Alcohol trainingDr Akwasi OseiConsultant Psychiatrist

Ag. Chief Psychiatrist - GHS

23 April 2009

Addiction as a disease

outline

• 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

Substance Abuse Harmful Use

Hazardous Use

moral Non-Hazardous Use

Non-User/Abstainer

Dependence Syndrome

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-amino-butyric 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 systems3. 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 ofDrugs of abuseLeads to Profound neurobiologicalchanges, which “supercharge” the mid-brain

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

• 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

• female gender• assertiveness• high commitment to school• high educational aspirations• close affective relationships• absence of parental problems• high religiosity

• close supportive relationships with positive-influencing peers

• high self-esteem• self-efficiency• creativity• good temperament• high sociability

Implications of disease model

• 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!