Transcript Addiction as a Disease PowerPoint Slides

Addiction as a disease
Alcohol training
Dr Akwasi Osei
Consultant Psychiatrist
Ag. Chief Psychiatrist - GHS
23 April 2009
outline
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Some definitions
Models of addiction
Disease model of addiction
Implications of disease model
Some definitions
• Drug abuse – use of hard drug in a manner or
amount that is harmful or potentially harmful
• Drug addiction – compulsive use of hard drug
in the presence of harm (psychological,
physical or social)
• Drug dependence – when one needs the drug
to avoid withdrawal state or to maintain
functional status
Models of addiction
(how to look at addiction)
• Moral issue
• Legal issue
• Disease model
The Spectrum of Substance Use
Disorders
Dependence Syndrome
Substance Abuse
Harmful Use
Hazardous Use
moral
Non-Hazardous Use
Non-User/Abstainer
The disease model of addiction
• This model sees addiction as not a moral
failure, not a criminal offence but a clinical
syndrome requiring appropriate medical or
health intervention
• Biopsychosocial condition
The Concept of Clinical Syndrome of
Addiction/Dependence
A psychobiological syndrome which comprises a strong
desire to use drug, preoccupation with using drug,
and sometimes withdrawal symptoms.
• Features of dependence:
• impaired control over use
• a strong desire to use drug
• preoccupation with using (given greater priority than
other activities)
• increased tolerance to use
• withdrawal symptoms on not using, or relief of
withdrawal symptoms after use
• continuation of using despite harmful effects
Biological basis of addiction as a
disease – the neurone
The synapse trasmission
The reward pathway
Neurobiology/mechanism of drug
addiction
• Three mechanisms at the synaptic junction of brain
nerve cells
• Neural – acute exposure
• Cellular (regulation of ion channels and electrical
properties) – long term exposure
• Molecular mechanisms – long term exposure
• All drugs of abuse initially act by influencing
amounts of neurotransmitter or by interacting
with specific neurotransmitter receptor at the
synapse
• Alcohol - Facilitates GABAA (Gamma-aminobutyric acid) receptor function, and inhibits
NMDA (N-methyl-D-aspartate) glutamate
receptor function
Cont’d
Repetitive substance use:
1. Re-sets the reward system
2. Activates the brain’s stress systems
3. Impairs the pre-frontal inhibitory systems
Cont’d
The result:
An “internal driving force” is generated,
which directs and drives further substance
use and is little influenced by voluntary
control
It is highly reactive to triggers, and the
consumption of the substance in question
How Dependence Develops:
the normal brain
The exposed
brain:
Repeated consumption of
Drugs of abuse
Leads to
Profound
neurobiological
changes, which
“supercharge” the midbrain
And this leads to
The driving force of
substance dependence
Consequences
of exposure:
Physical illness
brain damage
Mental disorder
Social
problems
Factors influencing onset of
addiction
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Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
Predisposing factors
• Biological factors
– Genetic, 10% addicts have genetic predisposition
– Familial
• Psychosocial
– Being a male
– Peer pressure
– Religion
– Home conditions
– Stability of parents’ marriage
– Cultural practices
precipitating/perpetuating factors
• Precipitating factors
– Exposure to drink or drugs for social and other
reasons
• Perpetuating factors
– Persistent exposure
– Lack of treatment
– Lack of social support
Protective factors
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female gender
assertiveness
high commitment to school
high educational aspirations
close affective relationships
absence of parental problems
high religiosity
• close supportive relationships with positiveinfluencing peers
• high self-esteem
• self-efficiency
• creativity
• good temperament
• high sociability
Implications of disease model
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No withdrawal of sympathy
Reduction in stigma
Will seek proper management for addicts
Knowledge leads to prevention and effective
treatment
• Addiction treatable but has high relapse rate
• Addicts should never consider themselves
ever as recovered, but as recovering
Thank you!