Concept, classification and stages of drug addiction (+Infographic)

Concept, classification and stages of drug addiction (+Infographic)

Concept

Addiction: A disease-generating lifestyle that damages the human being in his biological, psychological, social, familial, occupational, and spiritual unity.

Dependence: (Clinical criteria as per DSM-V, the Diagnostic and Statistical Manual of Mental Disorders). Unmanageability = Subjugation or loss of freedom in the face of the substance.

Addiction = Impulse due blockage of the cerebral cortex that happens when drugs are consumed and only the subcortex remains working, giving way to impulses.

Dependency = Lack or loss of emotional or spiritual control and familial, social and personal functionality.

Tolerance: When an individual needs to consume substances in greater quantity and frequency, so they increase them. Increased tolerance syndrome and decreased tolerance syndrome (for example the combination of the effects of alcohol with cocaine).

Classification of drugs according to their effects on the Nervous System

  • Stimulants: Cocaine, crack, amphetamines, cocoa, cigarettes, coffee.
  • Depressants (inhibitors): Alcohol, heroin, marijuana, anxiolytics.
  • Hallucinogenic, dissociative, and psychedelic drugs: Mushrooms, LSD, ecstasy, peyote.
  • Drugs with simultaneous effect: Cigars (stimulant and depressant) and marijuana (hallucinogenic and depressant).

Drug use generates tolerance and withdrawal, but these are not sufficient criteria to diagnose addiction, for which one also needs to meet the dependency criterion (DSM-V Clinical Criteria).

Withdrawal: The signs, symptoms and discomforts that appear when you stop consuming a certain substance or its effects pass. These are avoided by consuming it again, since the body and mind, already dependent on the drug(s) demand them. 

Pathways of entry and maintenance to addictions

Sociocultural Way: Through macrosocietal permissiveness towards the consumption of legal and illegal substances, which are given indiscriminate publicity and propaganda through the mass media, cultural customs associated with wine consumption, stereotypes and myths such as "men must drink"; and the microgroups including family, friends, colleagues and neighbors. This is a product of the customs, traditions and conventions of different cultures, it is closely related to the pressure exerted by big or small social groups. An example would be an adolescent who says yes to drugs to demonstrate "boldness" to his peers who, in their immaturity, underestimate him for not "having been initiated". Paradoxically, that same group during their adulthood will reject those who have not been able to free themselves from the drug as "weak or slow".

Hedonic Way: (from hedonism or pleasure Vs anhedonia), associated with consumerism. Although it’s closely linked to the first way, it is characterized by the search for "pleasure" being the most important motivation for repeated consumption, without realizing that those minutes of artificial "pleasure" will turn into decades of suffering for the addict and their loved ones. This way is the most important in patients with dissocial traits prior to addiction.

Assertive Way: Disinhibition, self-affirmation of security and confidence. It refers to the use of the substance as a crutch to face situations that are feared to some degree or cause insecurity or anxiety; it frequently happens to shy people.

Evasive Way: Avoid problems via consumption and "drown sorrows in alcohol". It has been highly emphasized in scientific literature to the point of considering it as the most relevant. It is the attempt to "drown" present or past sorrows of conscious or unconscious nature.

Symptomatic way: Relief of symptoms resulting from other diseases, comorbidities and dual diagnoses. Where there is an underlying condition, usually a psychiatric one such as depression, mania, obsessions, phobias and others.

Constitutional or Genetic Way: Genetics or biological inheritance, which is influential but not determinative; and environmental inheritance, through families tolerant to substances, learning processes, modeling, imitation and identification. It is the most questioned and must be taken into account carefully in subjects who present both a family history of drug addicts and an early onset, in the absence of other hegemonic pathogenic mechanisms nor dissocial tendencies.

Dependency syndrome

It is a set of physiological, behavioral and cognitive manifestations in which the consumption of a drug, becomes the highest priority for the individual, even greater than any other type of behavior that in the past had the highest value. The main manifestation of the dependency syndrome is the strong and sometimes insurmountable desire to ingest psychotropic substances including those prescribed by a doctor. Relapse into substance use after a period of abstinence leads to more rapid onset of the rest of the syndrome's features than when it happens in non-dependent individuals.

Diagnostic Guidelines

The diagnosis of dependency should only be made if three or more of the following features have been present at any time in the previous twelve months or on an ongoing basis:

  • Intense desire or compulsion to consume a substance.
  • Decreased ability to control the consumption of a substance or alcohol, sometimes to control the beginning of consumption and others to be able to end it or control the amount consumed.
  • Somatic symptoms of withdrawal when the consumption of the substance is reduced or ceased, when the diagnosis of withdrawal syndrome characteristic of the substance is confirmed; or the same substance (or a very similar one) is used with the intention of relieving or avoiding withdrawal symptoms.
  • Tolerance, that is, a progressively larger dose of the substance is required to achieve the same effects that originally had been produced by lower doses (clear examples are alcohol and opiate dependence, in which there are individuals who can reach to ingest doses sufficient to incapacitate or cause death to people who haven’t developed tolerance).
  • Progressive abandonment of other sources of pleasure or entertainment, due to the consumption of the substance, increase in the time necessary to obtain or ingest the substance or to recover from its effects.
  • Persistence in substance use despite obvious harmful consequences, such as liver damage from excessive alcohol use, depressed moods following periods of heavy substance use, or cognitive impairment secondary to substance use. It should be thoroughly investigated whether the person consuming the substance is aware, or may become aware, of the nature and severity of the harm.

Stages or phases of addictive disease related to disease awareness

  • Precontemplative: The person is not aware of the disease, is in total denial, self-delusion; does not recognize problems caused by consumption, therefore does not seek or accept help.
  • Contemplative: The person identifies and accepts that they have problems caused by consumption, is aware of their illness, but does not act, simply passively contemplating their situation instead.
  • Preparatory: They feel ambivalent, want to stop consuming and seek help, but at the same time want to continue consuming. Increased awareness of the problem.
  • Action: The addict is mobilized, energized, motivated to seek, accept and receive help. They know their illness. The actions cover all spheres of their life, producing changes in Lifestyle (personally and socially productive activities: study, work, self-improvement, healthy use of free time), as healthy alternatives to the addictive lifestyle, renouncing risk factors and situations such as fellow drinkers and places of consumption. They learn to manage symptoms and emotions (self-control, self-regulation) and to enjoy and feel happiness without substance use.
  • Relapse Prevention Stage: Either psychological, behavioral or of drug use. The awareness of the disease deepens and is reaffirmed. Risk Factors (related to drugs and psychosocial and personal problems) have been identified and resources (skills, abilities, "tools", learning, values and attitudes) are activated to maintain abstinence, coping and problem solving (Relapse Prevention and Action Plan). A Structure of Daily Life is consolidated, as part of the Life Project in the short term, as well as planning in the medium and long term. 

The four cardinal signs of addiction

1. Obsession.

2. Lack of control (ungovernability).

3. Denial.

4. Negative consequences.  

1.1. Obsession - compulsion. Addictive behavior is often compelling and exhausting. When one is addicted to something, they often can't stop thinking about it and planning their next use. When the time to consume the substance they’re addicted to approaches, they experience anxiety and excitement that will not subside until they’re done, the obsession will take much of their time, energy and attention.

2. Lack of Control. If you have acquired an addiction, you will usually be unable to control or stop the corresponding behavior once you have started (drank the first shot), with seeming ungovernability or subjugation and loss of freedom in the face of the substance (dependence). Despite all your good intentions or promises you can make to yourself and others. The distinctive feature of addictive behavior is that in trying to control it, the force of will is not enough! The substance or activity in question is controlling you, instead of you having control over its use.

3. Denial. Immature defense mechanisms are the mind's way of controlling attention and the trauma of having a long-term illness. Denial is a fictitious mental process, denying your own addiction and its consequences, that is, being out of touch with reality. Rationalization, intellectualization, minimization, displacements of the disease express rupture with objective reality through ideo-affective-conative dissociation, which can manifest as micropsychosis (alterations of the thought process). It can be expressed through the minimization the substance and its consequences, comparisons with other consumers or people or by absolute denial.

Forms of denial.

  • Strict denial: "I don’t have a problem."
  • Minimizing: “it is not so serious”.
  • Avoiding the topic entirely.
  • Blaming someone else.
  • Rationalizing and intellectualizing: "mine is not as serious as someone else's."

4. Negative consequences in all biopsychosocial dimensions. 

  • Biological: Digestive, hepatic, respiratory, cardiovascular, renal, neurological disorders, skin lesions and others.

  • Psychological: Negative mood states, depressive and anxious conditions, sleep disorders, defensive attitudes, low self-esteem, feelings of guilt, shame, suicidal ideas, suicide, violence, lack of projects, sexual dysfunctions, psychotic conditions and others.
  • Social: Criminal behavior, work problems due to absences, late arrivals, decreased performance, job loss, economic problems, legal conflicts and others.  
  • Family: Decrease in the quality of interpersonal dynamics, due absences, isolation from the family, loss of roles, duties and functions as a family member, communication disorders, couple instability.

Conclusions

If you think you are not on the right path, before making a bad decision, STOP! Seek family support and specialized health professionals.

You can do it! Start now...