Physical dependence happens when your body starts to rely on a substance to function. When you stop using the substance, you experience physical symptoms of withdrawal. This can happen with or without psychological dependence.
Understanding Psychological Addictions
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Some estimates suggest approximately 90 percent of people recovering from opioid addiction and 75 percent of people recovering from alcohol addiction or other substance addictions will have symptoms of PAWS.
Treating psychological dependence is a bit more complex. For some folks dealing with both a physical and psychological dependence, the psychological side of things sometimes resolves on its own once the physical dependence is treated.
The word addiction has been traced to the 17th century.[10] The consumption of addictive substances, such as alcohol, opioids, cocaine, and cannabis, has been traced back to ancient history of Syria, China, and South America.[11] During this time period, addiction was defined as being compelled to act out any number of bad habits. Persons abusing narcotics were called opium and morphine "eaters", and the term drunkard referred to abusers of alcohol. Medical textbooks categorized these "bad habits" as dipsomania or alcoholism[12] However, it wasn't until the 19th century when the diagnosis of addiction was first printed in medical literature. In the 1880s, Sigmund Freud and William Halsted began experimenting with users of cocaine. Freud in particular was convinced that cocaine could be the answer to many mental and physical problems and published a paper "On Coca" about its benefits.[13] Being unaware of the drug's powerful addictive qualities, Freud began to commend it as a means to overcome morphine addictions. Over time, Freud and Halsted inadvertently became guinea pigs in their own research and, as a result, their contributions to psychology and medicine changed the world. Freud publicly endorsed cocaine and its uses, theorizing that cocaine could be used as an anesthetic. This idea was later tested and found to be true.[13] However, most of his other claims about cocaine turned out to be false and his advocacy for cocaine severely hurt his career.
As cocaine continued to spread, physicians began looking for ways to treat patients with opium, cocaine, and alcohol addictions. Physicians debated the existence of the label "addictive personality," but believed the qualities Freud possessed (bold risk taking, emotional scar tissue, and psychic turmoil) were of those that fostered the "addictive personality".[12]
Physician Sigmund Freud, born on May 6, 1856, in Freiberg, France (an area now known as Pribor in the Czech Republic), was instrumental in the field of psychology. Dream interpretation and psychoanalysis, also known as talk therapy, are two of his well-known contributions. Psychoanalysis is used to treat a multitude of conditions including addictions.[14] As one of the most influential thinkers in the 20th century, he altered the way we perceive ourselves and communicate about our perceptions; as a number of his theories have been popularized and terms he created have entered into general language.[15]
The American Psychological Association (APA) is a professional psychological organization and is the largest association of psychologists in the United States. Over 100,000 researchers, educators, clinicians, and students support the association through their membership. Their mission "is to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives."[29]
APA supports 54 divisions, two of which pertain to addictions. Division 50, Society of Addiction Psychology promotes advances in research, professional training, and clinical practice within the range of addictive behaviors. Addictive behaviors include problematic use of alcohol, nicotine, and other drugs as well as disorders involving gambling, eating, spending, and sexual behavior.[30] Division 28, Psychopharmacology and Substance Abuse promotes teaching, research, and dissemination of information regarding the effects of drugs on behavior.[31]
The College of Professional Psychology (CPP), hosted by the American Psychological Association Practice Organization, previously offered a certificate to psychologists whom demonstrated proficiency in the psychological treatment of alcohol and other substance-related disorders. The CPP maintains the certificate of proficiency for persons who acquired it prior to 2011. The Society of Addiction Psychology certificate will be re-instated while the Society examines other avenues for credentialing professionals in addiction treatment.[32]
Many degrees provide space for the treatment of addictions. The educational background that each professional obtains will contain similarities but the philosophy and the viewpoint from which the material is delivered may vary. The required amount of education prior to earning a certificate or degree also varies. A few of the more commonly recognized fields of study are included.[41]
Both process addiction and behavioral addiction have many dimensions causing disarray in many aspects of the addicts' life. Treatment programs are not a one size fits all phenomenon, hence there are different modalities or levels of care. Effective treatment programs incorporate many components to address each dimension. The addict suffers from psychological dependence and some may suffer from physical dependence.[44]
Contingency Management can be a treatment used to treat psychoactive addictions, which aims to change behavior by incorporating positive and negative reinforcements.[45] Some common reinforcers used within contingency management are vouchers, prized-based, methadone take-home dosages, altering the dosage amount, and cash.[46] Based upon the principles of operant conditioning, contingency management treatments involve daily or frequent monitoring such as: the individual addicted to drugs providing a drug free urine sample, then receiving the incentive after showing proof of drug abstinence.[47] Therefore, within operant conditioning, continuing to receive the reward increased drug abstinence.
As an example, within prized-based contingency management, individuals with addictions earn opportunities to draw from a prize bowl each time they provide a negative drug sample, which means the more negative drug samples, the more prizes the individual can win. The prize bowl may contain rewards with slips of paper that say, "Good Job" as praise, "small= $1," "large= $20," or "jumbo= $100."[47] Contingency management has been shown to help individuals struggling with addiction reach abstinence with a wide range of addictive drugs (e.g., alcohol, opiates, cocaine, and nicotine).[47]
An outpatient treatment option facilitated by a treatment provider and used to expand on the support system the patient already has. Groups foster a non-judgmental environment allowing patients to meet and discuss difficulties and successes of their addiction while providing ongoing support that is needed to be successful with recovery.[49] This kind of group counseling is done for people with addictions in prison as well. It gives them a sense of community in a place where they would feel their lowest.
A variety of treatment approaches are utilized by health professionals in order to provide their clients the highest possible level of success to overcome their addictions. There is no one specific approach and often therapists will use multiple techniques.
Most psychological addiction begins with feelings that are out of control. Strong emotions like rage, jealousy, fear and hopelessness make some people feel helpless. To quell these uncomfortable feelings, abusers turn to drugs, alcohol or compulsive behaviors such as gambling, overeating or pornography.
Scientists will always debate whether psychological addiction is nature or nurture, circumstances or genetics. What they do know is that physical addiction has a strong genetic component. In addition, compulsive behavior is related to obsessive-compulsive disorders and certain anxiety disorders, which also have a strong genetic component.
Working with a psychologist or psychotherapist, an addiction counselor or a recovery group can be invaluable in such circumstances. Often, group feedback helps people understand places where they are psychologically stuck and places where breaking psychological addiction may be possible. Finding a recovery center or group is the first step to breaking free from the compulsion of addictive behavior and breaking psychological addiction.
Like nicotine, heroin and other drugs, gambling leads to the release of dopamine thus activating the reward system.Naltrexone, an opiate antagonist, reduces the release of dopamine in the nucleus accumbens therefore decreasing the feeling of pleasure and increases the release of GABA in the mesolimbic system which is a neurotransmitter which decreases the cravings.In the UK naltrexone is used only for the treatment of heroin addiction, however, in the USA it is becoming more widely used for other addictions.A significant issue with the use of naltrexone is that this drug can have serious side-effects such as anxiety, drowsiness, fatigue, panic attack and depression.Furthermore, this drug could also stop patients feeling pleasure in all other areas of their life which leads to non-compliance (the patients stop taking the drug) this reduces the effectiveness of the treatment.Kim, 2001 carried out a 12-week double-blind placebo-controlled trial of naltrexone and found that a dose of188mg/day reduced the frequency and intensity of gambling urges, as well as the behavior itself in 45 pathological gamblers compared to the placebo group.Another group of drugs, the Selective Serotonin Reuptake Inhibitors (SSRIs) is also used. The serotonin system is associated with impulse control, by inhibiting the reuptake of serotonin these drugs make more of it available in the synapses therefore should increase impulse control and reduce gambling. 2ff7e9595c
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