Addiction: Physiological, Psychological, and Social Aspects (Mini-Textbook Study Notes)

Addiction

Definition and Overview

Addiction is defined as a psychological or physical need for a substance or process, to the extent that the individual will risk negative consequences in an attempt to meet the need. It encompasses both substance-related and behavioral (process) disorders.

• Prescription medications that are dangerous when misused or abused:

  • Narcotics

  • Sedatives

  • Stimulants

• Illegal drugs commonly abused:

  • Cocaine

  • Heroin

  • Hallucinogens

  • Inhalants

Substance Use Disorders

Characteristics

Substance use disorders are chronic but treatable medical conditions. They directly activate the brain's reward system, producing feelings of pleasure primarily through the neurotransmitter dopamine.

• Intense cravings for the substance are a hallmark feature.

• Chronicity: These disorders persist over time but can be managed with appropriate interventions.

Substance-Induced Disorders

Types and Manifestations

Substance-induced disorders refer to mental health conditions that are directly caused by substance use or withdrawal.

• Intoxication: Acute effects of substance use.

• Withdrawal: Symptoms that occur when substance use is reduced or stopped.

• Substance/medication-related mental disorders:

  • Psychosis

  • Bipolar disorder

  • Sleep disturbances

  • Sexual dysfunction

Language Matters

Stigma Reduction in Terminology

Using person-first language helps reduce stigma and supports recovery.

Use...	Instead of...
Person with a substance use disorder	Addict, User, Substance or drug abuser, Junkie
Person with alcohol use disorder; Person who misuses alcohol/engages in unhealthy/hazardous alcohol use	Alcoholic, Drunk
Person in recovery or person who previously used drugs	Former addict, Reformed addict
Testing positive (on a drug screen)	Dirty, Failing a drug test

Dependence and Tolerance

Physiological Aspects

Dependence is a physiological need for a substance, resulting in withdrawal symptoms if not taken. Tolerance refers to the need for increased quantities of a substance to achieve the same pleasurable effects.

• Dependence: Loss of control over substance use; withdrawal symptoms.

• Tolerance: Escalating doses required for effect.

• Compulsive seeking: Individuals may seek substances at any cost.

Physiology and Psychology of Addiction

Neurobiological Factors

Addiction involves complex interactions between biological and psychological factors.

• Dopamine: Increases when pleasurable events occur, reinforcing drug use.

• Serotonin and other neurotransmitters also play roles.

• Limbic system: Controls emotions and pleasure, reinforcing addictive behaviors.

Example:

Drugs of abuse can cause exaggerated dopamine release compared to natural rewards like food, leading to stronger reinforcement of drug-seeking behavior.

Other Factors Contributing to Addiction

Genetic, Psychological, and Sociocultural Influences

• Genetics: 40-60% heritability; Adverse Childhood Experiences (ACEs) increase risk.

• Psychological: Trauma, anxiety, depression, and use of substances as coping strategies.

• Sociocultural: Academic failure, poor social skills, and environmental stressors.

Manifestations of Addiction

Types and Treatments

• Nicotine addiction: Treated with medications (bupropion, varenicline), behavioral therapy, and support groups.

• Alcohol addiction: Medications (disulfiram, naltrexone), behavioral therapy, support groups, detoxification, milieu therapy, family therapy.

• Substance addiction: Behavioral therapy, support groups, detoxification, milieu therapy, 12-step programs, family therapy.

• Process addictions: Psychotherapy, behavior therapy, milieu therapy, support groups, 12-step programs, family therapy. Examples include sex, gambling, shopping, and work.

Terminology

Key Terms in Addiction

• Abstinence: Refraining from substance use.

• Codependence: Family members help sustain the individual's habits.

• Co-occurring disorders: Mental health disorders that occur with substance abuse.

• Delirium tremens (DTs): Life-threatening withdrawal from prolonged alcohol use.

• Detoxification: Process of eliminating substances from the body, often with medical supervision.

• Dual diagnosis: Presence of both mental health and substance use disorders.

• Korsakoff psychosis: Thiamine deficiency, confusion, memory disorder.

• Wernicke encephalopathy: Thiamine depletion, abnormal eye movements, ataxia, confusion.

• Sobriety: Not using substances.

Comorbidities

Associated Conditions

• Mental and physical illnesses often co-occur with addiction.

• Social problems such as isolation, unemployment, and family disruption.

Effects on Family

Family Dynamics and Risks

• Increased risk for social isolation

• Defensive coping mechanisms (denial)

• Secrecy and shame

• Rigid and inflexible boundaries

• Enabling behavior

• Codependency (low self-esteem, guilt, need for approval, difficulty adjusting to change)

Characteristics of Codependency

Symptoms and Roles

• Difficulty identifying/expressing feelings

• Perfectionism

• Difficulty forming/maintaining close relationships

• Rigidity in attitudes and behaviors

• Over-responsibility

• Need for approval

• Difficulty making decisions

• Powerlessness

• Shame/low self-esteem

Codependency Roles in the Family:

• Caretaker

• Hero

• Scapegoat

• Lost child

• Mascot

Process Disorders

Non-Substance Addictions

• Gambling disorder: Significant impairment or distress due to gambling.

• Online shopping addiction (OSA): Low self-esteem, poor self-regulation, negative emotional states, social anonymity, cognitive overload.

• Internet gaming disorder (IGD): Withdrawal symptoms when games are taken away, lying about time spent gaming, using games to relieve negative mood.

Concepts Related to Addiction

Clinical and Family Considerations

• Cognition: Assess for Wernicke's encephalopathy, Korsakoff psychosis, dementia; anticipate thiamine therapy.

• Family: Involve family in treatment, communicate clearly, and educate about addiction.

• Infection: Assess for hepatitis C, endocarditis, pneumonia, tuberculosis, skin infections, HIV/AIDS.

• Nutrition: Balanced diet, vitamin and mineral supplements, discharge planning.

• Safety: Address risky behaviors, teach safety, support recovery.

• Trauma: Assess for trauma in patients and families, support recovery programs.

Harm Reduction and Health Promotion

Strategies and Resources

• Substance Abuse and Mental Health Services Administration (SAMHSA): Provides resources and support.

• Assess risk: Identify risk factors and intervene early.

• Education: Prevention, healthy coping mechanisms, treatment for mental health disorders, recovery.

Example:

• Needle exchange programs and non-judgmental safety strategies are key harm reduction approaches.

Nursing Assessment

Key Components

• Therapeutic relationship

• Maintain confidentiality

• Involve family

• Full disclosure

• SBIRT:

  • Screening (assess severity, appropriate level of care)

  • Brief intervention (motivational to change)

  • Referral to treatment (child care assistance, etc.)

Determining Level of Care

American Society of Addiction Medicine (ASAM) Dimensions

Dimension	Description
1	Acute intoxication and/or withdrawal potential
2	Biomedical conditions and complications
3	Emotional, behavioral, or cognitive conditions and complications
4	Readiness to change
5	Relapse, continued use, or continued problem potential
6	Recovery/living environment

Detoxification

Clinical Management

Detoxification is best managed in a hospital setting for individuals withdrawing from alcohol, opioids, or sedative-hypnotics.

• Treatment of concurrent mental health issues

• Physiological symptoms:

  • Change in mental status

  • Increasing anxiety and panic

  • Hallucinations

  • Seizures

  • Vital sign changes

Observation and Patient Interview

Assessment Methods

• Observable symptoms

• Interview: Individual, family, community

• Physical exam

• Diagnostic tests:

  • Serum drug levels

  • Toxicology

  • Breathalyzer

Interventions

Strategies for Management

• Promote communication

• Limit setting and boundary violations

• Promote safety during acute withdrawal

• Promote adequate nutrition

• Participation in treatment

Collaborative Therapies

Multidisciplinary Approaches

• 5 A's:

  • Ask (identify and document substance use status)

  • Advise (urge every patient to quit)

  • Assess (readiness to change)

  • Assist (counseling, planning, higher care if needed)

  • Arrange (follow-up)

• Behavior therapies:

  • Cognitive Behavioral Therapy (CBT): Replace maladaptive coping with adaptive strategies.

  • Dialectical Behavior Therapy (DBT): Regulate emotions, practice mindfulness, tolerate distress.

  • Motivational Interviewing (MI): Promote change talk and motivation.

• Milieu therapy: Supportive environment.

• Group therapy: Support groups (SMART), twelve-step programs.

• Family therapy

• Pharmacologic therapy: Disulfiram/Antabuse, naltrexone, clorazepate.

Lifespan Considerations

Special Populations

• Children/Adolescents

• Pregnant Women

• Older Adults

• Impaired Nurses

Impaired Nurses

Risks and Signs

• Easy access to prescription drugs

• Role strain (shoddy charting)

• Depression

• Signs of alcohol or drug use (excessive use of perfumes, mouthwash, mints, long sleeves in hot weather)

• Signs of withdrawal (tremors, restlessness, sweating, watery eyes, runny nose, stomachaches)

• Pennsylvania Nurse Peer Assistance Program (PNAP)

Summary

Addiction is a multifaceted disorder involving physiological, psychological, and social components. Effective management requires a comprehensive approach including medical, psychological, and social interventions, with special attention to language, family dynamics, and harm reduction strategies.

Additional info: Nutrition is referenced in the context of addiction management, particularly regarding balanced diet and vitamin/mineral supplementation for recovery and prevention of complications such as Wernicke's encephalopathy.