Addictions and substance abuse

Substance abuse and addictions are a leading cause of death and disability worldwide, prompt treatment can defenitely reduce suffering.

Rohit, began experimenting with cigarettes in high school as a way to fit in with the cool guys at school. It made him feel grown up and in some ways “responsible”. His father smoked, so did the hero on screen. He was careful enough not to get caught at home though. In college, he had his first beer and he loved it, it made him instantaneously funny and made him popular among some in his class. Ive done weed too! He claims. Rohit is now 30, and drinks half a bottle of brandy everyday. He trembles if cant find that drink every morning. Alcohol controls him ways he does not understand! .

Rohit is now dependent on alcohol, he requires increasing amounts to get him high, he has difficulty controlling intake, has withdrawal symptoms and has developed medical complications. So why cant Rohit just give up ??

There should be no guilt in fighting addictions, only confidence and will power!

There is as much shame and guilt in seeking treatment for substance or behavioural addictions as there is in seeking treatment for a fever or headache.

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In addicted states, during intoxication , there is a robust release of dopamine ( the pleasure hormone) in the nucleus accumbens ( a region of the brain responsible for reward), giving the user intense pleasure, proportional to the subjective “high”. 

The search for this pleasure now begins, with parts of the forebrain such the orbitofrontal cortex ( usually responsible for civil behaviour) urging the user to go to any extent to obtain more of the drug.

When the pleasurable effects reduce as the drug washes out of the body, levels of dopamine fall, leaving the user in a state of negativity ,in addition to physiological withdrawal symptoms (like tremors, sleeplessness and anxiety).

 A few hours after the negative affect stage, as the user walks by a bar, or sees someone smoking,  there is fast increase in dopamine levels in response to anticipation of drug use which again motivates procuring behaviour and use. In addicted states, the dopamine release during the anticipation of use exceeds dopamine release during drug use making it impossible for them to find the high they are looking for, therby leading to a never ending search for pleasure !

Regions of the brain such as the insula connect bodily sensations to emotions, increasing the subjective emotional significance of drug procurement and use

Understanding this model is the first step to fighting addiction, and soon as you begin fighting addiction, the brain will begin fighting back !

Several effective medications are available in treating alcoholism and other drug use problems. With a combination of medications, behavioral changes and psychotherapeutic measures , with time, the neural circuitry can be rewired to more or less an addiction free state !

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Psychiatry is a medical speciality, like surgery, general medicine and paediatrics. It involves the study, diagnosis and management of mental illnesses and distressing conditons, pertaining to both the mind and body. Misconceptions about psychiatric illness and treatment have some how prevented help seeking behaviour in those who need it the most. This Wall has to go, wherin visiting a psychiatrist should no longer be taboo, and people should be able to openly and freely discuss mental health issues. More here.