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Summary GGZ2029 Addiction ALL tasks and lectures
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This is an elaboration of all sources of all tasks and the lectures of the course 'Addiction'.
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COURSE 4 – ADDICTIONPROBLEM 1 – WHAT IS ‘ADDICTION’?
1. What is addiction and what are the DSM-V criteria? (also main aspects of
addiction → article)
Other (or unknown) Substance Use Disorder
Diagnostic criteria:
A. A problematic pattern of use of an intoxicating substance not able to be
classified within the alcohol; caffeine; cannabis; hallucinogen (phencyclidine
and others); inhalant; opioid; sedative; hypnotic; or anxiolytic; stimulant; or
tobacco categories and leading to clinically significant impairment or distress,
as manifested by at least two of the following, occurring within a 12-month
period:
1. The substance is often taken in larger amounts or over a longer period
than was intended;
2. There is a persistent desire or unsuccessful efforts to cut down or control
use of the substance;
3. A great deal of time is spent in activities necessary to obtain the substance,
use the substance, or recover from its effects;
4. Craving, or a strong desire or urge to use the substance;
5. Recurrent use of the substance resulting in a failure to fulfil major role
obligations at work, school, or home;
6. Continued use of the substance despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the effects of its
use;
7. Important social, occupational, or recreational activities are given up or
reduced because of use of the substance;
8. Recurrent use of the substance in situations in which it is physically
hazardous;
9. Use of the substance is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is likely to
have been caused or exacerbated by the substance;
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve
intoxication or desired effect;
b. A markedly diminished effect with continued use of the same
amount of the substance;
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for other (or unknown)
substance (refer to Criteria A and B of the criteria sets for other [or
unknown] substance withdrawal, p. 583).
b. The substance (or closely related substance) is taken to relieve or
avoid withdrawal symptoms.
,Coding based on current severity: Note for ICD-10-CM codes: If another (or
unknown) substance intoxication, other (or unknown) substance withdrawal, or
another other (or unknown) substance-induced mental disorder is present, do not use
the codes below for other (or unknown) substance use disorder. Instead, the
comorbid other (or unknown) substance use disorder is indicated in the 4th character
of the other (or unknown) substance-induced disorder code (see the coding note for
other (or unknown) substance intoxication, other (or unknown) substance withdrawal,
or specific other (or unknown) substance-induced mental disorder). For example, if
there is comotbid other (or unknown) substance-induced depressive disorder and
other (or unknown) substance use disorder, only the other (or unknown) substance-
induced depressive disorder code is given, with the 4th character indicating whether
the comorbid other (or unknown) substance use disorder is mild, moderate, or
severe: FI 9.14 for other (or unknown) substance use disorder with other (or
unknown) substance-induced depressive disorder or FI 9.24 for a moderate or severe
other (or unknown) substance use disorder with other (or unknown) substance-
induced depressive disorder.
Specify current severity:
305.90 (FI 9.10) Mild: Presence of 2 -3 symptoms.
304.90 (FI 9.20) Moderate: Presence of 4-5 symptoms.
304.90 (F19.20) Severe: Presence of 6 or more symptoms.
Source: DSM-V
The Challenge
Addiction is hard to define because of its wide variation. Paradigmatic addictive
substances are illegal drugs, people can also become addicted to legal drugs and
prescribed medications, in addition other behaviour forms of addictions increase;
gaming, gambling, work, food, etc. Addictions differ in population, kind of substance,
health impact, etc. so do withdrawal symptoms; alcohol withdrawal seems most
severe (risk of hallucinations, delirium and death). Also, variation in who gets
addicted. Rates of addiction are positively correlated with low SES, low IQ,
adolescence and early adulthood, childhood abuse, stress, psychiatric disorders
(particular personality disorders) and religion (negative correlation?).
Motivation for drugs use differs, Müller and Schumann (2011) identify eight goals of
non-addictive consumption (1) improved social interaction, (2) facilitated sexual
behaviour, (3) improved cognitive performance, (4) coping with stress, (5) alleviating
,psychiatric symptoms, (6) novel perceptual and sensory experiences, (7) hedonia or
euphoria, and (8) improved physical and sexual appearance. Pickard says many of
these motivations may survive once consumption becomes addiction.
Definitions
Various kinds of addiction give various definitions. First kind is needed to be
established. Dictionary definitions can be vague and are often misleading.
Descriptive (stipulative) definition is likely more precise but because of its descriptive
nature also may be misleading. A definition is wanted that is neither stipulative nor
dictionary. We need a precising (theoretical) definition; relatively precise class of
conditions that lies within limits of common usage but does not reflect all vagueness
of common usage. The goal of precising definitions is to be useful, theoretically and
practically. They serve several purposes; deciding who to treat, health insurance
companies who to pay treatment for, law courts to decide whether defendant is
controlled by addiction for treatment program, for scientists for data to allow them to
collect data that enable precise theories and finally individuals to decide how to
think and feel about someone with addiction. As a result, there may be multiple
definitions of addiction, each appropriate to different purposes and contexts.
Symptoms
The diagnostic and statistical manual of mental disorders defines substance
dependence (addiction):
A maladaptive pattern of substance use, leading to clinically significant impairment or
distress, as manifested by three (or more) of following, occurring at any time within
the same 12-month period:
(1) Tolerance
(2) Withdrawal
(3) Using more than was intended
(4) Persistent desire of unsuccessful efforts to control use
(5) A great deal of time spent obtaining, using, or recovering
(6) Reduction in other important activities because of use
(7) Continued use despite knowledge of it causing a persistent or recurrent
physical or psychological problem
Different combinations give different treatment. This suggests that the definition could
be improved in order to better serve clinical practice, and that DSM-IV (DSM-4)
definition cannot adequately serve scientists who study mechanisms of addiction
because of its individual variation.
Appetites
Foddy and Savulescu define: “an addiction is a strong appetite”, in which appetite is
defined as “a disposition that generates desires that are urgent, oriented toward
some rewarding behaviour, periodically recurring, often in predictable circumstances,
sated temporarily by their fulfillment, and generally provide pleasure”. Appetite can be
for substance and materials or activities. → provides some advantage to definition
DSM-IV; enables scientists to seek mechanisms for such strong appetites.
Nonetheless this definition is too narrow; it is useful to import the distinction between
liking and wanting as developed by the theory of incentive sensitization (Robinson
and Berridge): the salty water does not taste good even to the rat: the rat does not
like the water. But it nonetheless wants the water very much. Foddy and
Savulescu’s definition of appetite seem to combine liking with wanting. They
, mention “rewarding behaviour” and “pleasure”, so liking seems essential to addiction
on their account. But then their phrase “a disposition generates desires that are
urgent” sounds more like wants of a salt-deprived rat. They seem to require that
addicts both strongly like and want to use drugs. This double requirement is
problematic because some addicts report wanting it but report they don’t like it. The
definition is also too broad: it fails to distinguish addiction from heavy use based on
strong desire. Foddy and Savulescu definition hides important differences and does
not capture the core of our common understanding of addiction. A play of golf could
wrongly be defined as an addiction.
Control
The difference between heavy use and addiction is control. The importance of
control in understanding addiction is reflected in three criteria: (3) using more than
was intended, (4) persistent desire or unsuccessful efforts to control use, and (7)
continued use despite knowledge of resulting persistent or recurrent physical or
psychological problems.
Addicts cannot stop using drugs, what does this mean; not that they physical or
psychologically cannot but more often that they lack good enough reason to quit.
Like when your askes to go out: you cannot because you have work in the morning
which is good enough reason. So, what does lack ability, or they cannot stop taking
drugs mean? The truth is that physical and psychological ability to control his use is
reduced: he lacks the degree of control that we normally expect people to have over
their behaviour.
So what is control? Two accounts are common. One focuses on wants and claims
that an agent has control over a type of action if and only if:
(1) If they want to overall perform the type of action, then they usually do it;
(2) If they don’t want to overall to perform that type of action, then usually they
don’t do it.
Want-based accounts of control contrast with reasons-responsiveness accounts.
On this kind someone has control over a type of action if:
(1) If they have a strong overall reason to perform that type of action, then they
usually do;
(2) If they have a strong overall reason to not perform that type of action, then
usually they don’t.
Example one: difference of want-bases and reasons-responsiveness
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