Addiction as a Disease by lifemate

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									Addiction as a Disease
   Arlin J.Silberman D.O.,FAOAAM
   Certified in Addiction Medicine
   Certified in Addiction Psychiatry
   Fellow of the American Osteopathic
    Academy of Addiction Medicine
Abuse vs Dependence
   There is a difference between intentional
    drug abuse and pathological drug
    dependence.
   The latter is what is referred to as
    addiction.
Chemical Abuse
   Maladaptive pattern of drug use leading to
    impairment or distress,presenting as one
    or more of the following over a 12 month
    period-failure to fulfill obligations,use that
    is physically hazardous,drug related legal
    problems,and continued use despite
    social/interpersonal problems.
Chemical Dependence
   3 or more of the
    following:tolerance,withdrawal,drug used
    more than intended,inability to control
    use,effort to obtain drug,important
    activities replaced by drug use,use despite
    negative consequences.
Present Understandings
   Drug abuse causes short-term and long-
    term changes in brain function.
   Medial forebrain bundle(mesolimbic
    dopamine system)
History
   References made in the civilizations of
    ancient Egypt and Greece,called ‘drink
    madness’.
   In colonial America, Anthony Benezet
    noted drunkenness to self accelerate.
   In 1784 Dr.Benjamin Rush wrote a
    pamphlet describing an ‘odious
    disease’and a ‘disease induced by a vice.’
History cont.
   Rev.Lyman Beecher’s sermons in 1825
    describes ‘intemperance is a disease as
    well as a crime.’
   Dr.Samuel Woodward recommended
    special asylums for the treatment of
    inebriates.(1830’s)
First Treatment Facility
   In 1864 the New York State Inebriate
    Asylum founded by Dr.Joseph Turner.
Disease Concept
   Dr.William Sweetser described
    intemperance causing a ‘morbid alteration’
    in nearly all the major structures and
    functions of the human body.(1829)
Concept of Alcoholism
   Biological predisposition
   Drug toxicity
   Morbid craving
   Tolerance
   Disease progression
   Loss of volitional control over quantity
Opiate Addiction
   In the 1870’s dope fiends where
    caricaturized as Chinese immigrants when
    the majority were white middle-aged
    women using patent medicines laced with
    opium.
Criminalization
   Dr.CW.Earle led the first anti-drug
    campaign.”It is becoming altogether too
    customary in these days to speak of vice
    as disease”
   In the 1880’s the term ‘drug vice’ used.
Disease Concept
   American Association for the Cure of
    Inebriety formed in 1870.
   Founding principles-disease
    concept,curable,constitutional
    susceptibility which maybe inherited or
    acquired.
Moral Treatment
   Franklin Reformatory for Inebriates in
    Phila. recognized ‘drunkenness as a
    habit,sin,and crime.’(1874)
Alternative views of alcohol and
drug use
   Source of the problem was in the person
    in terms of vice and sin.
   Source of the problem was the product.
   Aggressive promotion of the product.
Disease Concept Abates
   By the end of the 1800’s the disease
    concept faded away.
Disease Concept Returns
   E.M.Jellinek presents disease model in
    1960.
   American Psychiatric Assoc. uses the
    term disease to describe alcoholism in
    1965.
   American Medical Assoc. follows in 1966.
Present Understandings
   Drug abuse causes both short-term and
    long –term changes in brain function.
   This makes it nearly impossible for users
    to stop on their own.
   The biology of the brain changes may
    never return to preuse state.
Our Understandings
   ‘Dependence’brain areas are parts of the
    brain that govern unconscious thought.
   Medial forebrain bundle,also known as
    mesolimbic dopamine system.
   Neurotransmitters involved in
    dependence.
Our understandings
   Functional dysregulation-they aren’t
    working right.
   One or more neurotransmitter chemicals
    involved.
Neurotransmitters
   Dopamine(affected by cocaine,
    amphetamines or alcohol).
   Serotonin(alcohol or LSD)
   Endorphins(alcohol or opiods)
Neurotransmitters
   GABA(alcohol or benzodiazepines)
   Glutamate(alcohol)
   Acetylcholine(alcohol or nicotine)
Genetic Factors
   Abnormal genes lead to abnormal
    proteins.
   This results in abnormal transmitter-
    synthesizing enzymes,abnormal
    transmitter breakdown enzymes,or
    abnormal receptors.
Genetic Factors
   The above factors lead to neurotransmitter
    dysregulation.
   This is why scientists believe that
    dependence is a chronic medical brain
    disease.
Needs Long Term Treatment
   As chronic relapsing disease like heart
    disease,diabetes and
    schizophrenia,disease management,not
    one shot treatment,is the most promising
    approach. Alan Leshner PhD.,Director
    NIDA.(1997)
Treatment Modalities
Behavioral approaches change brain
 chemistry.
Medications to treat withdrawal and
 cravings.
Medications Approved for Alcohol
Treatment
   Antabuse(disulfiram)
   Naltrexone
   Acamprosate
Critics of the Disease Model
   Stanton Peele-disease concept has
    spread to include eating,child
    abuse,gambling,shopping,premenstrual
    tension,compulsive love affairs,and almost
    every form of self destructive behavior.
Critics
   Herbert Fingarette states alcohol industry
    itself contributes to the public perception
    of alcoholism as a disease.(Heavy
    Drinking:The Myth of Alcoholism as a
    Disease.1988 Univ.of Calif.at Berkeley
    Press)
Bibliography
   William L.White(1998).Slaying the
    Dragon:The History of Addiction
    Treatment and Recovery in America.
    Bloomington,Ill.Chestnut Health Systems
   Diagnostic and Statistical Manual of
    Mental Disorders (DSM-IV)1994.
   www.addictiontoday.co.uk

								
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