Addiction as a Disease

1
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

2
Abuse vs Dependence

• There is a difference between intentional drug
  abuse and pathological drug dependence.
• The latter is what is referred to as addiction.

3
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.

4
Chemical Dependence

• 3 or more of the followingtolerance,withdrawal,dr
  ug used more than intended,inability to control
  use,effort to obtain drug,important activities
  replaced by drug use,use despite negative
  consequences.

5
Present Understandings

• Drug abuse causes short-term and long-term
  changes in brain function.
• Medial forebrain bundle(mesolimbic dopamine
  system)

6
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 diseaseand a disease
  induced by a vice.

7
History cont.

• Rev.Lyman Beechers sermons in 1825 describes
  intemperance is a disease as well as a crime.
• Dr.Samuel Woodward recommended special asylums
  for the treatment of inebriates.(1830s)

8
First Treatment Facility

• In 1864 the New York State Inebriate Asylum
  founded by Dr.Joseph Turner.

9
Disease Concept

• Dr.William Sweetser described intemperance
  causing a morbid alteration in nearly all the
  major structures and functions of the human
  body.(1829)

10
Concept of Alcoholism

• Biological predisposition
• Drug toxicity
• Morbid craving
• Tolerance
• Disease progression
• Loss of volitional control over quantity

11
Opiate Addiction

• In the 1870s dope fiends where caricaturized as
  Chinese immigrants when the majority were white
  middle-aged women using patent medicines laced
  with opium.

12
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 1880s the term drug vice used.

13
Disease Concept

• American Association for the Cure of Inebriety
  formed in 1870.
• Founding principles-disease concept,curable,consti
  tutional susceptibility which maybe inherited or
  acquired.

14
Moral Treatment

• Franklin Reformatory for Inebriates in Phila.
  recognized drunkenness as a habit,sin,and
  crime.(1874)

15
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.

16
Disease Concept Abates

• By the end of the 1800s the disease concept
  faded away.

17
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.

18
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.

19
Our Understandings

• Dependencebrain areas are parts of the brain
  that govern unconscious thought.
• Medial forebrain bundle,also known as mesolimbic
  dopamine system.
• Neurotransmitters involved in dependence.

20
Our understandings

• Functional dysregulation-they arent working
  right.
• One or more neurotransmitter chemicals involved.

21
Neurotransmitters

• Dopamine(affected by cocaine, amphetamines or
  alcohol).
• Serotonin(alcohol or LSD)
• Endorphins(alcohol or opiods)

22
Neurotransmitters

• GABA(alcohol or benzodiazepines)
• Glutamate(alcohol)
• Acetylcholine(alcohol or nicotine)

23
Genetic Factors

• Abnormal genes lead to abnormal proteins.
• This results in abnormal transmitter-synthesizing
  enzymes,abnormal transmitter breakdown enzymes,or
  abnormal receptors.

24
Genetic Factors

• The above factors lead to neurotransmitter
  dysregulation.
• This is why scientists believe that dependence is
  a chronic medical brain disease.

25
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)

26
Treatment Modalities

• Behavioral approaches change brain chemistry.
• Medications to treat withdrawal and cravings.

27
Medications Approved for Alcohol Treatment

• Antabuse(disulfiram)
• Naltrexone
• Acamprosate

28
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.

29
Critics

• Herbert Fingarette states alcohol industry itself
  contributes to the public perception of
  alcoholism as a disease.(Heavy DrinkingThe Myth
  of Alcoholism as a Disease.1988 Univ.of Calif.at
  Berkeley Press)

30
Bibliography

• William L.White(1998).Slaying the DragonThe
  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