Addiction Part 3
Posted by Eamonn Brady on
Other complications of Addiction
Coma, unconsciousness or death – People with drug addiction problems often take a mix of many drugs which increases risk of overdose.
Some diseases - injecting drugs especially if sharing needles increases risk of hepatitis and HIV/AIDS (though there is more public awareness of the risks of needle sharing and more needle exchange regimes nowadays). Alcohol abuse and smoking can lead to well publicised health problems. Drugs or alcohol can lead to risky sexual behaviour (unprotected sex), increasing the risk of developing sexually transmitted diseases.
Accidental injuries/death – drug and alcohol addiction problems increase the risk of accidents and injuries and even death due to falls, propensity for violence, driving under the influence to name a few.
Suicide – Substance abuse (but not nicotine addiction) increases suicide risk
Relationship problems – addiction leads to social, family, marital and relationship issues leading to family breakups, etc.
Child neglect/abuse - the high proportion of neglected and abused children have one or both parents with drug or alcohol addictions.
Unemployment, poverty and homelessness – It is more difficult to hold down a job when suffering from drug/alcohol addiction so unemployment, poverty and homelessness are more common.
How is Addiction diagnosed?
It is often family members or friend who raises concern about the person’s behaviour (rather than the person himself/herself doing so). Your GP is a good first point of contact. They'll be able to provide you with help and advice and recommend specialist addiction services.
The doctor will ask several questions, including how often the substance is consumed, whether the substance use has been criticised by other people, and whether the patient feels he/she may have a problem.
If the doctor suspects an addiction problem, the patient may be referred to a specialised addiction counsellor, psychologist or psychiatrist. A blood test may be required to determine whether the substance is still in the blood (whether the substance has been taken recently).
Here are some of the criteria that are looked at to help make a diagnosis:
- Tolerance - after some time (even only a few weeks) the substance has less effect on the person because their body has developed tolerance; this is a sign of addiction.
- There are physical/psychological withdrawal symptoms if the person stops using meaning the person uses the substance to avoid experiencing withdrawal or uses a similar or alternative substance to avoid experiencing withdrawal (eg) a heroin user using a benzodiazepine or cannabis to ease withdrawal symptoms.
- The person often takes higher-than-intended doses of the substance (eg) causing unintended overdoses
- The patient is continually tries to quit or cut down.
- More and more time is spent getting hold of the substance, using it, or recovering from its effects.
- The person’s substance abuse causes him/her to give up social, occupational or recreational activities.
- The person has occasional or frequent blackouts or memory lapses due to overuse of the substance
- The person’s behaviour and personality changes completely while using the substance (eg) a tendency for violence in an otherwise non-violent person
- Despite being aware the substance is causing psychological/physical problems, they continue using it.
Treatment options for Addiction?
The first step to treatment is for the person to acknowledge and realise they have an addiction. There is little (or no) chance of a person giving up unless they want to give up. Treatment can include community and hospital based options including counseling (psychotherapy), self-help groups, and medication. The HSE Community Alcohol and Drug Service (CADS) offers help and have centres in all parts of the country (see below)
Cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) have been shown to be very effective in treating addiction problems. In Ireland, these services are not as readily accessible as in the UK. MET is a counselling technique that can help tackle ambivalence (mixed feelings) a person may have about giving up the substance and about taking part in a treatment programme.
Treatment options consist of withdrawal from the substance and then continued support to help stay off the substance. Treatment varies depending on the substance the person is addicted to:
Addiction to depressants – depressants includes barbiturates or benzodiazepines (eg) diazepam (Valium®). Withdrawal symptoms include insomnia, anxiety, restlessness and sweating. Less common withdrawal symptoms include hallucinations, tremors, seizures, fast heart rate, high blood pressure and fever. In rare cases there can be delirium (severe confused state), which can be life-threatening. Benzodiazepines are only meant for short term treatment of anxiety like disorders in severe cases only. However they are often abused by people suffering from substance abuse problems (eg) to prevent the comedown from drugs like heroin.
Addiction to stimulants (eg) cocaine, amphetamines (“speed” being a street name). Withdrawal symptoms include tiredness, moodiness and depression, anxiety, low enthusiasm, sleep disturbance, and poor concentration. Treatment includes counselling and if the depression is severe, then anti-depressive medication may be prescribed.
Addiction to opioids – Opioids are a drug class that are often prescribed as painkillers. Examples include morphine, codeine, methadone and oxycodone. Heroin (medically called diamorphone) is also an opioid and is the most addictive of all opioids. Withdrawal symptoms can be severe and can include sweating, anxiety, insomnia, stuffy nose, high blood pressure and diarrhoea. For milder opioid addictions, the person may be able to go through withdrawal by “cold turkey” without the need for prescription medication once they get sufficient support (eg. counselling, CBT, family support, etc). For more severe opioid addiction the person may need to be prescribed methadone, or buprenorphine to ease cravings.
Community Alcohol and Drug Service (CADS)
The HSE Community Alcohol and Drug Service offer counselling and treatment services for adults suffering from addiction to alcohol, drugs and gambling. CADS have centres in Mullingar, Athlone and Longford. CADS provides counselling and treatment to help people get over their addiction. You can contact them at 04493 41630.
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.