PSYCHOLOGY PROJECT FILE

ADDICTIVE DISORDERS

INTRODUCTION
Addictive disorders, such as substance abuse and dependence, are
common disorders that involve the overuse of alcohol and/or drugs.
Addiction develops over time and is a chronic and relapsing illness.

There are three different terms used to define substance-related

addictive disorders:

Substance abuse
Substance abuse, as a disorder, refers to the abuse of illegal
substances or the abusive use of legal substances. It is an addictive
disorder that describes a pattern of substance (usually drug or
alcohol) use leading to significant problems or distress, such as
failure to attend school, substance use in dangerous situations
(like driving a car), substance-related legal problems or continued
substance use that interferes with friendships and/or family
relationships. Alcohol is the most common legal drug to be abused.

Substance dependence
Substance dependence is an addictive disorder that describes
continued use of drugs or alcohol, even when significant problems
related to their use have developed. Signs include an increased
tolerance—that is, the need for increased amounts of the substance
to attain the desired effect;

Chemical dependence
Chemical dependence is also an addictive disorder that describes the
compulsive use of chemicals (usually drugs or alcohol) and the
inability to stop using them despite all the problems caused by their
use.

The substances frequently abused, particularly by adolescents with

addictive disorders, include, but are not limited to, the following:

 Alcohol
 Marijuana
 Cocaine
  Opiates
 Tobacco

HISTORY OF ADDICTIVE DISORDER

Addiction can be defined as the continued use of mood-altering
addicting substances or behaviors (e.g., gambling, compulsive
sexual behaviors) despite adverse consequences. We have
learned that alcoholism is a primary, chronic disease with
genetic, psychosocial, and environmental factors influencing its
development and manifestations. It is characterized by
continuous or periodic impaired control over drinking,
preoccupation with the alcohol, use of alcohol despite adverse
consequences, and distortions in thinking, most notably
denial.This is a definition forwarded in JAMA in 1992, and
includes the thinking of the American Society of Addiction
Medicine and the National Council on Alcoholism and Drug
Dependencies. Since that time, continued exploration of the
nature of addiction includes other mood-altering substances
aside from alcohol, as well as a number of highly reinforcing
behaviors.
SYMPTOMS
People with addictive disorders may experience symptoms
differently. Some typical symptoms of addictive disorders may
include:

 Getting high on drugs or getting intoxicated (drunk) on a regular

basis
 Lying, especially about how much they are using or drinking
 Avoiding friends and family members
 Giving up activities they used to enjoy, such as sports or
spending time with non-using friends
 Talking a lot about using drugs or alcohol
 Believing they need to use or drink in order to have fun
 Pressuring others to use or drink
 Getting in trouble with the law
 Taking risks, such as sexual risks or driving under the influence
of a substance
 Suspension/expulsion from school or being fired from work for
a substance-related incident
 Missing school or work due to substance use
 Depressed, hopeless or suicidal feelings
DSM-5 CRITERIA FOR ANXIETY DISORDER

According to the DSM-5, alcohol use disorder is “a problematic pattern of

alcohol use leading to clinically significant impairment or distress, as
manifested by at least two of the following [criteria], occurring within a 12-
month period.”

In other words, if you experienced any two of the symptoms from the
following criteria/questionnaire in the past year, you can be diagnosed as
having an AUD:

1. Alcohol is often taken in larger amounts or over a longer period than was
intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control
alcohol use. A great deal of time is spent in activities necessary to obtain
alcohol, use alcohol, or recover from its effects. 
3. Craving, or a strong desire or urge to use alcohol. 
4. Recurrent alcohol use resulting in a failure to fulfill major role obligations at
work, school, or home. 
5. Continued alcohol use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of alcohol. 
6. Important social, occupational, or recreational activities are given up or
reduced because of alcohol use. 
7. Recurrent alcohol use in situations in which it is physically hazardous. 
8. Alcohol use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or
exacerbated by alcohol. 
9. Tolerance, as defined by either of the following: a need for markedly increased
amounts of alcohol to achieve intoxication or desired effect, or a markedly
diminished effect with continued use of the same amount of alcohol. 
10. Withdrawal, as manifested by either of the following: the characteristic
withdrawal syndrome for alcohol, or alcohol (or a closely related substance,
such as a benzodiazepine) is taken to relieve or avoid alcohol withdrawal
symptoms. 

ICD – 10 CRITERIA FOR TOBACCO

USE/ABUSE/DEPENDENCE
• If both use and abuse are documented, assign only
the code for abuse
• If both abuse and dependence are documented,

assign only the code for dependence

• If use, abuse and dependence are all documented,

assign only the code for dependence

• If both use and dependence are documented,

assign only the code for dependence

• The term “smoker” refers the coder to see dependence, drug, nicotine

• There is no code for past history of tobacco use, only a code for past history of tobacco
dependence

• Electronic cigarettes are battery-powered vaporizer devices that turn liquid nicotine
into a vapor that can be inhaled.

CAUSES
Addictive disorders are caused by multiple factors, including genetic
vulnerability, environmental stressors, social pressures, individual
personality characteristics and psychiatric problems.

From a neurological standpoint, addictive disorders arise when a

substance changes the way the user’s brain feels pleasure. Addictive
substances alter the brain’s ability to send and receive chemicals
called neurotransmitters, which cause pleasure. The addictive
substances can prevent nerves in the brain (called neurons) from
receiving these neurotransmitters, meaning the drug user relies on
the drug, rather than his or her natural brain chemicals, for feelings of
pleasure.

Most of the knowledge available regarding substance use and abuse

comes from studying adult populations. A lack of research studying
young adult substance use and abuse leaves questions concerning
how it differs from substance abuse in other age groups unanswered.

Some adolescents are more at risk of developing addictive disorders,

including adolescents with one or more of the following conditions
present:

 Children of substance abusers

 Adolescents who are victims of physical, sexual or
psychological abuse
  Adolescents with mental health problems, especially depressed
and suicidal teens
 Physically disabled adolescents

EPIDEMIOLOGY
Due to cultural variations, the proportion of individuals who develop a drug or behavioral
addiction within a specified time period varies over time, by country, and across
national population demographics 

 Asia
 The prevalence of alcohol dependence is not as high as is seen in other regions. In
Asia, not only socioeconomic factors but also biological factors influence drinking
behavior.
 The overall prevalence of smartphone ownership is 62%, ranging from 41% in
China to 84% in South Korea. Moreover, participation in online gaming ranges
from 11% in China to 39% in Japan. Hong Kong has the highest number of
adolescents reporting daily or above Internet use (68%). Internet addiction
disorder is highest in the Philippines, according to both the IAT (Internet Addiction
Test) – 5% and the CIAS-R (Revised Chen Internet Addiction Scale) – 21%.
 Australia
 The prevalence of substance use disorder among Australians was reported at 5.1%
in 2009. In 2019 the Australian Institute of Health and Welfare conducted a national
drug survey that quantified drug use for various types of drugs and
demographics.  The national found that in 2019, 11% of people over 14 years old
smoke daily; that 9.9% of those who drink alcohol, which equates to 7.5% of the
total population age 14 or older, may qualify as alcohol dependent; that 17.5% of
the 2.4 million people who used cannabis within the last year may have hazardous
use or a dependence problem; and that 63.5% of about 300000 recent users of
meth and amphetamines were at risk for developing problem use.
 Europe
 In 2015, the estimated prevalence among the adult population was 18.4% for heavy
episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and
3.8% for cannabis use, 0.77% for amphetamine use, 0.37% for opioid use, and
0.35% for cocaine use in 2017. The mortality rates for alcohol and illicit drugs were
highest in Eastern Europe.
 United States[
 Based upon representative samples of the US youth population in 2011,
the lifetime prevalence of addictions to alcohol and illicit drugs has been estimated
to be approximately 8% and 2–3% respectively. Based upon representative
samples of the US adult population in 2011, the 12 month prevalence of alcohol
and illicit drug addictions were estimated at 12% and 2–3% respectively. The
lifetime prevalence of prescription drug addictions is currently around 4.7%.
 As of 2016, about 22 million people in the United States need treatment for an
addiction to alcohol, nicotine, or other drugs. Only about 10%, or a little over
2 million, receive any form of treatments, and those that do generally do not
receive evidence-based care. One-third of inpatient hospital costs and 20% of all
deaths in the US every year are the result of untreated addictions and risky
substance use. In spite of the massive overall economic cost to society, which is
greater than the cost of diabetes and all forms of cancer combined, most doctors
in the US lack the training to effectively address a drug addiction.
 Another review listed estimates of lifetime prevalence rates for several behavioral
addictions in the United States, including 1–2% for compulsive gambling, 5% for
sexual addiction, 2.8% for food addiction, and 5–6% for compulsive shopping. A
 systematic review indicated that the time-invariant prevalence rate for sexual
addiction and related compulsive sexual behavior (e.g., compulsive masturbation
with or without pornography, compulsive cybersex, etc.) within the United States
ranges from 3–6% of the population.
 According to a 2017 poll conducted by the Pew Research Center, almost half of US
adults know a family member or close friend who has struggled with a drug
addiction at some point in their life.
 In 2019, opioid addiction was acknowledged as a national crisis in the United
States. An article in The Washington Post stated that "America's largest drug
companies flooded the country with pain pills from 2006 through 2012, even when
it became apparent that they were fueling addiction and overdoses."
 The National Epidemiologic Survey on Alcohol and Related Conditions found that
from 2012 to 2013 the prevalence of Cannabis use disorder in U.S. adults was 2.9%

PROGNOSIS
Drug addiction, also called substance use disorder, is a disease that affects a
person's brain and behavior and leads to an inability to control the use of a
legal or illegal drug or medicine. Substances such as alcohol, marijuana and
nicotine also are considered drugs. When you're addicted, you may continue
using the drug despite the harm it causes.

Drug addiction can start with experimental use of a recreational drug in social
situations, and, for some people, the drug use becomes more frequent. For
others, particularly with opioids, drug addiction begins when they take
prescribed medicines or receive them from others who have prescriptions.

The risk of addiction and how fast you become addicted varies by drug. Some
drugs, such as opioid painkillers, have a higher risk and cause addiction more
quickly than others.

TYPES OF ADDICTIVE DISORDER

Addiction can be either physical or behavioral, and often they go hand in hand. Though
alcohol and tobacco are commonly recognized types of addiction, there are actually
hundreds of types of medically and scientifically recognized addictions.

Cravings, compulsions, inability to stop, and lifestyle dysfunction all point to

the existence of some type of addiction. A person can be addicted to
behaviors just as seriously as one can be addicted to substances such as
alcohol or hard drugs.

The addictive behaviors that result from both types of addiction can have
serious negative consequences though, from all that comes with a substance
use disorder to the perils of a gambling addiction, or even compulsive
shopping and sexual behavior to an unhealthy degree.

Addiction is a complex disease. The type of addiction doesn’t really matter

as much as the underlying issue causing the patient to chase that pleasurable
feeling while incurring adverse consequences.  

These adverse effects with the development of addiction can include financial
issues, destructive behavior, relationship issues, family conflict, and the
negative feelings that come up as a result of these things.  

Physical Addictions

Physical addictions are the ones that are generally better known. These are
addictions to substances that are ingested or otherwise put into a person’s
body. Some common physical addictions include:

 Alcohol
 Tobacco
 Opioids
 Prescription drugs
 Cocaine
 Marijuana
 Amphetamines
 Hallucinogens
 Inhalants
 PCP

Physical addictions can generally be grouped into three categories: alcohol,

illicit drugs, and prescription drugs.

 Alcohol addiction is arguably among the most common. It manifests in

the form of alcohol dependency, binge drinking, or regular heavy
drinking. Alcohol addiction often starts with social drinking and then
progresses further and further until one finds him or herself dealing
with an unbreakable addiction.
 Illicit drug addiction is an addiction to illegal substances that cause
short-term disruptions in the brain resulting in an altered perception
of reality. Illegal drugs cause long-term changes to the brain and other
organs, leading to severe addiction.
 Prescription drug addiction is using approved medications in any way
that has not been prescribed by a doctor. This is becoming
increasingly problematic in the United States today.

Behavioral Addictions
Behavioral addiction is classified as any time that one loses control of their
actions in order to engage in behaviors that result in brief feelings of
happiness. That person becomes dependent on the pleasurable feelings that
come as a result of certain behaviors and begins to compulsively act on that
behavior.

Some common behavioral addictions include:

 Food Addiction
 Sex Addiction
 Internet Addiction
 Pornography Addiction
 Using computers and/or cell phones
 Video Game Addiction
 Work Addiction
 Exercise Addiction
 Spiritual obsession (not to be confused with religious devotion)
 Seeking pain
 Cutting
 Shopping Addiction
 Exercise
 Gambling Addiction

If you have an impulse control disorder, you are especially susceptible to the
compulsive behavior that could lead to a severe addiction. Similarly, mental
health issues or mental disorders can exacerbate the risk for both a
substance use disorder and a behavioral addiction.  

Physical and behavioral addictions are often linked. Over half of those
suffering from addiction to one substance are also using other substances.
Additionally, those battling substance abuse disorders often suffer from
behavioral addictions as well.

There are many similarities between substance addiction and behavioral

addiction. Some of the similarities include the excitement or “high” resulting
from use or behavior, craving the “high”, development of tolerance leading
to increased use or repeated behavior, loss of control, and psychological and
physical withdrawal symptoms

TREATMENT
Behavioral therapy
A meta-analytic review on the efficacy of various behavioral therapies for treating drug
and behavioral addictions found that cognitive behavioral therapy (e.g., relapse
prevention and contingency management), motivational interviewing, and a community
reinforcement approach were effective interventions with moderate effect sizes.
Clinical and preclinical evidence indicate that consistent aerobic exercise, especially
endurance exercise (e.g., marathon running), actually prevents the development of certain
drug addictions and is an effective adjunct treatment for drug addiction, and for
psychostimulant addiction in particular. Consistent aerobic exercise magnitude-
dependently (i.e., by duration and intensity) reduces drug addiction risk, which appears to
occur through the reversal of drug induced addiction-related neuroplasticity. One review
noted that exercise may prevent the development of drug addiction by
altering ΔFosB or c-Fos immunoreactivity in the striatum or other parts of the reward
system. Aerobic exercise decreases drug self-administration, reduces the likelihood of
relapse, and induces opposite effects on striatal dopamine receptor D2 (DRD2) signaling
(increased DRD2 density) to those induced by addictions to several drug classes
(decreased DRD2 density). Consequently, consistent aerobic exercise may lead to better
treatment outcomes when used as an adjunct treatment for drug addiction.

Medication
Alcohol addiction
Alcohol, like opioids, can induce a severe state of physical dependence and produce
withdrawal symptoms such as delirium tremens. Because of this, treatment for alcohol
addiction usually involves a combined approach dealing with dependence and addiction
simultaneously. Benzodiazepines have the largest and the best evidence base in the
treatment of alcohol withdrawal and are considered the gold standard of alcohol
detoxification.
Pharmacological treatments for alcohol addiction include drugs like naltrexone (opioid
antagonist), disulfiram, acamprosate, and topiramate Rather than substituting for alcohol,
these drugs are intended to affect the desire to drink, either by directly reducing cravings
as with acamprosate and topiramate, or by producing unpleasant effects when alcohol is
consumed, as with disulfiram. These drugs can be effective if treatment is maintained, but
compliance can be an issue as alcoholic patients often forget to take their medication, or
discontinue use because of excessive side effects. According to a Cochrane
Collaboration review, the opioid antagonist naltrexone has been shown to be an effective
treatment for alcoholism, with the effects lasting three to twelve months after the end of
treatment.
Cannabinoid addiction
A 2013 review on cannabinoid addiction noted that the development of CB1
receptor agonists that have reduced interaction with β-arrestin 2 signalling might be
therapeutically useful. As of 2019, there has been some evidence of effective
pharmacological interventions for cannabinoid addiction, however, none have been
approved yet.
Nicotine addiction
Another area in which drug treatment has been widely used is in the treatment
of nicotine addiction, which usually involves the use of nicotine replacement
therapy, nicotinic receptor antagonists, or nicotinic receptor partial agonists. Examples of
drugs that act on nicotinic receptors and have been used for treating nicotine addiction
include antagonists like bupropion and the partial agonist varenicline. A 2019 review
looking at the partial agonist cytisine, names it an effective, and affordable cessation
treatment for smokers. When access to varenicline and nicotine replacement therapy is
limited (due to availability or cost), cytisine is considered the first line of treatment for
smoking cessation.
Opioid addiction
Opioids cause physical dependence, and treatment typically addresses both dependence
and addiction.
Physical dependence is treated using replacement drugs such
as suboxone or subutex (both containing the active ingredients buprenorphine)
and methadone. Although these drugs perpetuate physical dependence, the goal of opiate
maintenance is to provide a measure of control over both pain and cravings. Use of
replacement drugs increases the addicted individual's ability to function normally and
eliminates the negative consequences of obtaining controlled substances illicitly. Once a
prescribed dosage is stabilized, treatment enters maintenance or tapering phases. In the
United States, opiate replacement therapy is tightly regulated in methadone clinics and
under the DATA 2000 legislation. In some countries, other opioid derivatives such
as dihydrocodeine dihydroetorphine and even heroin are used as substitute drugs for
illegal street opiates, with different prescriptions being given depending on the needs of
the individual patient. Baclofen has led to successful reductions of cravings for
stimulants, alcohol, and opioids, and also alleviates alcohol withdrawal syndrome. Many
patients have stated they "became indifferent to alcohol" or "indifferent to cocaine"
overnight after starting baclofen therapy. Some studies show the interconnection between
opioid drug detoxification and overdose mortality.