1. Alcohol training Dr Akwasi Osei Consultant Psychiatrist Ag. Chief Psychiatrist - GHS 23 April 2009 Addiction as a disease

2. outline Some definitions Models of addiction Disease model of addiction Implications of disease model

3. Some definitions Drug abuse – use of hard drug in a manner or amount that is harmful or potentially harmful Drug addiction – compulsive use of hard drug in the presence of harm (psychological, physical or social) Drug dependence – when one needs the drug to avoid withdrawal state or to maintain functional status

4. Models of addiction (how to look at addiction) Moral issue Legal issue Disease model

5. The Spectrum of Substance Use Disorders Substance AbuseHarmful Use Hazardous Use moralNon-Hazardous Use Non-User/Abstainer Dependence Syndrome

6. The disease model of addiction This model sees addiction as not a moral failure, not a criminal offence but a clinical syndrome requiring appropriate medical or health intervention Biopsychosocial condition

7. The Concept of Clinical Syndrome of Addiction/Dependence A psychobiological syndrome which comprises a strong desire to use drug, preoccupation with using drug, and sometimes withdrawal symptoms. Features of dependence: impaired control over use a strong desire to use drug preoccupation with using (given greater priority than other activities) increased tolerance to use withdrawal symptoms on not using, or relief of withdrawal symptoms after use continuation of using despite harmful effects

8. Biological basis of addiction as a disease – the neurone

9. The synapse trasmission

10. The reward pathway

11. Neurobiology/mechanism of drug addiction Three mechanisms at the synaptic junction of brain nerve cells Neural – acute exposure Cellular (regulation of ion channels and electrical properties) – long term exposure Molecular mechanisms – long term exposure

12. All drugs of abuse initially act by influencing amounts of neurotransmitter or by interacting with specific neurotransmitter receptor at the synapse Alcohol - Facilitates GABAA (Gamma-amino- butyric acid) receptor function, and inhibits NMDA (N-methyl-D-aspartate) glutamate receptor function

13. Cont’d Repetitive substance use: 1.Re-sets the reward system 2.Activates the brain’s stress systems 3.Impairs the pre-frontal inhibitory systems

14. Cont’d The result: An “internal driving force” is generated, which directs and drives further substance use and is little influenced by voluntary control It is highly reactive to triggers, and the consumption of the substance in question

15. How Dependence Develops: the normal brain

16. The exposed brain: Repeated consumption of Drugs of abuse Leads to Profound neurobiological changes, which “supercharge” the mid- brain And this leads to The driving force of substance dependence

17. Consequences of exposure: Physical illness brain damage Mental disorder Social problems

18. Factors influencing onset of addiction Predisposing factors Precipitating factors Perpetuating factors Protective factors

19. Predisposing factors Biological factors – Genetic, 10% addicts have genetic predisposition – Familial Psychosocial – Being a male – Peer pressure – Religion – Home conditions – Stability of parents’ marriage – Cultural practices

20. precipitating/perpetuating factors Precipitating factors – Exposure to drink or drugs for social and other reasons Perpetuating factors – Persistent exposure – Lack of treatment – Lack of social support

21. Protective factors female gender assertiveness high commitment to school high educational aspirations close affective relationships absence of parental problems high religiosity

22. close supportive relationships with positive- influencing peers high self-esteem self-efficiency creativity good temperament high sociability

23. Implications of disease model No withdrawal of sympathy Reduction in stigma Will seek proper management for addicts Knowledge leads to prevention and effective treatment Addiction treatable but has high relapse rate Addicts should never consider themselves ever as recovered, but as recovering

25. Thank you!