ADDICTION DISORDER

SUBMITTED BY
M.SATHISH CRRI
GOVERNMENT YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPIT
CHENNAI -106.
 INTRODUCTION

Addiction disorder is a neuropsychological disorder characterized by a persistent and

intense urge to use a drug or engage in a behaviour that produces natural reward,
despite substantial harm and other negative consequences.

Repetitive drug use often alters brain function in ways that perpetuate craving, and
weakens (but does not completely negate) self-control.
 DEFINITION

Addiction disorders or addictive disorders are mental disorders involving high

intensities of addictions (as neuropsychological symptoms) that induce functional
disabilities
 PREVELANCE

An increasing number of research studies over the last three decades suggest that a
wide range of substance and process addictions may serve similar functions.
The current article considers 11 such potential addictions (tobacco, alcohol, illicit
drugs, eating, gambling, Internet, love, sex, exercise, work, and shopping), their
prevalence, and co-occurrence, based on a systematic review of the literature.
Data from 83 studies (each study n = at least 500 subjects) were presented and
supplemented with small-scale data. Depending on which assumptions are made, overall
12-month prevalence of an addiction among U.S. adults varies from 15% to 61%.
The authors assert that it is most plausible that 47% of the U.S. adult population
suffers from maladaptive signs of an addictive disorder over a 12-month period and that
it may be useful to think of addictions as due to problems of lifestyle as well as to
person-level factors.
 TYPES OF ADDICTION
DISORDERS

There are two main groups of addiction:

Substance addictions (substance use disorders).

Non-substance addictions (behavioral addictions).
 SUBSTANCE ADDICTION

Healthcare providers and the medical community now call substance addiction substance
use disorder. The American Psychiatric Association’s Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) has concrete diagnostic criteria for substance use disorders.

Substances are drugs that have addiction potential. They can be prescription medications
or non-medical drugs and include:

Alcohol
Caffeine.
Cannabis (marijuana).
Hallucinogens, such as PCP and LSD.
Hypnotics, sedatives and anxiolytics (anti-anxiety drugs), such as sleeping pills,
benzodiazepines and barbiturates.
NON SUBSTANCE ADDICTION

Behavioral addictions can occur with any activity that’s capable of stimulating your
brain’s reward system. Behavioral scientists continue to study the similarities and
differences between substance addictions, behavioral addictions and other
compulsive behavior conditions like obsessive-compulsive disorder (OCD) and
bulimia nervosa.
The DSM-5 currently only recognizes gambling disorder as a diagnosable
behavioral addiction in the subsection of “non-substance-related disorders” in the
category of “substance-related and addictive disorders.”
The DSM-5 doesn’t currently include other behavioral addictions due to a
lack of research on them. However, any activity or habit that becomes all-consuming
and negatively impacts your daily functioning can cause significant mental, social
and physical health issues, as well as financial issues in some cases.
Examples of potentially addictive activities include:
Gambling.
Eating.
Exercising or dieting.
Shopping.
Shoplifting or other risky behaviors.
Having sex.
Viewing pornography.
Video gaming (internet gaming disorder).
Using the internet (such as on your phone or a computer)
 CAUSES OF ADDICTION
Biological factors:

Genes:
Estimates vary but scientists find that genetic factors contribute about half the risk for
developing a substance use disorder. For example, one factor linked to vulnerability is variation in a
gene that determines the makeup of brain receptors for the neurotransmitter dopamine. Another
factor appears to be the nature of the body’s hormonal response to stress.

Physiological factors:
Variations in liver enzymes that metabolize substances are known to influence one's risk of
alcohol use disorder.

Gender:
Males are more likely to develop substance use disorder than females, although the so-called
gender gap may be narrowing for alcohol use disorder, and females are more subject to intoxication
effects at lower doses of alcohol.
Psychological Factors:

Personality factors:
Both impulsivity and sensation seeking have been linked to substance use and gambling disorders.
Impulsivity may be particularly related to the risk of relapse.

Trauma and abuse:

Early exposure to significant adverse experience can contribute to the development of substance use
disorders by overwhelming an individual's coping ability, perhaps by sensitizing brain pathways of
alarm/distress, or by adding to the burden of stress.

Mental health factors:

Conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder
(PTSD) increase the risk of addiction. Difficulties managing strong emotions are also linked to substance use.
Environmental Factors:

Family factors:

While strong family relationships have been shown to protect against substance use
disorders, several aspects of family functioning or circumstances can contribute to addiction risk.
Having a parent or sibling with an addictive disorder raises the risk, as does a lack of parental
supervision or support. Poor-quality or troubled parent-child relations and family disruptions such as
divorce also add to one's risk, as does sexual, physical, or emotional abuse.
Research shows that marriage and taking on child-raising responsibilities mitigate the risk of
addiction.
Accessibility factors:

Easy availability of alcohol or other substances in one’s home, at school or work, or in one’s
community increases the risk of repeated use.
 SYMPTOMS

Recurrent use of a substance, or engagement with an activity, that leads to impairment

or distress, is the core of addictive disorders. The clinical diagnosis of an addiction is based
on the presence of at least two of a number of features:
The substance or activity is used in larger amounts or for a longer period of time than
was intended.
There is a desire to cut down on use or unsuccessful efforts to do so.
Pursuit of the substance or activity, or recovery from its use, consumes a significant
amount of time.
There is a craving or strong desire to use the substance or engage in the activity.
Use of the substance or activity disrupts obligations at work, school, or home.
Use of the substance or activity continues despite the social or interpersonal problems
it causes.
Participation in important social, work, or recreational activities drops or stops.
Use occurs in situations where it is physically risky.
Use continues despite knowing it is causing or exacerbating physical or
psychological problems.
Tolerance occurs, indicated either by need for markedly increased amounts of the
substance to achieve the desired effect or markedly diminished effect of the same amount
of substance.
Withdrawal occurs, manifest either in the presence of physiological withdrawal
symptoms or the taking of a related substance to block them.
The severity of the condition is gauged by the number of symptoms present. The
presence of two to three symptoms generally indicates a mild condition; four to five
symptoms indicate a moderate disorder. When six or more symptoms are present, the
condition is considered severe.
 PSYCHOPATHOLOGY

Addiction disorders involve both psychological and physical dependence on the

substance(s) of use. Severe dependence is characterized by an inability to regulate use.
Substance use disorders and addiction stem in part from adaptive changes in the
brain as it seeks to regain homeostasis.[5] Chronic and/or prolonged stress plays a strong
role in developing drug-seeking behavior; it alters the corticotropin-releasing factor and
hypothalamic-pituitary-adrenal axis (CRF/HPA)".
In animal model studies, it demonstrated CRF circuitry could increase "dopamine
activity in the mesolimbic reward circuit."[6]

Stimulants, specifically cocaine and amphetamines, exert their effect by preventing the
recycling of dopamine, norepinephrine, and serotonin. This results in increased concentrations
of these neurotransmitters within the synaptic cleft. The influx of these neurotransmitters gives
the user a euphoric effect.
 Worldwide and in the United States, tobacco use disorder is the most prevalent
addiction. Most commonly, nicotine is absorbed through the lungs when individuals burn and
inhale tobacco products.
It is absorbed through the pulmonary circulation, crosses the blood-brain barrier in less
than 10 seconds, and attaches to the nicotinic cholinergic receptors in the central nervous
system (CNS). The metabolite of nicotine is cotinine, which can be detected as a urinary
marker of the substance.
Nicotine influx in the CNS leads to neurotransmitters' release, especially dopamine,
which stimulates the brain’s reward area. Chronic nicotine use results in tolerance, when
excessive stimulation of nicotine acetylcholine receptors results in desensitization of the
receptors; these neuroadaptations produce a state where the brain requires nicotine to function
in homeostasis.
This is referred to as physiological dependence.[9] CYP2D6 metabolizes nicotine.
Therefore, it can alter the metabolism of other medications, such as antipsychotics.
 Alcohol produces euphoric effects through the dopamine neurons of the mesolimbic
system. Alcohol inhibits NMDA receptors and results in the upregulation of GABA receptors.
Chronic consumption of alcohol leads to GABA receptor desensitization and tolerance,
potentiating the loss of drinking control.
Alcohol is mostly absorbed in the digestive tract's mucosal lining, specifically at the
proximal small intestine, where B vitamins are absorbed. Individuals who drink excessively
may have a deficiency of B vitamins.[11] Vitamin B1 (Thiamine) and vitamin B9 (Folic Acid)
are the two most common B-vitamins deficiencies.
Deficiency of thiamine can lead to neurological findings such as hyporeflexia and
sensory and motor deficiency. More profound deficiencies over time can lead to Wernicke's
Encephalopathy and Korsakoff syndrome .
 Chronic alcohol consumption can also result in Vitamin B9 (Folic acid) deficiency; after 8-
16 weeks of deficient stores of folic acid in the body, individuals may develop "glossitis,
angular stomatitis, and oral ulcers," along with "depression, irritability, insomnia, cognitive
decline, fatigue, and psychosis."[13]

Opioids include codeine, heroin, hydrocodone, hydromorphone, methadone,

meperidine, morphine, and oxycodone.
Opioids bind to delta, kappa, and mu receptors, which provide analgesia for severe pain
and produce euphoria feelings. Higher doses carry a risk of respiratory suppression and
death.
Individuals with chronic exposure to opioids can experience profound withdrawal symptoms if
opioid use is stopped abruptly. The withdrawal symptoms include but are not limited to diarrhea,
excess sweating, excess lacrimation, nausea, vomiting, and insomnia.
Sedative, Hypnotic, Anxiolytics are a class of medications that can cause CNS
depression, and if taken inappropriately, the effects can be fatal.
They include benzodiazepines: alprazolam, clonazepam, lorazepam,
diazepam, chlordiazepoxide; Barbiturates: phenobarbital, pentobarbital,
butabarbital; it also includes other sedative medications.
Other classes of drugs have properties that share a similar mechanism of
action with benzodiazepine and barbiturates. These agents mediate gamma-
aminobutyric acid (GABA) effects, producing inhibitory effects within the central
nervous system.
Alcohol can be classified in this group, but alcohol is more commonly used
and is not utilized therapeutically, so healthcare experts have classified it separately.
[15] The euphoric and sedative effects of these agents precipitate and perpetuate a
cycle of overuse and dependence.
 Regarding cannabis, it contains multiple types of terpenophenolic compounds, called
cannabinoids, that cross the blood-brain barrier; the most studied cannabinoids are cannabidiol
(CBD) and tetrahydrocannabinol (THC).
Cannabinoids act on the cannabinoid receptors, which are located in the central and
peripheral nervous system. CBD and THC both come from the hemp plant, also known as
marijuana; legal rules and regulations differentiate the definitions.
There are many types of hemp plants that produce various percentages of THC and CBD.
Hemp has less than or equal to 0.3% of THC by dry weight, while marijuana has more than 0.3
% of THC by dry weight. CBD is a non-psychotropic cannabinoid that does not exert euphoric
properties like THC.
THC, the psychoactive cannabinoid, exerts its effects in the brain’s reward center in
increasing dopamine levels in the prefrontal cortex, providing the euphoric effect.[2] THC
activates the CB1 and CB2 receptors of the endocannabinoid system, which gives its
psychoactive properties and regulating eating, learning, memory, growth, development, and
anxiety.
CBD does not activate CB1 or CB2 receptors, but limited studies show it has neuroprotective
and anti-inflammatory effects.
 There are various hallucinogens; the most common one presented in the hospitals is
phencyclidine or phenylcyclohexyl piperidine (PCP), or also known by its street name
"angel dust," is not only a hallucinogen but also acts as a stimulant.
Its mechanism of action is characterized by NMDA receptor antagonism impairing
the feeling of pain and other various neurological functions and psychosis.
It can also facilitate the increase of dopamine and norepinephrine and provide a
sympathomimetic effect.[19] Another common hallucinogen is Lysergic acid diethylamide
(LSD), or known by its street name as "acid"; it has a mechanism of action that is not fully
understood, but from studies so far, it facilitates serotonin receptors 5HT2A, 5HTAR,
5HT2C, and 5HT1A.
LSD exerts receptor modulation leading to cognitive impairment and hallucinations.
Other hallucinogens include MDMA with street names of “Molly, Ecstasy, X,” another
hallucinogen is Ketamine with a street name of “K-Hole.”
DIFFERENTIAL DIAGNOSIS

Depression can be exhibited from opioids, alcohol, sedative, anxiolytic,

hypnotic, and cannabis use. It is also associated with withdrawal from
stimulants.

Mania and anxiety can be exhibited from stimulants (cocaine and

amphetamine).

Psychosis can be associated with substances but varies from

individual to individual and with time.
 PSYCHIATRIC MANAGEMENT
Substance use is a treatable condition and complete remission is entirely possible.
Recovery, however, is often a long-term process that may involve multiple attempts. Relapse is
now regarded as part of the process, and effective treatment regimens address prevention and
management of recurrent use.
Treatment can include any of a number of components, which are often deployed in combination
and are likely to change over the course of recovery:

Detoxification, conducted under medical supervision, may be needed but is only the first stage
of treatment.
Medications that reduce or counter use of illicit substances are suitable for some individuals,
or medications may be used to target co-occurring disorders such as anxiety and depression.
Motivational Interviewing, which is a short-term counseling process to help a person resolve
ambivalence about treatment and find and hold onto incentives for change.
Cognitive Behavior Therapy (CBT) can help a person recognize and cope with
situations that trigger the desire to use substances.
Group therapy and other peer-support programs leverage the direct experience of
many to support individual recovery and prevent the recurrence of substance use.
Family therapy helps individuals repair any damage done to family relationships
and to establish more supportive ones.
Life skills training, including employability skills, may be part of an individual's
treatment plan.
Good treatment programs also feature the regular monitoring of individual
progress.
Treatment is available in a variety of settings, from a doctor’s office or
outpatient clinic to long-term residential facility. No one way will be right for
everyone, and there is evidence that one's commitment to change is more important
than the type of treatment program he or she selects. Whatever the treatment under
consideration, say independent researchers, there are number of features to look for to
identify an effective program:
 Patients undergo comprehensive medical and psychiatric screening.
Treatment addresses individual needs, including co-occurring conditions, whether chronic
pain, anxiety, or hepatitis.
Families are involved in treatment.
There is continuity of care via active linkages to resources in subsequent phases of
recovery.
The facility maintains a respectful environment.
Treatment services are evidence-based and reflect best practices.
Staff members are licensed and certified in the disciplines they practice.
The program is accredited by a nationally recognized monitoring agency.
Patient response to treatment is monitored and the program or facility offers outcome data
reflecting treatment performance
Medication:

Alcohol addiction
Alcohol, like opioids, can induce a severe state of physical dependence and produce
withdrawal symptoms such as delirium tremens. Because of this, treatment for alcohol addiction
usually involves a combined approach dealing with dependence and addiction simultaneously.
Benzodiazepines have the largest and the best evidence base in the treatment of alcohol
withdrawal and are considered the gold standard of alcohol detoxification.[186]

Pharmacological treatments for alcohol addiction include drugs like naltrexone (opioid
antagonist), disulfiram, acamprosate, and topiramate.[187][188]
Rather than substituting for alcohol, these drugs are intended to affect the desire to drink, either
by directly reducing cravings as with acamprosate and topiramate, or by producing unpleasant effects
when alcohol is consumed, as with disulfiram
These drugs can be effective if treatment is maintained, but compliance can be an issue as
patients with disordered alcohol use may forget to take their medication, or discontinue use because
of excessive side effects.[189][190] The opioid antagonist naltrexone has been shown to be an
effective treatment for alcoholism, with the effects lasting three to twelve months after the end of
treatment.
 BEHAVIORAL ADDICTION

Behavioral addiction is a treatable condition.[192] Treatment options include

psychotherapy and psychopharmacotherapy (i.e., medications) or a combination of both.
Cognitive behavioral therapy (CBT) is the most common form of psychotherapy used in
treating behavioral addictions;
it focuses on identifying patterns that trigger compulsive behavior and making lifestyle
changes to promote healthier behaviors. Because cognitive behavioral therapy is considered a
short-term therapy, the number of sessions for treatment normally ranges from five to twenty.
[193]
During the session, therapists will lead patients through the topics of identifying the
issue, becoming aware of one's thoughts surrounding the issue, identifying any negative or
false thinking, and reshaping said negative and false thinking.
While CBT does not cure behavioral addiction, it does help with coping with the condition in
a healthy way. Currently, there are no medications approved for treatment of behavioral addictions in
general, but some medications used for treatment of drug addiction may also be beneficial with
specific behavioral addictions.
Cannabinoid addiction
The development of CB1 receptor agonists that have reduced interaction with β-arrestin
2 signaling might be therapeutically useful.[194] As of 2019, there has been some evidence
of effective pharmacological interventions for cannabinoid addiction, but none have been
approved.[195]

Nicotine addiction:
Another area in which drug treatment has been widely used is in the treatment of
nicotine addiction, which usually involves the use of nicotine replacement therapy,
nicotinic receptor antagonists, and/or nicotinic receptor partial agonists.[196][197]
Examples of drugs that act on nicotinic receptors and have been used for treating
nicotine addiction include antagonists like bupropion and the partial agonist varenicline
 Opioid addiction
Opioids cause physical dependence and treatment typically addresses both dependence and
addiction. Physical dependence is treated using replacement drugs such as buprenorphine (the
active ingredient in products such as Suboxone and Subutex) and methadone..
Although these drugs perpetuate physical dependence, the goal of opiate maintenance is to
provide a measure of control over both pain and cravings. Use of replacement drugs increases the
addicted individual's ability to function normally and eliminates the negative consequences of
obtaining controlled substances illicitly.
Once a prescribed dosage is stabilized, treatment enters maintenance or tapering phases. In
the United States, opiate replacement therapy is tightly regulated in methadone clinics and under
the DATA 2000 legislation. In some countries, other opioid derivatives such as
dihydrocodeine,dihydroetorphine and even heroin are used as substitute drugs for illegal street
opiates, with different prescriptions being given depending on the needs of the individual patient.
Baclofen has led to successful reductions of cravings for stimulants, alcohol, and opioids and
alleviates alcohol withdrawal syndrome.
Many patients have stated they "became indifferent to alcohol" or "indifferent to cocaine" overnight
after starting baclofen therapy. Some studies show the interconnection between opioid drug detoxification
and overdose mortality.
Psychostimulant addiction:
There is no effective and FDA- or EMA-approved pharmacotherapy for any form of
psychostimulant addiction.[207] Experimental TAAR1-selective agonists have significant
therapeutic potential as a treatment for psychostimulant addictions.
 YOGA AND NATUROPATHY
TREATMENTS
YOGA THERAPY
Asanas:
Joints exercises, shashankasana, makrasana,shavasana, advasana,
Pranayama:
Nadishodhana pranayama, Bhramari pranayama,Sheetali, sheetkari pranayama
Mudra:
Pranamudra, chinmudra,hridaya mudra,
Bandha:
Uddhiyana Bandha
Relaxation Techniques:
DRT, MSRT,YOGA NIDRA
ACUPUNCTURE

CHROMOTHERAPY
Green colour visualisation.
Yogic diet
Satvik diet – can regularly consume fresh fruits and vegetables,ghee,milk and milk products.

HYDROTHERAPY:
Mud pack to abdomen and eyes
Plantain leaf bath
Steam bath
Full mud bath
Cold hip Bath
Neutral Enema
MASSAGE THERAPY:
Partial massage to abdomen
Head massage
Foot massage

MAGNETOTHERAPY
Lead 1 & 5