Pharmacology 13c – Addiction
1. Describe the contribution of addictive substances and processes to many major
2. Describe how addictive or compulsive behaviour is assessed.
3. Discuss appropriate treatments, pharmacological or otherwise, employed to treat
Importance and Epidemiology of Addiction
A GP with an average list of patients will have over two hundred patients
suffering from addictive or compulsive behaviour of some kind.
One in every five hospital beds are occupied by people with alcohol related
Fifty percent of patients seen in Accident and Emergency Departments in the
evenings or at weekends will have problems associated with alcohol or drugs.
In the UK, illegal drugs kill 15 people each day, alcohol 100, compulsive
overeating 200 and nicotine 300.
85% of all suicides are in people with addictive behaviour of some kind.
Most Major Illnesses are Caused by some Addictive substance:
• Cancer of the lung: nicotine addiction.
• Heart attacks: nicotine addiction, alcoholism, compulsive overeating, drug
• Liver disease: alcoholism, compulsive overeating, drug addiction.
• Accidents: alcoholism, drug addiction
• Diabetes: compulsive overeating
Doctors should be aware of patients emotional problems because these will result in
physical problems later in life. Emotional problems are a significant contributory
factor to the body/mind interrelationship and affect a wide range of clinical conditions
Addictive or compulsive behaviour is a disease of feeling rather than of thought. One
can tell if the behaviour is addictive if the patient possess a number of tendencies:
– Use alone.
– Use primarily for mood altering effect.
– Use as a medicine.
– Protection of supply.
– Using more than planned.
– Higher capacity than others.
– Continuing despite damage.
– The tendency to cross addict.
– Drug seeking behaviour.
– Drug dependent behaviour.
– Continuing despite repeated concern of others.
PROMIS Questionnaire enables addicts to be distinguished from the normal
population and medical students.
• Depression and addiction are synonymous and should not be treated medicinally.
• Sadness is a normal human response to distressing circumstances and should
also not be treated medicinally
Consequences of Addiction
There are numerous consequences of addictive behaviour result in failure:
• Emotional. • Educational.
• Behavioural. • Financial.
• Social. • Legal.
• Marital. • Spiritual.
• Professional. • Physical.
There are 3 main types of addictive behaviour. Pateints often have many in the same
• ‘Hedonistic’: alcohol, recreational drugs, prescription drugs (antidepressants,
tranquilisers, sleeping tablets and mood altering pain killers), nicotine, caffeine,
gambling and risk taking, sex and love addiction.
• Nurturant of self: food (binging, vomiting, starving, purging) stimulated
primarily by refined carbohydrates (sugar and white flour), exercise, work,
shopping and spending.
• Relationship addiction (using other people as if they were drugs) and compulsive
helping (using oneself as a drug for other people).
These may have separate genes.
Studies & Findings
Scandinavian adoption studies show that alcoholism goes more commonly with the
parental origin than with the adoptive environment.
Patients discover for themselves the mood altering effects of some substances and
processes. The inner sense of emptiness (involutional melancholia) should be
distinguished from sadness, (which is a response to distressing circumstances) and is
relieved so that patients feel normal when they take a mood altering substance or
process. The effect wears off in time and therefore the process is repeated.
The compulsive helper is a mirror image of primary addiction. The compulsive
helper needs to be needed and the addictive behaviours are care-taking and self denial
(these are mutually destructive). Professional helpers need to understand the
boundaries between normal helping and compulsive helping so that they do not make
Addicts need to be confronted (politely and with understanding for their illness) on
their behaviour and not enabled to carry on with it without getting the consequences.
Whilst it may seem sensible to treat the conditions caused by the addiction, this will
not treat the addiction itself. Treatment for the addiction itself will come from support
groups such as alcoholics anonymous – a mood altering process. As addiction is also
a chronic condition patients will need to be on the treatment for a long time.
The programme recommended is the “Twelve Step Programme”. This is deemed to be
much better than any medical treatment (anti-depressants, narcotics, naltrexone e.t.c.)