Definitions and Concepts in Physical Dependency

Most exposures to drugs that are considered to have addiction potential do not result in the disease of addiction [11]. Each person has a particular underlying genetic risk for developing addiction if exposed to a certain type of drug in a certain environment [16, 17, 18]. Environmental factors play a critical role, and exposure to the drug(s) of abuse plays an essential role. Although the choice to try a drug may be voluntary, the drug effects can be influenced profoundly by genetic factors [11, 18]. In addition, enduring and possibly permanent neuroadaptive responses to long-term drug use may contribute to persistency of drug intake, relapse, and craving [11, 19].

The interaction of the drug with a person's biology involves reinforcement pathways - the reinforcing effects of certain drugs contribute largely to their abuse liability [20, 21]. These reinforcing properties are associated with their ability to increase neurotransmitters such as dopamine and serotonin levels of in the brain. The neuronal pathways of drug addiction are components of the mesocortico-limbic dopaminergic systems [20]. Cocaine, amphetamines, ethanol, and opioids all increase extracellular fluid dopamine levels in the nucleus accumbens, although through different mechanisms [11, 8, 6, 22]. The mesolimbic circuit has been implicated in acute reinforcing effects, memory, and conditioned responses linked to craving and the emotional and motivational changes of the withdrawal syndrome [19, 8]. The mesocortical dopamine circuit is involved in the conscious experience of the effects of drugs, drug craving, and the compulsion to take drugs [19]. Generally, addictive drugs act as positive reinforcers (producing euphoria) or negative reinforcers (alleviating symptoms of withdrawal or dysphoria) [8]. Drug characteristics such as rapid onset and intensity of effect increase the potential for abuse [8].

Personality and personal choice is clearly involved in the initiation of drug use -some individuals are inherent risk takers and have novelty-seeking traits, while others are more risk averse [8]. The interaction of the environment with biology creates an individual's psychologic make up (Figure V-1), influencing their learning and how they will respond to environmental stimuli [8, 11].

Addiction is not merely a disorder of drug abuse, and the widely held view of drug addiction as a moral or behavioral problem rather than a medical disease undermines treatment efforts [15]. To devise effective treatment strategies for addiction, it is necessary to understand the interactions of pharmacologic, biochemical, psychiatric, genetic, behavioral, social, and spiritual realms.

Twin studies have established substantial genetic influences on substance abuse disorders [23, 16, 24, 25, 17]. Alcoholism is the best-studied addiction: about 40%

Figure V-l. An integrative model of substance related disorders

of the risk for the disease appears inherited [15, 26]. In addition, the environment and social influences play a role in the development of substance disorders [23, 16, 18]. There is considerable psychiatric co-morbidity among substance abusers, and these patients may have more serious substance abuse histories, poorer outcomes, and increased relapse [27, 28, 29, 8]. Spirituality has long been emphasized as an important factor in recovery from addiction. People with strong spiritual beliefs are healthier, heal faster, and live longer than those without them. A report by the National Center on Addiction and Substance Abuse concluded that clinicians should understand better the importance of spirituality and religion to the prevention and treatment of addiction, and of the spiritual and religious resources available in their communities [30]. In summary, addiction therefore can be considered

• A primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations (Figure V-2)

• Characterized by behaviors that include one of more of the following:

1. Impaired control over drug use

2. Compulsive use

3. Continued use despite harm

4. Craving

Figure V-2. Addiction: A multi-factor disease state
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  • edgardo
    What are concepts physical dependency?
    1 year ago

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