Addiction: symptoms

Symptoms of dependence

Dependence is a complex biopsychosocial problem, the specifics of which are poorly understood not only by the general public, but also by many public health workers. The main symptom of this disorder is behavior characterized by compulsive acquisition and consumption of psychoactive substances. The diagnosis of addiction (also called addiction) is set in accordance with the criteria of the American Psychiatric Association. These criteria are applicable to any dependency vial and suggest the presence of behavioral symptoms associated with the production and use of psychoactive substances. According to these criteria, a diagnosis of dependence can be established if there are at least three of these symptoms. These behavioral symptoms of dependence are actions to extract the drug, which are built into normal daily activities. Although the diagnosis takes into account the presence of tolerance and abstinence, in themselves they are not sufficient to establish a diagnosis. Tolerance is characterized by the need for a substantial increase in the dose of the substance to achieve the desired effect or a pronounced weakening of the effect with the constant administration of the same dose. An abstinence syndrome (withdrawal syndrome) is characterized by ricochetial vegetative manifestations that occur when the substance is suddenly discontinued, which was previously used regularly for a certain period of time, depending on the nature of the substance and the dose administered. The manifestations of the withdrawal syndrome, as a rule, are opposite to those effects caused by the substance used. Substance abuse is the less severe form of pathological behavior associated with substance acquisition and its diagnosis is possible with only one or two of these symptoms. Only when tolerance or abstinence is combined with a change in behavior, the condition is regarded as a dependence.

There is a certain terminological confusion associated with this concept. It occurs for two reasons. First, it is widely believed that tolerance (addiction) and withdrawal symptoms, in fact, are synonymous with the notion of dependence. In fact, addiction (addiction) is a behavioral disorder that can be accompanied by tolerance and withdrawal syndrome, and can arise in isolation from them. Many drugs prescribed for the treatment of pain, anxiety and even hypertension, cause tolerance and withdrawal syndrome (with discontinuation). These phenomena are associated with normal physiological adaptation in response to regular drug administration. Distinguish these concepts is very important, since patients with severe pain often abolish the opioids they need only because they develop tolerance, and with a sudden discontinuation of the introduction, symptoms of withdrawal occur. In practice, patients who take opioids for severe pain rarely display behavioral symptoms that make it possible to diagnose dependence (according to DSM-IV). The term "physical dependence" is more often applied to this situation, which is not accompanied by the development of addiction and to which the criteria for DSM-IV dependency are not applicable.

The second reason for the confusion is that the actions associated with obtaining a psychoactive substance are usually not the only problem requiring treatment for a drug addict who has sought medical help. In most cases, there are very serious medical, psychiatric, social, labor and legal problems, against which the actions related to obtaining a drug recede into the background. Therefore, the addiction treatment program should be comprehensive. The result of treatment may be more dependent on the concomitant mental disorders, rather than on the number, frequency and duration of use of the psychoactive substance. The bias treatment algorithm presented in Fig. 8.1, requires a comprehensive examination and involves an impact on all related disorders.