3. Defining Addiction
Addiction is derived from the Latin verb ‘addicere,’ to
give or bind a person to one thing or another.
Drug addiction is a chronic, relapsing brain disease
characterized by compulsive drug seeking, craving,
loss of self-control, and impaired decision making.
NIDA, 2010
This is reflected in an individual pathologically
pursuing reward and/or relief by substance use and
other behaviors.
4. Introd…
Substance or drug refers to licit (legal) or illicit (illegal)
chemical agent that once taken in the body is capable of
causing physiological and psychological changes
Psychoactive substance is a chemical compound that
produces emotional, cognitive or behavioral changes
Substance dependence a syndrome characterized by the
“three C’s”
Compulsive drug use (in terms of time and effort)
Loss of control (unable to stop use)
Consequences of use (physical, social, psychological)
5. Dependence: the repeated use of a drug or chemical
substance, with or without physical dependence
Physical dependence indicates an altered physiologic
state caused by repeated administration of a drug, the
cessation of which results in a specific syndrome.( there is
no need to be excessively drunk to see those symptoms)
Characterized by tolerance and withdrawal
Tolerance a neurological adaptation to the psychoactive
effect or a substance; more of the drug is required to
achieve the same effect
Withdrawal a constellation of symptoms and signs that
occur within hours or days after cessation of the drug
6. Psychological dependence, also referred to as
habituation, is characterized by a continuous or
intermittent craving for the substance to avoid a dysphoric
state
Abuse : Use of any drug, usually by self-administration, in
a manner that deviates from approved social or medical
patterns
Intoxication : A reversible syndrome caused by a specific
substance (e.g., alcohol) that affects one or more of the
following mental functions: memory, orientation, mood,
judgment, and behavioral, social, or occupational
functioning.
7. Types of Addictions
Any pleasurable experience is potentially addictive!
Give examples.
Addictive disorders can be broadly divided into two
categories:
1. Addiction to drugs and alcohol (substance)
2. Behavioral addictions: gambling, sex, shopping,
internet, exercise…
DSM- 5 recognizes only Gambling Disorder as the only
diagnosable disorder. For the others, there is no enough
empirical data yet to label them as disorders.
8. Professions Dealing with
Addiction
Addiction psychiatry is a medical subspecialty
within psychiatry that focuses on the evaluation,
diagnosis, and treatment of people who are suffering
from one or more disorders related to addiction.
Addiction Medicine a specialization in the treatment
of addiction, mainly medical aspects such as
detoxification, MMT …
13. 3 Cs of Addiction
1. Compulsive use: strong urge (craving)
2. Loss of control: how much, for how long.
3. Continued use despite adverse consequences
(psychological, physical, social)
14. Causes of Substance Abuse
There is no single cause for substance use
disorders; various factors contribute:
1. Availability: drugs/substances that can be
accessed from different sources is one of the
main factors leading to frequent use.
Drugs that can be bought without prescription:
Nicotine, Alcohol and Khat
Drugs prescribed by doctors: Opioids, Barbiturates,
Benzodiazepines
Drugs obtained from illicit sources: Heroin, cocaine
and Cannabis etc..
15. Causes of Substance Abuse
2. Personal factors
Personality vulnerability:- sensation seeking,
Impulsivity
Disrupted families
Behavioral problems during early childhood:- Poor
school record, truancy
Depression and anxiety
16. Causes of Substance Abuse
3. Social factors
Permissive society
Social pressure (peer pressure)
Unemployment
Homelessness
4. Genetic factors:- a person who has a close relative
with alcohol use disorder is at risk for the same
disorder.
22. Characteristics of Addictive
Substances
They have pleasurable effects
The effects are rapid in onset and therefore
particularly reinforcing
With repeated exposure, tolerance occurs as a
neuroadaptive response
The reward system is profoundly re-set such that
normal human pleasures and rewards become
ineffective- aka ‘hijacking’
25. DSM-5 Classification of SRD
Source: APA Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition (DSM-5), 2013
26. Substance Use Disorders
Key Concepts
Problematic Use
Occurring within the past 12 months
At least 2 of the 11 criteria under 4 categories
27. DSM 5 Substance Use
Disorders
Category 1- Impaired control:
1. Larger amounts or over a longer period
2. Unsuccessful attempt to cut-down or quit
3. Time wastage
4. Craving
Category 2- Social impairment:
5. Failure to fulfill major role obligations at work, school,
or home
6. Persistent or recurrent interpersonal problems
7. Important social, occupational, or recreational
activities may be given up or reduced
28. Category 3- Risky use:
8. Recurrent substance use in situations in which it is
physically hazardous,
9. Continue substance use despite knowledge of having a
persistent or recurrent physical or psychological
problem
Category 4- Pharmacological criteria:
10. Tolerance
11. Withdrawal Grading of Severity
1. Mild: 2-3 criteria met
2. Moderate: 4-5
3. Severe: ≥6
29. Substance Induced Disorders
Mainly secondary psychiatric complications
Essential criteria
1. Temporal relatedness: active use or within 1 month
of cessation
2. Capacity to produce the disorder
3. Exclude other causes
30. Substance Induced Disorders
(DSM-5)
Psychoti
c D/O
Bipola
r D/O
MD
D
Anxiet
y D/O
OCD
s
Slee
p
D/O
Sexua
l D/O
Deliriu
m
Neuroc
o-
gnitive
D/O
SU
D
SI S
W
Alcohol I/W I/W I/W I/W I/W I/W I/W I/W/P X X X
Caffeine I I/W X X
Cannabis I I I/W I X X X
Hallucinogens
Phencyclidi
ne
I I I I I X X
Other
hallucinoge
ns
I I I I I X X
Inhalants I I I I I/P X X
Opioids I/W W I/W I/W I/W X X X
S.H.A. I/W I/W I/W W I/W I/W I/W I/W/P X X X
Stimulants I I/W I/W I/W I/W I/W I I X X X
Tobacco W X X
Other(Unknown) I/W I/W I/W I/W I/W I/W I/W I/W I/W/P X X X
31. Prevalence of Substance Use in
Ethiopia- Report from the 2015 STEPS Survey
Percentage who currently smoke
tobacco daily
Male: 6.2% (5.0-7.4)
Female: 0.2% (0.1-0.4)
Total: 3.5% (2.8-4.1)
Percentage who engage in heavy
episodic drinking (6 or more drinks
on any occasion in the past 30 days)
Male: 20.5 (18.2-22.7)
Female: 2.7 (2.0-3.3)
Total: 12.4 (11.0-13.7)
Percentage who currently chew Khat
Male: 21.1 (17.6-24.7)
Female: 9.4 (7.2-11.5
Total: 15.8 (13.1-18.5)
32. Evaluation of Persons for SRD
A separate assessment form provided
Interview techniques
Non-judgmental (role of values)
Build rapport
Be empathic
Use open ended questions
Use reflection
Rarely confrontational
Use collateral information
Use DSM-5 Criteria
33. Summary: Evaluation
Thorough history, P/E and MSE is important
Lab Investigations
To determine use: samples (blood, urine, saliva, hair)
To assess complications: as necessary (e.g.. LFT, U/S of
abdomen in alcohol use disorder)
To track treatment progress: e.g. opioid screen from
patients on methadone; MCV, LFT, U/S of liver in
alcohol
34. The Ten Key Components
of Treatment for Addiction
1. Information and understanding
2. Acceptance and engagement
3. Initiating treatment: diagnosis and detoxification
4. Pharmacotherapies
5. Psychological therapies: MI, CBT, CRA, CRAFT, CM…
6. Identification and treatment of underlying and
complicating disorders
7. Family and social support
8. Self- help fellowships
9. Aftercare
10. Lifestyle and environmental change
