Addiction - Symptoms

Symptoms of addiction

Addiction is a complex biopsychosocial problem that is poorly understood not only by the general public but also by many health care professionals. The primary symptom of this disorder is behavior characterized by compulsive acquisition and use of psychoactive substances. The diagnosis of addiction (also called dependence) is established in accordance with the criteria of the American Psychiatric Association. These criteria apply to any form of addiction and require the presence of behavioral symptoms associated with the acquisition and use of psychoactive substances. According to these criteria, a diagnosis of addiction can be established if at least three of these symptoms are present. These behavioral symptoms of addiction are actions to obtain the drug that are integrated into normal daily activities. Although the presence of tolerance and withdrawal are taken into account in the diagnosis, they are not sufficient in themselves to establish the diagnosis. Tolerance is characterized by the need for a significant increase in the dose of the substance to achieve the desired effect or a marked weakening of the effect with continued administration of the same dose. Withdrawal syndrome is characterized by rebound vegetative symptoms that occur when a substance that has been used regularly for a period of time, depending on the nature of the substance and the dose administered, is suddenly discontinued. Withdrawal symptoms are usually the opposite of the effects caused by the substance being used. Substance abuse is a less severe form of pathological behavior associated with obtaining a substance, and its diagnosis is possible if only one or two of the listed symptoms are present. Only when tolerance or withdrawal are combined with behavioral changes is the condition considered to be an addiction.

There is some terminological confusion associated with this concept. It arises for two reasons. First, it is widely believed that tolerance and withdrawal are essentially synonymous with the concept of addiction. In fact, addiction is a behavioral disorder that may or may not be accompanied by tolerance and withdrawal. Many drugs prescribed for the treatment of pain, anxiety, and even hypertension cause tolerance and withdrawal (when stopped). These phenomena are associated with normal physiological adaptation in response to regular administration of drugs. It is important to distinguish between these concepts, since patients with severe pain often stop taking opioids they need simply because they develop tolerance, and withdrawal symptoms occur when the administration is suddenly stopped. In practice, patients taking opioids for severe pain rarely exhibit behavioral symptoms that would qualify them for a diagnosis of dependence (according to DSM-IV). The term “physical dependence” is more often applied to this situation, which does not involve the development of addiction and to which the DSM-IV criteria for dependence do not apply.

The second reason for confusion is that the actions associated with obtaining the psychoactive substance are usually not the only problem requiring treatment in 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 associated with obtaining the drug recede into the background. Therefore, the addiction treatment program must be comprehensive. The outcome of treatment may depend to a greater extent on concomitant mental disorders than on the amount, frequency, and duration of psychoactive substance use. The addiction treatment algorithm presented in Fig. 8.1 requires a comprehensive examination and involves addressing all concomitant disorders.