Drug & Alcohol Dependence
The word addiction is often used to refer to any behaviour that is out of control in some way. People often describe themselves as being addicted to a television show or to clothes shopping. The word is also used to explain the experience of withdrawal when a substance or behaviour is stopped (eg “I must be addicted to coffee: I get a headache when I don’t have my cup in the morning”).
However, experiencing enjoyment or withdrawal doesn’t necessarily imply addiction. Because the term “addiction” is commonly used in such a vague way, there have been many attempts to define it more clearly.
A simple way of describing addiction is the presence of the four Cs:
- Loss of Control of amount or frequency of use
- Compulsion to use
- Use despite Consequences.
Consider a person who finds alcohol so pleasurable that he regularly goes to the bar after work (Craving). His drinking escalates to overcome tolerance, and he experiences withdrawal when he abstains. He tries and repeatedly fails to cut down (loss of Control). He begins to reorganize his life in order to maximize drinking opportunities, neglecting his work and family (Compulsion). Eventually his spouse leaves and he loses his job (Consequences).
Why do people keep using?
Addictive behaviours can be hard to change. One thing that makes change so difficult is that the immediate effects of addictive substances tend to be positive. People may feel good, have more confidence and forget about problems. In contrast, the problems from use might not be obvious for some time.
People may come to rely on the effects of addictive substances to bring short-term relief from difficult or painful feelings. The effects of addictive substances can make problems seem less important, or make it seem easier to talk and to be with others. People may come to believe that they cannot function or make it through the day without addictive substances. When people use addictive substances to escape or change the way they feel, using can become a habit, which can be hard to break.
Continued addictive substances use, especially heavy use, can cause changes in the body and brain. If people develop physical dependence and then stop using, they may experience distressing symptoms of withdrawal. Changes to the brain may be lasting. These changes may be why people continue to crave addictive substances and slip back into substance use long after they have stopped using. When people who are addicted stop their substance use, they often compare the experience to leaving an important relationship.
It is recommended that a qualified health professional assesses individuals displaying addictive behaviours. An assessment offers the opportunity to diagnose, treat and develop a treatment plan in collaboration with the person. Once an individual receives the correct treatment they begin their road to recovery. When patients receive a diagnosis they often feel relief in knowing they are not alone and are provided with an explanation to their behaviours. Treatment beyond the medical detoxification stage includes assessment for any concurrent mental health problems, appropriate medications which may, for example, help diminish alcohol craving, and introduction to self help groups to maintain recovery. An important part of treatment is planning an individualized post hospitalisation support program, to facilitate ongoing recovery.