Causes of Substance Abuse & Addiction
Are any other tests involved in the drug abuse diagnosis process?
Use of structured and semi structured interviews helps further describe the extent and severity of substance use and its impact in multiple domains. Remember the CRAFFT and CAGE questions? There are also more extensive questionnaires that have been used both in physicians’ offices and in research. For individuals who have complaints other than substance use, routine questions surrounding substance use and use of screening questionnaires avoid omitting an otherwise important coexisting condition. Once one is screened and drug abuse is found to be significant, a more thorough evaluation can be made. A drug use screening inventory screens multiple domains and identifies youth in need of further assessment. Self-reported and self-administered instruments are available in paper-and-pencil or computer-assisted versions. The Addiction Severity Index was used to create adolescent screens such as the Adolescent Problem Severity Index, the Adolescent Drug Abuse Diagnosis Instrument, and the Teen Addiction Severity Index. Other measures include the Adolescent Drug Abuse Diagnosis (ADAD), Adolescent Diagnostic Interview (ADI), and Diagnostic Interview Schedule for Children (DISC), and Teen Addiction Severity Index (TASI). Self-administered tests include the Minnesota Multiphasic Personality Inventory-A (MMPI), Personal Experience Inventory (PEI), Personal Experience Inventory (PEI), Personal Experience Screening Questionnaire (PESQ), Problem Oriented Screening Instrument for Teenagers (POSIT), Drug Use Screening Inventory-Revised (DUSI-R), and Substance Abuse Subtle Screening Inventory (SASSI).
These questionnaires may not be routinely used by practitioners because they rely more on a clinical interview. These inventories increase reliability of subsequent psychiatric interviews. In addition, some of these scales can be read ministered to determine improvements or positive response to treatment over time.
It is true that brain images (through CT scans and MRIs) can detect damage from drug use?
Although brain images can be used to detect brain conditions where there are structural changes, like masses or tumors, these tests are not used primarily to arrive at a psychiatric diagnosis. They are, however, extensively used to advance research in substance abuse. In fact, the use of functional imaging (seeing how the brain works in real time) among live volunteers has given us a better understanding of which parts of the brain are involved in addiction. The part of the brain that is strongly implicated in drug abuse involves the same circuitry (connections) that also underlies the things that make us feel good or drive us to feel better. These are the nucleus accumbens and ventral tegmental area.
Is drug abuse or dependence considered to be a brain disorder?
Yes, but saying this is in no way minimizing the contributions of family and social factors that interplay with the biology of addiction. Advances in the way we image the brain and even look at how the brain works among live research participants have opened up remarkable theories and postulates on how addiction works. The studies done through the National Institute of Mental Health established functional and chemical changes in the brain resulting from drug use.
What parts of the brain are affected?
There are a number of brain areas that are implicated in drug use. Two brain regions are most commonly associated with the reinforcing effects of drugs: the nucleus accumbens and the ventral tegmental area. Neurons made up of dopamine project from the ventral tegmental area to the nucleus accumbens, forming the central mesocorticolimbic dopamine system. They then project into the deeper areas of the brain (limbic system) to the amygdala and hippocampus. These areas are responsible for memory stores of emotionally laden stimuli. They also project into more superficial surfaces (the cortex) of the brain, which are responsible for how certain stimuli in the environment become more prominent. This explains the phenomenon of craving. Expectedly, these are also the same areas that are involved when we talk about the things that normally make us feel happy-when we get satisfied from food or eating chocolates, when being greeted by friends or families, or when watching our favorite programs on TV, listening to music, or having downtime with our families.
What changes for drug addicts is the way these usual sources of happiness become less reassuring, and drugs take a predominant role in these individuals. Addictive behavior is very much a part of the context of drug-seeking behavior. This is illustrated by cues in the environment that remind one of drugs to the extent of causing craving with psychological and bodily manifestations. Relapse has already started even before the resumption of use; that is, when individuals have experienced craving, they have relapsed
Relapse has already started even before the resumption of use; that is, when individuals have experienced craving, they have relapsed.
Guia’s comment:
I now know that addiction really causes brain changes. I grew up in a family where responsibility and choices were important. It is a matter of strong will and character, so if you are weak, you are more likely to use drugs. I realize now that it is not that simple. Having read and seen brain images with drug effects, I know that drugs affect the brain not only in how it functions but also in how the chemical messengers are altered. I am more realistic in dealing with my son’s cravings.
Is there any brain messengers involved in drug use?
Yes. The most commonly implicated brain chemical messenger (neurotransmitter) is dopamine. This is the same chemical that lights up the brain when we eat chocolates, when we get praise, or feel happy being with friends. This is also involved with sexual satisfaction. Other chemical messengers and receptors (where the chemical messengers bind to exert their effects) include gamma hydroxybutyric acid, serotonin, nicotinic and cholinergic receptors, and the N-methyl-D-aspartate systems.
How is drug testing done?
Monitoring of body fluids for the presence of substances is an important adjunct to treatment. Blood samples or gastric contents are tested during acute intoxication and in emergency room settings. Urine toxicology is more practical and is widely used to monitor response to treatment. Immunoassay techniques are useful screening tests, followed by gas chromatography/mass spectrometry for confirmation. Quantitative assay is useful to track reuse within a defined period of time. Immunoassay is a biochemical test that involves measuring a property of the drug to be identified, called the analyte, to determine its presence or concentration. Assays are based on the ability of a substance to bind to the analyte, and an immunoassay can be qualitative or quantitative. A qualitative measurement consists of a sample without the analyte and one with the lowest concentration detectable, and a quantitative measurement requires references of known quantities. Positive screening tests are then confirmed by gas chromatography/ mass spectrometry. This procedure is considered the gold standard as it is a very specific test for the presence of a particular drug. They work synergistically to identify the substance compared to when either used separately.
Gas chromatograph utilizes very fine columns through which different substances (drugs) pass through. Based on their intrinsic properties, these substances will travel along these tubes at varying elapsed times. The mass spectrometer will then capture these molecules and break them into charged (ionized) fragments which are then quantified. Because “dirty” urines have far-reaching implications, sample collection is important. The following are suggested:
1. Removal of access to articles that promote adulteration (removal of articles of clothing used for concealment, water fountains, etc.)
2. Minimum of 60 milliliters (2 oz.) to prevent short sampling
3. Proper labeling and identification of sample
4. Proper documentation of the chain of custody
Random serial drug testing gives an objective measure of the individual’s attempt at his or her sobriety. In addition the testing serves as a deterrent to relapse. The aim is for the adolescent to eventually incorporate this sense of control as his or her own personal tool.
Hair sampling is not commonly used, but it is more sensitive and can detect drug use as far back as 3 months. Saliva and sweat can also be sampled.
