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MEDICAL MODEL OF SUBSTANCE ABUSE AND SUBSTANCE DEPENDENCE

Substance use disorders are complex chronic, relapsing and remitting diseases in both presentation and pathogenesis, resulting in significant morbidity and mortality. Despite the neurochemical changes and the chronic and relapsing nature of these diseases, treatment is effective and recovery possible. http://www.drugabuse.gov/scienceofaddiction

Substance use disorders are characterized by compulsive drug seeking and use despite harmful physical, psychiatric, and interpersonal consequences. (9,10)
Substances of abuse alter brain function, impact many health conditions, and can lead to major public health problems, including the transmission of HIV, hepatitis, and tuberculosis.
Steady use of psychoactive substances causes biochemical and structural changes in the brain that limit self control and result in substance abuse and dependence as defined in the DSM IV-TR (see text under the heading “Diagnostic Criteria,” below). Substances of abuse acutely activate and chronically dysregulate brain reward functions, largely via mesolimbic dopamine pathways. Brain-imaging studies show changes in both anatomy and physiology in areas known to be critical for judgment, decision making, learning, memory, and behavior control. (11) See also http://www.drugabuse.gov/pubs/teaching/Teaching6/Teaching.html.
“Addiction” is a commonly used but frequently nonspecific term. In this text, “addiction” is defined as a chronic, relapsing brain disease, characterized by compulsive drug seeking and use despite known harmful consequences. It may include physical dependence, which refers to brain changes associated with daily substance use that produce noxious symptoms (e.g., gooseflesh, runny nose, hyper-alertness, sweating, tremor, confusion) when the person stops using (i.e., withdraws). Withdrawal is a powerful stimulus to use again, and the symptoms abate when use is restarted. However, physical dependence is not the same as addiction.

Please click the video button on the left to watch Cliff, a Family Physician, talking about his substance use and how he became addicted.

Substance use disorders have a multi-factorial etiology, including genetics (can account for 40–60%), biologic changes in brain function, and pre-existing co-morbid Axis I psychiatric disorders.(9,10,11) Family history, societal, and life events can also be important etiologic factors. However, most people who "experiment" with drugs or alcohol do not develop a substance use disorder.

Please click the video buttons on the left to watch Michelle discuss how mental health issues led to addiction and Rhonda discuss the complex life circumstances that led to her addiction.

Substance use disorders are a major co-factor in societal violence.
Substance use often begins in childhood or adolescence, when the brain continues to undergo dramatic changes. One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that enables us to assess situations, make sound decisions, and keep our emotions and desires under control—putting adolescents at increased risk for poor decisions (such as trying drugs or continued abuse). Moreover, the immature brain may be particularly vulnerable to chemical changes caused by psychoactive drugs, and therefore drug use may increase the risk of abuse or dependence in adolescents and young adults. Adolescents who use alcohol or other psychoactive drugs also frequently have academic and social problems, as well as encounters with the criminal justice system.
Symptoms of substance abuse, dependence, and withdrawal can mimic symptoms of major psychiatric disorders.
Treatment works! Treatment enables people to regain control of their lives and counteract the powerful disruptive effects on the brain and behavior of substance abuse or dependence. (10,11,12)
Relapse rates for treatment of substance use disorders are similar to those of other chronic illnesses, like asthma or diabetes. Thus, substance use disorders should be treated like any chronic illness, with relapse serving as a trigger for renewed intervention.