Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences. It is considered a disorder of the brain reward system involving neurotransmitters like dopamine. Addiction has biological, psychological, social, and spiritual components. Treatment involves a biopsychosocial approach including medication, psychotherapy, and addressing co-occurring psychiatric disorders and social support systems to help patients maintain recovery and prevent relapse.

1. ADDICTION –
SUBSTANCE ABUSE
An overview
AHMED ALBEHAIRY, M.D
PSYCHIATRY CONSULTANT,
MOH

2. Essence of Addiction
“Compulsive drug seeking behavior, and
use, in the face of negative
consequences”
“Physical dependence is not that
important”
Drug Abuse and Addiction Research
The Sixth Triennial Report to Congress from the
Secretary of Health and Human Services 1999, p.2.

3. ‫‪Annual prevalence of global illicit‬‬
‫-8991 ‪drug use over the period‬‬
‫1002‬
‫المنشطات‬
‫كل أنواع‬
‫الموا‬ ‫الحش‬ ‫كل‬
‫أكستا‬ ‫كوكايي‬ ‫هيروي‬
‫ ‬ ‫د‬ ‫ي‬ ‫أمفيتامي‬ ‫الفيو‬
‫س‬ ‫ن‬ ‫ن‬
‫المخ‬ ‫ش‬ ‫نات‬ ‫نات‬
‫درة‬ ‫ي‬
‫عدد المتعاطين‬ ‫.741‬
‫0.581‬ ‫4.33‬ ‫0.7‬ ‫4.31‬ ‫9.21‬ ‫2.9‬
‫) بالمليون(‬ ‫4‬
‫نسبة‬
‫المتعاطين‬
‫من إجمالي‬ ‫1.3‬ ‫5.2‬ ‫6.0‬ ‫1.0‬ ‫2.0‬ ‫2.0‬ ‫51.0‬
‫عدد‬
‫السكان‬
‫نسبة ‬
‫المتعاطين‬
‫من إجمالي‬ ‫22.0‬
‫3.4‬ ‫5.3‬ ‫8.0‬ ‫2.0‬ ‫3.0‬ ‫3.0‬
‫عدد‬

4. ‫سن بداية المخدر‬
‫إنتشار إستعمال المواد المغير للعقل حسب الفئة العمرية‬
‫%51‬
‫%01‬
‫إستعمال المواد المخدرة و المسكرة‬
‫%5‬
‫%0‬
‫سنة 42-51‬ ‫سنة 43-52‬ ‫سنة 44-53‬ ‫سنة فأكثر 55 سنة 45-54‬

5. ‫معدل الاصابة بالطضطرابات النفسية المصاحبة‬
‫لستخدام المواد المغيرة للعقل داخل البحث‬
‫الضطرابات النفسية‬ ‫يستخدم‬ ‫ل يستخدم‬ ‫المجموع‬
‫العدد‬ ‫165‬ ‫1001‬ ‫2651‬
‫حدوث إضطرابات‬
‫نفسية‬
‫%‬ ‫%9.53‬ ‫%1.46‬ ‫%001‬
‫العدد‬ ‫5032‬ ‫64652‬ ‫15972‬
‫عدم حدوث أي‬
‫إضطرابات نفسية‬ ‫%001‬
‫%‬ ‫%2.8‬ ‫%8.19‬
‫ ‬

9. Complex Illness
 Chronic use and abuse
 Relapsing condition
 Compulsive seeking and using
 Loss of control
 Changes in values
 Changes in lifestyle
 Problems in accountability
 Dishonesty
 Ambivalence

10. F1 x .2 Dependence
syndrome

11. Other Types of Addiction
 Gambling/Eating/Internet/sex

12. Comorbidity
 Substance Abuse in Suicide
 ADHD
 Chronic Pain Management
 Psychosis Among Substance Users .
 The Anxiety
 AIDS Care
 The Association Between Cannabis and A

13. Pathogenesis of Addiction

14. Etiological Factors
BIO
PSYCHO
SOCIAL
SPIRITUAL
( Multifactorial)

15. Biological aspects of addiction
- Reward circuits : DA mesolimbic pathway.
- Neurotransmitters of reward circuits: DA, CB1,2,
U ENK,BZD-A, GABA, NMDA, m- Glu, Ach, 5HT,
NA.
- VTA, NA, Amygdala, thalamus, DLPF, OFC.
- Bottom up, and Top down.
- Molecular Mechanisms of Neuroadaptation

17. Neurobiology of addiction and
seeking , motivational ,
learning , related memory .

21. Addiction: Dysregulation
in the Motive Circuit
 Stage 1: Acute Drug Effects
 Stage 2: Transition to Addiction
 Stage 3: End-Stage Addiction

23. The Neurobiology
of Adaptive Behavior
Dopamine can be seen as serving two functions in the
circuit:
1) to alert the organism to the appearance of novel
salient stimuli, and thereby promote neuroplasticity
(learning), and
2) to alert the organism to the pending appearance of
a familiar motivationally relevant event, on the basis
of learned associations made with environmental
stimuli predicting the event.( cues).

25. The orbitofrontal cortex and the anterior
cingulate gyrus, which are regions
neuroanatomically connected with limbic
structures, are the frontal cortical areas most
frequently implicated in drug
addiction.
These regions are also involved in higher-order
cognitive and motivational functions, such as
the ability to track, update, and modulate the
salience of a reinforcer as a function of
context and expectation and the ability to
control and inhibit prepotent responses.

26. These results imply that addiction connotes
cortically regulated cognitive and emotional
processes, which result in the overvaluing of
drug reinforcers, the undervaluing of
alternative reinforcers, and deficits in
inhibitory control for drug responses. These
changes in addiction, which the authors call I-
RISA (impaired response inhibition and
salience attribution), expand the traditional
concepts of drug dependence that emphasize
limbic-regulated responses to pleasure and
reward.
 (Am J Psychiatry 2002; 159:1642–

27. The Neural Basis of Addiction:
A Pathology of Motivation and
Choice
Cellular adaptations in prefrontal glutamatergic
innervation
of the accumbens promote the compulsive character of
drug seeking in addicts by decreasing the value of natural
rewards, diminishing cognitive control (choice), and
enhancing glutamatergic drive in response.

28. The Amygdala
The Amygdala is especially critical
in
establishing learned associations
between
motivationally relevant events and
otherwise

31. A Hijacking of Neural Systems
Related to the Pursuit of Rewards
An explanation of addiction
 - long-term memories persist for many years or even
a lifetime .
From this point of view,
sensitized dopamine responses to drugs and drug
cues might lead to enhanced consolidation of drug-
related associative memories,
but the persistence of addiction would seem to be
based on the remodeling of synapses and circuits
that are thought to be characteristic of long-term
associative memory .

33. Potential
Psychotherapeutic Targets
These include drugs that
1) decrease the motivational value of the
drug,
2) increase the salience and
motivational value of nondrug
reinforcers,
or 3) inhibit conditioned responses
to stimuli predicting drug availability.

37. Addiction as a Brain
Disease
Am J Psychiatry 155:6, June 1998
EDITORIAL, THOMAS R. KOSTEN, M.D.
Will these demonstrations that addictive
disorders are genetically influenced brain
diseases persuade our
leaders and fellow citizens that these patients
deserve the same level of compassion and
treatment as is provided to other medical
patients? Not without our help in educating
them.

38. Management of Addiction
Assessment . Bio psycho social
Intervention
bio psycho social
Follow up and maintenance

39. Implications for Treatment
Must restore
 Medical integrity
 Personal integrity
 Social integrity

40. Psychopharmacological
Treatment of patients
- Symptomatic detox treatment .
Physical, psychological
- Anticraving.
- Antagonist.
- Partial agonist.
- Agonist or replacement.

41. Alcohol
- Benzodiazepine, chlordiazepoxide 5-20
mg three or four times daily.
- Antiepileptic ;carbamezapine .
- vitamin B, thiamine , wernick’s
encephalopathy respectively.

42. Alcohol
-Naltrexone .
At night , after meal, liver
-Acomprosate. Campral
333mg, 2-1-1, renal , diarrhea, headach
-Disulfram.
500mg for 1st wk then 250mg, nausea,
metronidazole
-Topramate.

43. opiate
- Alpha 2 agonist, naltrexone.
- symptomatic treatment .
- Naltrxone, xr.
- buperinophin, withdrawel, maintenance.

44. Cocaine & amphetamine
Antidepressants
Antiepileptic
Cocaine vaccine.

45. Nicotine
- Symptomatic
- varencelline , chantix. Patial agonist, alpa2
B4. 0,5mg / day and in wk inc to 1mg/day
- wellbutrin.
depression, suicidal thoughts, and suicidal
actions
- Nicotine replacement.

46. BZD, BARBITURATE
Symptomatic.
Taperring.
Vitamine B
antiepileptic.

47. Cannabinoids, hallucinogen,
PCP, inhalent,
- Supportive .
- antidepressants.
- Antipsychotic.

48. Tools of managing self efficacy in
addict
- Individual psychotherapy .
- Group .
- Team work.
- Motivational skills.
- Ex addict .
- Family involvement.
- Relapse and lapse investigations.

49. Self efficacy and solve
problem
- Psycho education
- Anticipation of risky situations .
- Discussion ??????
- Training , motivation.
- List of problems
- Prioritize the problems .
- Analysis of the problems.( cognitive
errors and other related psychosocial
issues).

50. Problem solving
- Alternative solutions.
- Choose the suitable solution ( with,
against, and key persons).
- Test the solution .
- Approve the solution or choose other
alternative.
- Recycle and repeat.

51. Types of problems to be
solved
- cues.
- Craving
- Psychiatric disorders.
- Medical disorders.
- Legal problem.
- Family .
- financial.

52. Self efficacy and problem solving
mean
Continous motivation for change of
- Attitude .
- Thoughts .
- Mood .
- Behavior .

53. The Stages of Change
are:
 Precontemplation (Not yet acknowledging that
there is a problem behavior that needs to be
changed)
 Contemplation (Acknowledging that there is a
problem but not yet ready or sure of wanting to make
a change)
 Preparation/Determination (Getting ready to
change)
 Action/Willpower (Changing behavior)
 Maintenance (Maintaining the behavior change)
and
 Relapse (Returning to older behaviors and
abandoning the new changes)

60. Possibility of relapse in addiction therapy
Relapse prevention

61. Key Themes in Relapse
Prevention
1- identify risk relapse factors and develop
strategies to deal with.
2- understand relapse as a process and as an
event.
3- understand and deal with cues and cravings.
4- understand and deal with social pressures to
use substance.
5- develop and enhance a supportive social
network.

62. Key Themes in Relapse
Prevention
6- develop methods of coping with
negative emotional states.
7- assess the pt. for co morbid psychiatric
disorder.
8- help and learn the pt. methods to cope
with cognitive distortions.

63. Relapse warning signs!!!????
- Attitude changes.
- Thoughts changes.
- Mood changes.
- Behavior changes.

64. Cognitive behavioral model of the
relapse process
Decreased
Coping Increased
Probability
response Self efficacy
Of relapse
High risk
situations
AVE
disonance
No Initial use Increased
Decreased conflicts
Coping Of Probability
Self efficacy Of
response substance Self
relapse
attribution

65. Family intervention in
addiction treatment
- F Counseling
- Enabling, coping with relapse and
craving.
- F therapy

66. Family Therapy
 confessions and confrontations.
 Parenting skills.
 Discussions skills.
 Solving problem skills.
 Anger management in the family.
 Family firmness.
 Therapeutic alliance ( patient , family
and therapists).

67. Thank you