What is dependence?

Causes

Substance abuse is caused by a combination of factors, including inherited genes,
environmental stressors, and, often, an underlying or preexisting mental health
issue, such as depression or anxiety. Social factors, such as peer
pressure to experiment, also come into play. Environmental
stress, whether at work or home, is also a major contributor to cravings that
drive a person to abuse substances.

Physiologically, addictive substances flood the brain’s reward circuit, primarily
with the hormone dopamine. When these reward pathways are
continually overstimulated, the brain produces less of its own hormones and
dopamine receptors. Dependence occurs when the user's brain neurons adapt to
chronic drug exposure and can function normally only in the presence of the drug.
Without the drug, the person experiences a number of withdrawal symptoms,
including agitation, anxiety, and insomnia. The person progressively takes greater
amounts of the substance to overcome tolerance, which leads to profound chemical
changes in neurons and brain circuits that compromise the long-term functioning
and health of the brain.

Risk Factors

Aside from genetics, risk factors for developing a pharmacological dependence
include surviving a disaster or experiencing psychic trauma. Disaster and trauma
survivors are prone to stress-related disorders such as post-traumatic stress
disorder and depression. Such persons may
self-medicate with alcohol or other drugs to relieve
unbearable symptoms. People who suffer from drug dependence are about twice as
likely to suffer from mood disorders than the general
population.

Social factors also may play a role in drug abuse and
addiction. The attitudes and beliefs of one's family members,
peers, and friends about drug use are a significant factor in initial drug use.
Once an individual has begun using a drug, the development of dependence is
thought to depend upon that person's genetic traits, and some people may be
particularly susceptible with developing dependence

Symptoms

According to the fifth edition of the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
published in 2013, there are eleven diagnostic criteria for substance use disorder
organized into four categories: impaired control, social impairment, risky use,
and pharmacological dependence. According to the DSM-5, pharmacological dependence
is characterized by tolerance to the effects of a substance and symptoms of
withdrawal when discontinuing or decreasing use of the substance. The World Health
Organization describe dependence syndrome as "a cluster of physiological,
behavioral, and cognitive phenomena in which the use of a substance or a class of
substances takes on a much higher priority for a given individuals than other
behaviors that once had greater value." Behavioral symptoms of dependence include
neglect of other interest and obligations due to substance use, including the time
spent attaining the drug and recovering from its use, and repeated substance use
despite negative consequences.

Screening and Diagnosis

Toxicology screens, known as drug tests, can be used to determine whether
substances are present in the body. The sensitivity of these tests depends on the
drug itself, when it was taken, and whether the test is done on blood or urine.
Blood tests are more successful at detecting toxic substances, but urine tests are
used more often, in part because they can be done at home and are cheaper and less
invasive to perform than drawing blood samples.

Treatment and Therapy

It can be difficult to convince a person with a drug dependence that he or she
needs treatment. Denial, a common indicator of addiction, is
less of a hurdle when the person is approached and treated with empathy and
respect.

Once a problem has been acknowledged, treatment involves stopping the substance
use either gradually or abruptly (with a period of detoxification) and providing support for the person to
remain drug-free. Dependence is characterized by relapse, as
withdrawal from the substance can cause uncomfortable withdrawal symptoms, and
many people who want to quit have to try several times. Even after long periods of
sobriety, relapses are possible.

The term detoxification refers to a controlled environment in which people may be
monitored as their bodily systems return to normal. Medications may be used to
control withdrawal symptoms, especially with heavy alcohol use, because suddenly
stopping the substance can lead to death in extreme cases of alcohol
abuse. Medications are available for treating dependence to
nicotine, alcohol, and opiates but not to stimulants or marijuana.

Treatment programs exist as in-patient or out-patient services and should be
evaluated based on the type of drug abused, the duration of dependence, and
whether the goal is to quit entirely or to minimize a habit’s deleterious effects.
Twelve-step
programs such as Alcoholics Anonymous and
Narcotics
Anonymous provide networks of support for total
abstinence through reliance on a higher power; some people,
however, do not respond to the spiritual underpinnings of these programs.

Individual and group therapies that employ cognitive-behavioral therapy focus on changing negative
thought patterns to alter behaviors, often with the goal of reducing the habit’s
impact on work and family. Rehabilitation (or rehab) centers exist to separate
more seriously dependent patients.

Prevention

Education on drug dependence is important for prevention, as are strategies for
coping with stress. These strategies can include meditation, yoga,
cognitive-behavioral strategies, physical exercise, and progressive-relaxation
techniques. For those who are recovering from dependence, relapse prevention
involves avoiding places frequented by people using drugs and developing a new
social network that supports the recovering individual in leading a drug-free
lifestyle.

Bibliography

American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th ed. Washington, DC: Author, 2013.
Print.

"Dependence Syndrome." World
Health Organization. WHO, n.d. Web. 27 Oct. 2015.

Essau, Cecelia A.
Substance Abuse and Dependence in Adolescence: Epidemiology, Risk
Factors, and Treatment. New York: Taylor, 2002.
Print.

Kleber, Herbert, et
al. “Treatment of Patients with Substance Use Disorders.” American
Journal of Psychiatry 164 (2007): 5–123. Print.

Liptak, John J., Ester
Leutenberg, and Amy Brodsky. The Substance Abuse and Recovery
Workbook. Duluth: Whole Person, 2008. Print.

White, Jason M.
Drug Dependence. Upper Saddle River: Prentice Hall,
1990. Print.