frequency of performing the behaviour, impact that the behaviour or the taking of the substance is having on the patient’s functioning in general and so forth. The GP may also order some investigations such as blood and urine samples, but those are not diagnostic measures in their own right. So these are just additional investigations that may be requested.

The GP will also refer the patient in cases where they suspect addiction and substance misuse to a psychiatrist for further assessment. And there are some wonderful facilities for those who are really, really struggling here in Cardiff. Gone are the days of the psychiatric units being that kind of dreaded environment that the media had portrayed. Today, psychiatric units actually provide a lot of freedom to patients to actually help themselves and learn how to help themselves in the long term. So treatment, therefore there are various types of treatments.

We start off by considering the basis of the behaviour, when this behaviour was acquired, because as we’ve said, if it’s stress related or some kind of adverse experiences in the environment, it’s important to sort of help the patient explore those things through talking therapy. And one of the key interventions that we tend to use in this regard is cognitive behavioural therapy, CBT, which some of you may be aware of. It’s an evidence based first line talking therapy which enables the patients to consider their thought processes, to also consider their emotional responses to certain situations and how their thoughts and those emotional, emotional responses are influencing their behaviour. And through that, consider a process of behaviour modification.

We also know that certain lifestyle changes are important. For instance, avoiding certain triggers in the environment, also how we deal with craving and withdrawal symptoms as well. So if a patient is going to limit their exposure to a substance, we need to educate them in terms of what withdrawal will entail because it can be somewhat unpleasant depending on the patient and the circumstances. There are also certain medications that we can use. There are certain medications designed for certain types of addiction and substances that are used. So, for instance, when it comes to alcohol misuse, there are certain medications such disulfiram, naltrexone, and so forth. That are really effective in helping overcome the addiction to that particular substance.

But social intervention is also key. So this involves helping patients in the longer term with their occupational and social circumstances, holding down jobs, housing and so forth. So in essence, treatment across all of these conditions relies on what we refer to as the bio psycho social approach. We need a strong biological component along with the psychological and the social. We can’t focus on one or the other. It’s basically considering all three because as with all of us, our patients are holistic people, and as such can only be treated as holistic individuals with complex circumstances that need to be considered.

So for further supports and information there are certain websites that provide a great deal of additional information depending on the type of addiction that you’re looking at. For instance, more broadly, there is Beating Addiction. And more information is provided on the slide in terms of how to contact the specific organisation. There’s also Drug Wise UK when we’re looking more at those kind of physiological, uh, addictions when it comes to certain substances. There’s Dan 24/7, which is really good at providing further support to those who may be struggling. And there is also Gamblers Anonymous for those who are experiencing difficulty with their gambling behaviour getting out of control and again meeting the criteria for addiction. It is important to reach out.

These, these experiences tend to be more common than one thinks. And then of course we also have Mind. Mind UK tends to be a very good source of information as well as support. And for more information, you can also consult the NHS website, which provides Not only information about addiction, but also where you can seek support and which NHS services help in that regard as well.