Alcohol & Drug

Introduction

Alcoholism and drug dependence can affect all aspects of a person’s life.  Long-term use of alcohol and other drugs, both licit and illegal, can cause serious health complications affecting virtually every organ in the body, including the brain.  It can also damage emotional stability, finances, career, and impact family, friends and the entire community in which an alcoholic or drug abuser lives.

When a person uses alcohol and/or drugs, the brain is flooded with dopamine.  Dopamine is a neurotransmitter that resides in the parts of the brain that control movement, emotion, cognition, motivation and feelings of pleasure.  When these systems are overloaded by substances, the individual experiences euphoria, which many drug abusers attempt to recreate by repeatedly abusing a substance.  However, the brain of a substance abuser adjusts by producing less dopamine or reducing the number of receptors that can receive or transmit signals.  As long as people are addicted to or abusing substances, they cannot feel the joy and pleasure of everyday life.  Many drug abusers feel depressed or flat when they are not taking drugs and need to take drugs to get their dopamine levels back to normal.

Not everyone who uses alcohol or drugs is an addict or alcoholic.  A person becomes a substance abuser when the substance becomes so crucial that he or she is willing to risk other important aspects of life in order to have the substance.  This may be after the first time a substance is used, or it may take years.

Symptoms

According to DSM-IV-TR, Substance addiction (alcohol and drugs) is characterised by the following symptoms:

  • Presence of three or more of the criteria listed below in the last 12 months
    • Tolerance: Does the patient tend to need more of the substance over time to get the same effect?
    • Withdrawal: Does the patient experience withdrawal symptoms when he/she does not utilise the substance
    • Continued use of substance despite harm: Is the patient experiencing physical or psychological harm from the drug?
    • Loss of control: Does the patient made a conscious, but unsuccessful, effort to reduce his/her substance use
    • Salience: Does the patient spend significant time obtaining or thinking about the drug, or recovering from its effect?
    • Reduced involvement: Has the patient given up or reduced his/her involvement in social, occupational or recreational activities due to the substance?

Risk Factors and Causes

There is no single factor that determines whether a person will develop alcoholism or a drug addiction. A person’s overall risk for addiction is determined by their biological makeup, including genetics, and their exposure to drugs and alcohol.

Risk factors include:

  • Genetics
  • Age
  • Social Circle
  • Stress
  • Mental Disorders
  • The type of drug used
    • Research shows that the risk for developing alcoholism or drug addiction can be inherited. This means that if you have a family member with an addiction, you have a greater likelihood of becoming an addict yourself.  Individuals who have a parent or sibling with an addiction are two to four times more likely to become substance-dependent compared to somebody who does not have a relative with an addiction problem.
    • Adolescents are at greater risk of drug abuse and addiction than the general population, due to their inclination toward risky behaviour as well as to their biological inheritance. Also, the younger a person is when they start using drugs or alcohol, the more likely they are to develop a problem.
    •  Your friends can be a huge influence on how much you drink, or if you use drugs. This is especially true for young people. If you are frequently surrounded by drugs and alcohol, you are more likely to use them, thus increasing your risk of becoming substance-dependent.
    •  Many people turn to alcohol and drugs as a way of unwinding. However, if you are not careful, your body may require more frequent use of these substances to help you relax, especially if you have a genetic predisposition to addiction.
    •  People with depression or anxiety disorders in particular are more likely to abuse alcohol and drugs.
    •  Drugs that are smoked or injected into a vein are more likely to cause addiction because they produce a quick, powerful effect — they reach the brain sooner than drugs that are taken by mouth. This rapid “high” also fades faster, causing the person to need more and more of the substance to regain the pleasurable feeling.

Treatment

Medication and behavioural therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual’s life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person’s success in achieving and maintaining a substance–free lifestyle.

Medications

Medications can be used to help with different aspects of the treatment process.

Withdrawal

Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself “treatment”—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated.

Treatment 

Medications can be used to help re-establish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will require treatment for all of the substances that they abuse.

Behavioural Treatments

Behavioural treatments help patients engage in the treatment process, modify their attitudes and behaviours related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioural approaches.

Outpatient behavioural treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counselling. Some programs also offer other forms of behavioural treatment such as:

  • Cognitive Behavioural therapy,which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
  • Multidimensional family therapy,which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
  • Motivational interviewing,which capitalizes on the readiness of individuals to change their behaviour and enter treatment.
  • Motivational incentives(contingency management), which uses positive reinforcement to encourage abstinence from drugs.

Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. TCs differ from other treatment approaches principally in their use of the community—treatment staff and those in recovery—as a key agent of change to influence patient attitudes, perceptions, and behaviours associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the re-socialization of the patient to a drug-free, crime–free lifestyle.

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Address

We are here. #09-21/22/23, Novena Medical Centre, 10 Sinaran Drive, Singapore 307506.

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E-mail: clinic@promises.com.sg