OVERVIEW

Ever felt attached to a substance or activity to the extent that it seems you are enslaved to it? Well, you might be addicted to it. You don’t necessarily have to be using recreational drugs to be an addict as most people think.
However, any substance or activity which you have an urge to take or perform to make you feel better or do better is an addiction.
In that case, let us explore addiction into detail.

DEFINITION 

Addiction is defined as a psychological and physical inability to stop consuming a chemical, drug, activity or substance, even though it is causing psychological and physical harm.
As mentioned earlier, addiction does not refer only to substance dependence such as heroin or cocaine. It can also involve inability to stop partaking in activities such as gambling, sexual intercourse, working, eating, watching pornography and so on. In such circumstances, a person is said to have a behavioral addiction.
When a person begins to experience an addiction, they cannot control how they use a substance or partake in an activity, and eventually they become dependent on it to cope with daily life.

ETIOLOGY

Every addiction always starts from an urge and a loss of self-control. This urge is what is referred to as cravings. After the initial use of the substance or partaking of the activity for the first time, they engage in substance abuse or in the activity voluntarily. However, addiction sets in over time and causes a loss of self-control.

What then are the forms of addiction?

Types

Addiction is grouped into two main categories mainly behavioral addiction and substance addiction.

1. Substance addiction:

This involves overuse of medications, recreational drugs or chemicals. These normally include pain medications such as opioid painkillers, recreational drugs such as heroin and chemicals such as alcohol.

It is important to note that substance misuse or abuse is not the same as substance addiction. Substance misuse or abuse refers to the incorrect, excessive or non-therapeutic use of substances altering both body and mind.

Whereas substance addiction is chronic and involves a long-term inability to cease or moderate intake, substance abuse is acute and involves moderate or ceased intake of a substance due to serious consequences of previous abuse.

2. Behavioral addiction:

This involves the inability to stop partaking in activities which alter or harm the psychological and physical state of the person.

These activities are numerous, however the most common ones are gambling, eating, working, playing videogames, watching pornography and sexual intercourse.

 

EPIDEMIOLOGY

In a recent study on addictive disorders in Sub-Saharan Africa, alcohol and cannabis were the main psychoactive substances associated with addictive disorders.

Among the youth, cannabis is the third most frequently used substance in Africa and with up to 40% of young people admitted to psychiatric hospitals in Africa on account of cannabis or drug-induced psychosis.

Tobacco, the second most frequently used psychoactive substance among young people in Africa is responsible for about 200,000 tobacco-related deaths in the year 2000 according to WHO.

The prevalence of tobacco smoking was 29% for males and 7% for females and among adolescents aged 13-15, it ranged from 13% in Kenya to 37% in Uganda.

Inhalant use (vaping or shisha) is also widespread among children and adolescents in Africa, especially those from the poorest economic backgrounds, with broken families, who have dropped out of school, or who are street children who are difficult to reach. This has harmful effects to organs such as the kidney, liver, bone marrow and heart. Most of the young users may not be aware of these adverse effects on their health.

Signs & Symptoms 

The primary features of addiction are as follows:

• Impaired control:

A craving or strong urge to use the substance or uncontrollably engage in harmful levels of habit-forming behavior.

• Social problems:

Failure to complete major tasks at work, school or home. Social, work or leisure activities are forfeited or cut back because of substance use or harmful behavior.

• Hiding substances or behaviors and otherwise exercising secrecy.

• Profound changes in appearance, including a noticeable abandonment of hygiene.

• Substance effect:

Tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance).

• Increased risk-taking, both to access the substance or activity and while using it or engaging in it.

DIAGNOSIS

Diagnosis and treatment of addictions involves a multidisciplinary approach between the doctor and the psychiatrist.

However, your health practitioner can identify an addiction by the following:

• Asking relations or colleagues about the person’s behaviors and any physical symptoms

• Interact with the person and observe how he or she acts

• Some blood tests can be done to see if it is an issue with the person’s physical health

WITHDRAWAL

Withdrawal refers to clinical features experienced by addicts when they cease taking a substance or engaging in a harmful behavior.

The following are symptoms they may experience:

• Anxiety
• Irritability
• Tremors
• Nausea
• Vomiting
• Fatigue
• Loss of appetite

Abrupt stop of substance addiction such as alcohol or benzodiazepines without medical supervision, can lead to fatal withdrawal symptoms.

Treatment

Advances in medicine has led to the easy diagnosis and management of addiction.

The following methods used include:

• Behavioral therapy and counselling

• Medications

• Electro-convulsive therapy

Addiction treatment is highly personalized and often requires the support of the individual’s community or family.

Treatment differs based on the substance or behavior involved.

Prevention 

The following strategies are normally implemented in reducing the prevalence of addiction and rehabilitating those suffering from addictive disorders:

• Assertive Community Treatment:

Developed from deinstitutionalization, it provides a safe net for people with addictive disorders. This involves a team of social workers, rehabilitation specialists, counselors, nurses and psychiatrists (a multidisciplinary team).

The team provides individualized services to people who have serious addictions and cannot or will not go to the clinic for help.

These services are provided in the person’s own home or neighborhood.

• Social Support:

Recent studies have shown that strong social support may significantly improve recovery from physical and mental illnesses. Self-help groups and mutual aid groups such as Alcoholics Anonymous;

Narcotics Anonymous which focus on addictive behavior and National Alliance for the Mentally Ill, which focuses on supporting families of people who have a severe mental illness, have been of immense benefit.