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ADDICTION: Disease or Bad Habit?

Disease or Bad Habit?

Many are the times I hear people, especially frustrated parents say, “Amerudi kwa tabia yake mbaya ya kuvuta bangi…nimechoka na yeye! Shauri yake!” (He’s gone back to his bad habit of smoking cannabis… I’m tired! It’s his fault!” While initiation of alcohol or any other ‘drug’ use may be as a result of peer pressure or bad company, some people may find themselves self medicating with substances due to an underlying mental illness such as major depressive disorder (depression) to lift their mood; bipolar mood disorder in attempt to stabilize their mood; anxiety disorder to calm themselves, attention deficit hyperactivity disorder (ADHD) to try and concentrate on a task; or schizophrenia perhaps to make the ‘voices’ disappear.

According to the American Society of Addiction Medicine (ASAM), Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.

Apart from drug addiction, people can develop addictions to other human behaviour or experiences such as food, sex, gambling, pornography, exercise, internet, television, shopping, role-playing games, among others. Addiction is commonly used interchangeably with the term ‘Substance Use Disorders’, which refers to a pattern of continued pathological use of a psychoactive substance that may cause serious physiological, behavioral and social consequences.

According to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), a diagnosis of substance use disorder is made considering the following criteria:

1. Taking the substance in larger amounts or for longer than you are meant to.

2. Wanting to cut down or stop using the substance but not managing to.

3. Spending a lot of time getting, using, or recovering from use of the substance.

4. Cravings and urges to use the substance.

5. Not managing to do what you should at work, home, or school because of substance use.

6. Continuing to use, even when it causes problems in relationships.

7. Giving up important social, occupational, or recreational activities because of substance use.

8. Using substances again and again, even when it puts you in danger.

9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.

10. Needing more of the substance to get the effect you want (tolerance).

11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

The severity of the disorder depends on the number of symptoms: mild – 2 to 3 symptoms; moderate – 4 to 5 symptoms; severe – 6 or more symptoms. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Psychoactive substances work on the mind or on behavior by altering one’s mood and the way they think and act. They can be broadly categorized as depressants, hallucinogens and stimulants. Depressants such as alcohol, benzodiazepines, opiates/opioids, low dose cannabis and some inhalants/solvents slow down the respiratory and cardiac centres in the brain. Hallucinogens distort the senses and produce hallucinations, which are experiences that depart from reality. Examples are high dose cannabis, ecstasy and ketamine. Stimulants are either synthetic or plant derived substances that increase alertness and arousal by stimulating the central nervous system. They include nicotine, khat (miraa), cocaine, amphetamine and methamphetamine.

Some prescription drugs such as benzodiazepines (diazepam, alprazolam, bromazepam etc) and opioids like pethidine, morphine, codeine, fentanyl, methadone among others, have a high potential for addiction when used without medical supervision, on high doses or for longer duration than prescribed. There has also been an emergence of new psychoactive substances (NPS) either in pure form or a preparation, which are sold even through the internet. Examples include ketamine, piperazines, pnenethylamines, synthetic cannabinoids, synthetic cathinones, plant based substances. There is also an increasing trend towards using more than one drug at a time, especially among the youth.

Diagnosis of Substance Use Disorder can be made by a health professional after getting a detailed history of one’s complaints and drug use, doing physical examination and laboratory investigations. Assessments using appropriate tools/tests can also aid in making a diagnosis. Management is by use of both medication and psychosocial interventions. Treatment can take various forms such as management of withdrawal symptoms also referred to as medical detoxification; management of intoxication and overdose; maintenance treatment as in the case of opioid use disorders. Some people may present with concurrent medical or psychiatric disorders which also require treatment.

Relapse prevention is also a key component of treatment of substance use disorders. All these interventions can be done either in an outpatient or inpatient setting depending on the severity of the illness and the psychosocial needs of the person.

If anyone is concerned that they may be having a problem with substance abuse or addiction, it is important that they seek help immediately from the nearest health facility whereby they shall be directed to the appropriate health care providers.

Please remember that:

· Addiction is a disease, not a choice

· Addiction is progressive, chronic and can be fatal

· Young brains are at highest risk due to its unique stage of development (especially adolescents)

· Addiction is very treatable especially if one seeks help early

· It is important to focus on prevention of addiction

· Early interventions, assessment and treatment are the keys to successful recovery from addiction

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