PRIMARY SYMPTOMS OF ADDICTION

The primary symptoms of all types of addiction, including obsessive alcohol, drugs (including prescription opioids) and maladaptive behaviors are:

• Impaired control over the performance or use
• Craving – preoccupation with performing a behavior or obtaining the substance
• Compulsion – continued behavior or use of substance despite adverse consequences
• Distorted thinking, most notably denial, and reduced cognitive function
• Development of tolerance for the effects of the behavior or substance. Individuals will require greater frequency of a behavior, or more and higher doses of a substance, to satisfy the need
• Increasingly severe withdrawal symptoms when the behavior is not performed or the substance is not available
• Loss of ability to monitor or manage the obsession, including efforts to reduce or control

Effects on the central nervous system:

• Blood brain barrier (alcohol or drugs)
• Neurotransmitters (epinephrine, dopamine, serotonin, endorphins, etc.)
• Brain reward circuit (dopaminergic neurons) positive reinforcement

Tissue dependence and withdrawal:

• Physiologic adaptation of body due to prolonged exposure of chemical
• Cross-dependence (extends to drugs in the same class)
• Negative reinforcement

Tolerance:

• Pharmaco-dynamic
• Dispositional
• Cross-tolerance (extends to drugs in the same class)

Phases of Chemical Dependency

Prodromal Phase:

1. Increase of tolerance (needed more to get effect)
2. Temporary loss of memory (blackouts, can’t remember)
3. Sneaking chemical (hiding, etc.)
4. Preoccupation with chemical use
5. Hurried ingestion of chemicals
6. Avoidance of reference to personal chemical use

Crucial or Basic Phase:

1. Loss of memory becomes more frequent (more blackouts)
2. Loss of control (inability to predict how much, how long, etc.)
3. Alibis and excuses (justification)
4. Reproof by significant others (disapproval about use)
5. Extravagance (money, time, advice)
6. Aggression (verbal or physical)
7. Persistent remorse (depression, guilt)
8. Periodic abstinence (tried to stop)
9. Change in chemical use pattern (attempting to control, change brands, time, etc.)

Severe Phase:

1. Loss of friendship (no more invitations, family, etc.)
2. Loss of position or clients (employment, family and social)
3. Significant others change habits or activities
4. First treatment (inpatient, outpatient, AA)
5. Resentments (yourself and others)
6. Escape (geographical, psychological, social—in effect, to control or start over)
7. Protecting supply (know where you can get it, “stash”)
8. Morning usage of chemicals

Chronic Phase:

1. More or less, continuous use of chemicals beyond an 18 hour period (binges, drug runs)
2. Ethical deteriorations (violates one’s own moral standards)
3. Inconsistent inappropriate thinking (cognitive distortions, paranoia)
4. Decrease of tolerance (needs less to get effect)
5. Indefinable fears and anxieties
6. Tremors (hand shaking, difficulty writing)
7. Psycho-motor inhibitions (inability to perform routine tasks without using chemicals)
8. Recognition of spiritual need (I need help)
9. Note: The word “chemical” in this list refers to all mood-altering chemicals, including ethyl alcohol.