Addiction & how its perception has changed overtime
The word “addict” comes from the Latin word “addictus”, which means “to devote, or sacrifice. Previously, the term “addiction” referred to a form of self-imposed enslavement. In the 18th century, addiction was thought to be a problem of willpower or morality. In other words, the person with an addiction was considered as having a weak character. However, society’s understanding of what causes addictive behavior has changed over time. A question that continues to exist is what makes some people consume substances in moderation whereas others may not. What is truly intriguing is the transition of casual or moderate substance consumption to chronic usage. History provides frequent accounts of people struggling with addiction. According to the American Psychiatric Association, addiction is described as the “continued, compulsive use of substances or behaviors despite harmful consequences”. Society viewed addiction as an individual’s lack of willpower to refrain from consuming substances. In the 19th century, society began to conceptualize addiction as an act of self – medication for an untreated mental illness, rather than a moral failing. The self-medication hypothesis explains that people who use addictive substances in problematic ways are seeking relief from psychological suffering. Research shows that even when the underlying psychiatric symptoms might get treated, people who are addicted will continue to use substances in problematic ways. Studies show that addictive substances typically make psychiatric symptoms worse in the long run. Today we use the Disease model of addiction which asserts that addiction is its own disease with its own genetic footprint and not a consequence of another mental illness. The disease model of addiction is based on two major scientific underpinnings.
1) Addiction is heritable. Research shows that 50 to 60% of the risk of becoming addicted is inherited. 50% of biological offspring of people with alcohol addiction will go on to develop an alcohol use problem, even if adopted by another family and raised in a non-addictive environment.
2) The brain undergoes permanent changes as a result of heavy, prolonged use of addictive substances. Transmission of the brain‘s pleasure neurotransmitter (Dopamine), is reduced, and this dopamine-deficit state persists long after substance use has ended.
The disease model of addiction provides the most valid and inclusive explanation until now. It also removes stigma to a great extent instead of blaming or discriminating people who have addiction issues. The understanding that addiction is in fact a disease has resulted in many positive changes in the way substance use problems are addressed.
How DSM has evolved overtime with respect to addiction?
Substance use disorders are generally referred to as addiction to substances like alcohol, cannabis, nicotine, heroin, etc. However, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), includes the classification of addiction that are not only substance-related but also includes behaviors like gambling. Since DSM-III, substance use disorders have been included as a separate diagnostic category. Before the third edition, however, they were still regarded as manifestations of underlying psychiatric symptoms. The most important change occurred between the DSM-IV and DSM-V. In the DSM-IV, addiction could be categorized as substance abuse or substance dependence. A substance abuse diagnosis required patients to have one or more of the symptoms listed for the same category at any given time. A substance dependence diagnosis required the manifestation of 3 or more symptoms listed for that category in a 12-month period. According to the DSM-IV, people who met the criteria for both substance abuse and substance dependence for a particular substance were diagnosed with substance dependence only, as it was classified at a higher severity than substance abuse (Substance Abuse and Mental Health Services Administration, 2016). However, this particular diagnostic criteria was becoming problematic as there were people who might have two symptoms of substance dependence, but no symptoms of substance abuse. So these people could not meet any specific diagnostic criteria. The term “abuse” also has a negative connotation which causes stigmatization among people with addiction issues. For these reasons, the DSM-V combines these diagnoses into a single category called Substance Use Disorders. Although we have reached this far, have we really been able to bridge the gap between the addiction and mental health services?
Risk factors of addiction
Society has gone from a moral to the self-medication hypothesis and to the disease model of addiction in understanding its root causes. It’s also important to know about a few risk factors for addiction. Studies have shown that addiction is the result of our genes interacting with our environment to produce this diseased state. As mentioned above we know that genes play an important role here. Genetic studies have also attempted to characterize genetic vulnerability to addiction. People with co-occurring mental illnesses are also at increased risk of becoming addicted. In addition to the genes we are born with, our life experiences also have an impact on increasing our risk for addiction. It is seen that the risk for addiction also goes high when we’re raised in a home where parents or caregivers use substances. Pressure from peers to experiment with substances and social networks where substance use is common is also seen as risk factors for addiction, especially during adolescence. One of the biggest risk factors for getting addicted to any drug is by having an easy access to that drug. With greater access, we’re more likely to try a drug. In trying it, we’re more likely to get addicted to it. On the contrary, when drug supply is decreased, use decreases. One of the example is that cigarettes are available on every street corner for the price of a cup of tea. But we also now have electronic cigarettes – stylish, discreet, odorless, rechargeable, etc.
BIBLIOGRAPHY:
- The self-medication hypothesis of substance use disorders: a reconsideration and recent applications E J Khantzian 1
- https://www.etymonline.com/word/addict
- Evaluation of revised criteria for the DSM-III substance use disorders diagnoses https://elischolar.library.yale.edu/cgi/viewcontent
- Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun.
- Is addiction is a disease? https://drugfree.org/article/is-addiction-a-disease/
- Risk Factors Associated with Drug Use: The importance of ‘risk environment’, July 2009 Drugs: ;Education Prevention and Policy