Addictions

It is common for us to engage in the occasional alcoholic drink, either in a social context or to cope with negative emotions. Most people do not get addicted to alcohol after a couple of drinks, but a significant minority are genetically predisposed to get “hooked” and may fall into a vicious cycle where problems associated with alcohol use leads to negative emotions such as depression, which fuels more drinking. This is when the brain may have been hijacked by alcohol, and an addiction (or dependence) has developed.
There are many types of addictions, though they can be broadly grouped into substance addictions and behavioural addictions. The common theme in all addictions is that they hijack the reward centre of the brain, the nucleus accumbens, and causes the person to lose control over their addiction. Addictions are thus fundamentally a brain disease and are influenced by profound genetic, social and cultural factors.
Types of substance addictions
  • Alcohol
  • Nicotine (cigarette smoking)
  • Sleeping pills
  • Illicit substances such as heroin, amphetamines, cannabis
  • Caffeine
Types of behavioural addictions
  • Problem Gambling
  • Excessive internet use, gaming
  • Some forms of behaviours such as compulsive sexual behaviour and compulsive shopping are less well understood but have been conceptualised as addictive behaviours.
By far, alcohol use disorder is one of the most commonly diagnosed addiction disorders and it takes an enormous public health toll on society. According to the Singapore Mental Health Study (2011), roughly 3.6% of the local population may suffer from alcohol use disorder to some degree. This translates to a huge number and affects tens of thousands of local families. Globally, alcohol is the most commonly abused substance after nicotine.
The Singapore study also found that those with alcohol use disorder had significantly higher odds of having major depressive disorder, gastric ulcers, lung disease and chronic pain. Yet only one in five had ever sought treatment.
Excessive alcohol use affects every part of the body, literally from head to toe. It leads to many metabolic, gastrointestinal, neurological and psychiatric complications, and ultimately to death.
Complications of alcohol use disorder
  • Heart disease and heart failure
  • Stroke
  • Obesity
  • Gastric ulcer
  • Liver disease
  • Inflammation of the pancreas
  • Cancers (mouth, throat, liver, colon, breast)
  • Nutritional deficiencies
  • Dementia
  • Depression
  • Psychosis
Symptoms of alcohol use disorder
  • Loss of control over the quantity of alcohol consumed, drinking more than initially intended
  • Cravings to drink
  • Drinking alone rather than for social reasons
  • Bodily harm (injuries and illness) associated with alcohol use
  • Psychological harm (depression, memory problems, blackouts, hallucinations)
  • Social harm (affecting relationships and work in negative ways, running into financial and legal problems due to alcohol)
  • Neglecting important duties due to alcohol
  • Tolerance – drinking progressively large amounts over time to achieve the same effect
  • Withdrawal symptoms such as anxiety, headaches, nausea, tremors and sweating when one stops drinking
  • Primacy – alcohol becoming the central theme and sole purpose in one’s life. All life activities revolve around alcohol.
  • Multiple failed attempts to quit alcohol use
  • Narrowing of drinking repertoire from a wide variety of drinks, to beverages with higher and purer alcohol content
Risk factors for alcohol use disorder
  • Drinking alcohol regularly
  • Drinking at an early age
  • Family history of alcohol problems
  • Depression and other psychological conditions
  • History of emotional trauma, abuse or neglect
  • Cultural factors such as glamorising or endorsing alcohol use in a social setting
Abuse and addiction of illicit drugs are much less common than alcohol addiction, but continues to plague a minority of the population. In Singapore, methamphetamine has become the most commonly abused illicit. The Central Narcotics Bureau estimates that there are almost 4500 amphetamine users in 2019, a steady and rather dramatic increase from below 2000 users in 2015. This is followed by heroin. The following chart is reproduced from the CNB website.
Treatment

  • Substitution therapy using medications. In the acute phase of substance withdrawal, the priority is in alleviating withdrawal symptoms. Benzodiazepines are used to treat alcohol withdrawal. For smoking cessation, there are many nicotine replacement therapies available. They come in the form of gum, inhalers or skin patches.
  • There are at least 3 FDA approved medications which help to reduce cravings in alcohol addiction. One such medication is Naltrexone.
  • Rehabilitation involves intense counselling and education. Some centres such as Institute of Mental Health offers a short course residential program in the inpatient setting to help facilitate detoxification and rehabilitation in a safe and medically supervised facility.
  • Psychological therapy in the form of Motivation Interviewing and Cognitive Behavioural Therapy have been proven to facilitate behavioural change and improve motivation in persons struggling with addictions. This can be done in the outpatient setting.
  • Practical help in the form of social services, supported employment, caregiver and family support, crisis interventions are just as important to support persons in recovery. Some sufferers from addictions relapse and may require several attempts before they finally succeed in quitting for good.
  • There are different approaches to quitting or controlling the addiction. Sufferers are encouraged to discuss with their doctor if an abstinent approach or harm reduction approach is more suitable and sustainable.
  • Support groups such as Alcoholics Anonymous (AA) are easily accessible in the community. AA host online sessions several times a day and they also have support groups for family members. The challenge is getting the sufferer motivated enough to want to change. AA describes themselves as a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.

SEEK HELP TODAY

Individuals with an addiction problem fall into a downward spiral, as the addiction wreak havoc to their family and social life, work and finances, physical and mental health. Because their brains are “hijacked” by the addiction, they lose control over their actions and behaviors. They lose sight of what is important in their lives. They lose themselves and are no longer the person they used to be.

With professional help and proper treatment, individuals struggling with addiction have the chance to regain their lost identities, reconnect with loved ones, and reboot their lives. A watchful coach and steadfast guardian angel will prove invaluable and instrumental in the recovery journey, which may be arduous.

The first step towards recovery is to have the courage to seek help. If you suspect that you or a family member is suffering from an addiction, find the strength to seek help early. Call or whatsapp us to arrange a consultation with our psychiatrists or psychologists. Early treatment often translates to better health outcomes.
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