Addictions are disorders of human behavior capable of generating discomfort in all vital areas of the person who lives prey to them. Although not much is yet known about the specific pathogenesis of addictive disorders, dependence or substance use disorders (as they are usually called at the professional level), it is accepted by the scientific community that not all people exposed to the use of potentially psychoactive substances or repetitive behaviors develop this type of pathology, but that it is due to a multi-causal result that responds to the vulnerability-stress-confrontation model.
This means that the interaction of intrinsic factors (innate and genetic vulnerability) and extrinsic factors (aspects related to experiences, education, maturational development, coping with stress and exposure to certain stimuli). Therefore, a person vulnerable to developing an addictive disorder is considered to be at risk throughout his or her life, if different factors are aligned in relation to a potentially pleasurable stimulus (substance or behavior).
According to the above mentioned, addictions can be considered diseases of the person in which not only the organic and psychological part of the human being comes into play, but also extends beyond the individual and permeates his different areas of functioning, the way he handles himself in life and his way of relating to the world. It is precisely this openness to the outside world, its effects and its consequences that determines the prognosis and long-term recovery and defines the multidisciplinary and integrative approach that the person with addiction needs during the different phases of treatment.
At what point is a behavior considered to be addictive?
The development sequence of addiction is very similar in different people, the difference lies in the time it takes for each of the development phases to settle.
The first phase is the punctual pleasurable consumption in which there is no impact on the individual and he/she enjoys some control to choose when and where the exposure to the stimulus or potentially pleasurable substance takes place.
The second phase is considered inertia. At this point there is a more repeated exposure, tolerance and dependence phenomena appear in which control has diminished but the evident consequences are minimal. It is precisely in this state that people recognize the existence of a more attenuated well-being and pleasure than in the previous phase and often “do not know why they do it” and there is a certain need to maintain a repetition of consumption, as well as a false sensation of innocuousness and of “being able to stop consuming whenever they want”.
The third phase is addiction itself. At this point, seeking behavior becomes frequent, repetitive, obsessive and uncontrollable. There comes a time when the person is not able to stop the addictive behavior because it generates a significant personal discomfort and the repetition becomes unstoppable to avoid the so-called “negative reinforcements” such as: anxiety, fear, insomnia, irritability, obsessiveness… symptoms that appear when the person is not consuming the substance or performing the addictive behavior. In this phase, during 24 hours a day, the person’s thoughts revolve around the consumption or the possibility of it.
Most common addictions
The most common addictions continue to be those derived from substance use, mainly alcohol, tobacco (nicotine), cocaine and cannabis. These are followed by the rest of the illegal drugs, with increases in the incidence of designer drugs and heroin.
As for other types of substances, there is an increased incidence of self-administration of tranquilizers from the benzodiazepine group and morphine-derived analgesics, which can generate phenomena of dependence and tolerance with an easy escalation of doses. For this reason, this type of drug requires strict supervision by the health professional.
On the other hand, there are behavioral addictions. The best known is compulsive gambling, while other behavioral addictions include addiction to new technologies, to work, to sex, to compulsive shopping, etc. Precisely in this type of repetitive behaviors, the boundary between addiction and compulsion is blurred, since in this type of people we often find the coexistence of other mental disorders concomitant to the repetitive behavioral conduct.
Psychiatric treatment for addictions
The Psychiatry expert, as a medical health professional, has the fundamental role of:
- Evaluate the signs and symptoms.
- Make the recommendation to request complementary tests such as analytical and neuroimaging tests.
- Evaluate the medical repercussions of the substances consumed.
- Make a reliable diagnosis of the addictive disease or other emotional disorders or psychiatric disorders.
- Define the most efficient and individualized therapeutic actions for each patient, according to his or her evolutionary stage.
The psychiatrist needs a team of professionals from other disciplines and other areas of knowledge with experience in dealing with addictions, such as psychologists, occupational therapists, nurses or social workers. The objective is to create a bond and a stable therapeutic relationship with the patient and his or her closest environment that is capable of generating a prolonged state of abstinence and a displacement of the addictive behavior towards healthier behaviors that ensure the differentiation and autonomy of the patient.
Recommended therapy in the approach to addictions
The medical and psychological approaches used in addictions should move away from absolute positions and therapeutic nihilism. For many years it seemed that in the treatment of addictions “anything goes” or “nothing works”. It is neither one thing nor the other. To ensure a good outcome for the patient with addiction, it is necessary to identify the real needs of the patient and to evaluate his or her evolutionary state and assumption of real change. Thus, the professional must encourage a transparent, honest and objective approach by the whole team, which includes patients, family and professionals alike. It is necessary that the treatment and therapies have proven efficacy and that they are the most appropriate in each of the patient’s stages of recovery, working towards autonomy and assumption of responsibilities in a climate of trust and maximum commitment.