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HC 1. WHAT IS ADDICTION? AN INTRODUCTION, DR. INGMAR FRANKEN , EUR. + NOTESON COURSE
Voor toets à weet globale getallen, niet precies.
Van meest naar minst addictive: sigaretten, heroïne, cocaine, alcohol, amphetamine en
cannabis. Dus sigaretten meest!!!
Alcohol-dependent is one of the highest prevalence of psychological disorders.
Substance use disorder is one of the most prevalent psychiatric diseases
Why study addiction?
• Number of smokers has reached all-time high (1.1 billion). In 2019 8 million people
killed by smoking
• 13.5% of deaths among people in 20s are linked to alcohol
• 1/3rd of europeans are suffering from mental disorder in 1 year, zoals anxiety of
depressie. Mannen vaker alcohol-dependence.
• Gambling probleem in Australië
• Addiction is almost everyday in the news
Top 3 incidence mental disorders last 12 months in Nederland:
1. Any mood disorder
2. Any anxiety disorder
3. Any SU
(is without smoking. Smoking isn’t treated as mental health in NL. Than would be highest
probably)
Societal relevance of substance use
• Impact on health (health care &
hospitals, morbidity, mortality)
• Relationship with crime (>50%
crimes is substance related)
• Impact on public safety
(substance-affected driving
impact chemical waste on
environment)
• Impact on work-related
productivity
Is it a real disorder?
Brain disease model: addiction = brain disease (not everyone agrees)
Theodore Dalrymple: addiction is NOT a disease, addicts are poseurs with a weak will
It is on continuous scale, when is it a disease? Has to do anything with the will
è Will is less as result of brain function (Ingmar franken)
è Less brain disease, little bit free will (if you use drugs I will shoot you. Probably they
don’t do it)
1
,Know global numbers! Dis=disorder
Addiction & substance use cannot be understood apart from the social and historical
context (religion, availability, culture)
• Addiction is context dependent.
• Prohibition of alcohol rond 1920/1930 in US
• Tijdens eerste wereldoorlog was cocaine legaal. Je kon zelfs aandelen kopen.
• Anyway by most psychologists & psychiatrists seen as one of most prevalent
psychiatric disease (Substance use disorder, DSM-5)
• DSM-5 criteria (most about loss of control)
o 2 of following 11, within 12-months
§ Taking substance in larger amounts/for longer than meant to
§ Wanting to cut down or stop, but not managing to
§ Spending a lot of time getting, using, or recovering from use
§ Cravings to use the substance
§ Not managing to do what you should at work, home or school,
because of substance use
§ Continuing to use, even when it causes problems in relationships
§ Giving up important social, occupational or recreational activities
because of substance use
§ Using substances again and again, even when it puts the you in
danger (drunk driving e.g.)
§ Continuing to use, even when the you know you have a physical or
psychological problem that could have been caused/made worse by
the substance
§ Needing more of the substance to get the effect you want (tolerance)
§ Development of withdrawal symptoms, which can be relieved by taking
more of the substance
2
, Verschil DSM-V en DSM-IV:
• In DSM-V staat craving erbij als nieuwe criteria
• In DSM-IV stond dat het noodzakelijk was gearresteerd te zijn geweest of in
aanraking met politie, dit is er in de DSM-V uitgehaald als criteria
• In DSM-IV werd onderscheid gemaakt tussen alcohol dependence en alcohol abuse,
dit verschil is niet meer in de DSM-V.
Belangrijk om te onthouden volgens Ingmar dat er bij verslaving sprake moet zijn van:
- Loss of control
- It needs to cause problems
Types of substances:
• Tobacco (e.g. cigarettes)
• Stimulants (e.g. Cocaine, Amphetamine(speed), XTC)
• Depressants (dempen CNS, make you more relaxed. E.g. alcohol, benzodiazepines,
GHB)
• Opiods (e.g. heroin, prescription drugs. Pain killers often. Misused for getting
high/pleasant effects)
• Hallucinogens (e.g. LSD, Cannabis, Ketamine)
Most die bc of tobacceo, then alcohol, then opiates
Nieuwe trend à painkillers. In US gem van 115 opiod overdose each day.
3
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