This research paper will evaluate the biological aspects of addictive substance or behavior and how it affects the brain and organs. Biological aspects include dopamine levels that are replaced in the brain due to the reward system being overtaken and the absorption rate of the drug once it is ingested will be discussed. The biological aspects are extensive and permanent if the individual does not get the help they need. Furthermore the clinical issues of addictive substance or behavior will be discussed along with medical treatments and ethical issues. This includes treatments such as counseling and treatment programs that are effective. Lastly the Christian worldview implications and how it affects Christian counselors will be addressed. How the church may view individuals who have an addiction and how a counselor approaches a client with an addiction. Addiction is something that is an epidemic in the world of the devil and it should be evaluated and taken seriously.
People use drugs for a variety of reasons, some may be to self-medicate, to overcome anxiety, to deal with a past that they want to forget, or even just to fit in with a crowd. However, most of the users, initially, do not think or care of the after side effects which could include addiction. There are many factors that come into play on if a person will be more susceptible to addictions such as “heredity, environment, psychoactive drugs and compulsive behaviors” (Inaba & Cohen, 2011). Substance/Behavior
Drugs affect many areas of a person’s body, the central nervous system (CNS) is effected “causing mental, emotional and physical changes” (Inaba & Cohen, 2011). Pharmacokinetics describes this process by which a drug is “absorbed, distributed, metabolized, eliminated, and excreted by the body” (Inaba & Cohen, 2011). The factors that contribute to this process include: “route of administration, speed of transit to the brain, rates of metabolism, process of elimination, affinity for nerve cells and neurotransmitters” (Inaba & Cohen, 2011). All of these factors contribute to how the drug biogically affects the person administering the drug. A person who injects heroine on an empty stomach will not have the same effect as a person who digests a pill of heroine after a meal. There are more aspects that involve if the person will become addicted to the drug. Metabolism and excretion also play a part in the effects on the brain. Metabolism is “the body’s mechanism for processing, using, and inactivating a foreign substance that has entered the body” (Inaba & Cohen, p. 2.7, 2011). Metabolism applies to everything that is ingested into our bodies, including food. Excretion is “the process of eliminating the foreign substance and its metabolites from the body” (Inaba & Cohen, p. 2.7, 2011). When a drug is ingested the metabolic process begins along with the excretion process by the kidney. This explains why alcoholics have kidney problems and sometimes failure after years of alcohol abuse. An example of how a drug travels from Inaba and Cohen is:
“when someone swallows a 10 milligram tablet of Vicodin or drinks a beer the drug passes through the esophagus and the stomach into the small intestine, where it is absorbed into the capillaries enmeshed into the intestine walls. The capillaries transport the drug into the veins which carry it to the liver where it is partially metabolized. It is then pumped back to the heart and subsequently to the rest of the body.” That is just one example of how a drug is passed through the body and absorbed into the users system. There are many other ways that the drug can enter into the body. The first time alcohol or drugs are ingested “dopamine levels spike higher than they do with food…and that experience is remembered,” the experience is stored in the amygdala which controls emotion and hippocampus which controls emotion. After using the substance over and over the brain no longer produces its own dopamine. (Carlson & Carlson, 2013). There are more side effects that occur if the substance is not taken again, including depression and sometimes physical symptoms. (Carlson & Carlson, p.35, 2013). If the person stopped filling the void they have created with the substance their brain will eventually start reproducing its own dopamine again. There are addictions that can develop from behavior disorders, non-substance abuse disorders.
These could be gambling, shopping, and many other compulsive/impulse control disorders. There are studies that suggest that “26-37% of those with alcohol dependence also had a lifetime history of a mood disorder (with depression being the most common), whereas 32-37% met lifetime criteria for an anxiety disorder” (McLachlan & Starkey, 2012). When a person who is addicted to a compulsive disorder is going through withdrawals “the urge or craving while abstaining from the behaviors may have a similarity with cravings during drug withdrawal in substance addictions” (El-Guebaly, Mudry, Zohar, Tavares,& Potenza, 2012). To a person who is withdrawing from a gambling addiction they will feel the same way as a person who is trying to stop drinking. There are groups such as Gamblers Anonymous and Alcoholics Anonymous that help these individuals through the process of overcoming their addictions. When a person who is suffering from an addiction decides to make a change they can go through a process before they decide to take action. The stages are pre-contemplation, contemplation, preparation/ready for action, action, maintenance, and possibly relapse. (James, p. 74, 2012). Pre-contemplation is when the person is not considering change and denying they have a problem. Contemplation is when the addict is sitting on the fence about if they have a problem or not.
Preparation/ready for action is described as when they are making a mental plan for how and when they are going to act. Action is practicing the new behavior for three to six months. The maintenance stage is continuing to maintain the new behavior for more than six months after the action plan. Relapse occurs if the old behaviors happen again, (James, 2012). An important part of overcoming the behaviors that go along with addiction is the creation of memories. Memories are created from the time we are born, we learn things about ourselves such as what makes us laugh or what makes us cry. A person may have a bad experience with a drug or alcohol and that memory stays with them. It could even deter them from trying it again or the person could be pressured into giving it one more try before they decide. Memories are actually “solid bits of protein imprinted on the brain as microscopic memory bumps called dendritic spines” (Inaba & Cohen, p. 2.12, 2011). When people use psychoactive drugs the memories are imprinted on the brain. These memories include, “where they got the drug, the reason they used it, and what feelings resulted” (Inaba & Cohen, 2011). These memories are problematic because they are especially powerful for the user’s brain. The memories will affect how often a person uses in the future. If a person has a euphoric and amazing experience when they use a drug they will remember it vividly and have a hard time forgetting the experience.
If something happens to them that causes depression or makes them have a bad day they will go back to this euphoric state and want to recreate that situation again. Furthermore, if the person has a preconceived susceptibility to addiction to a substance they are more likely to continue to go back to this substance to solve their problems rather than dealing with them in a healthy way. Many factors such as environment when the person was raised will also play a factor, if the person was not taught the proper coping skills in dealing with issues their only memory of how to escape a problem will be the occurrence of the drug use. The same instance occurs with a person who suffers from a behavioral disorder such as gambling. When a person gambles they feel valued and appreciated. A person with a gambling addiction is treated like a king when they walk into a casino or a place that caters to gamblers. They bring them drinks to their table, they have beautiful girls around them, and they are treated as if they are someone important. To a person who has never been treated like that in their life, it can develop into an addiction, an addiction to winning the money and an addiction to being treated like a king.
Their memories and reward systems are replaced with this experience and it is hard to overcome. The reward/control pathway of the brain “encourages a human to perform or repeat an action that promotes survival” (Inaba & Cohen, p. 2.14, 2011). A psychoactive drug urges a person to take the drug again because it closely resembles the natural reward system of the brain. For substance abusers this pathway is seriously altered, “the go circuit becomes overactive and the stop circuit becomes dysfunctional and does not shut off the craving” (Inaba & Cohen, 2011). The craving to do the drug again becomes seemingly unbearable for the individual because their reward system is in overload. The individual may wish that they could stop the addiction or not even want to but they cannot stop because of the affect the drug/habit has had on their brain.
The reversal of the reward system also makes normally enjoyable circumstances not enjoyable to the individual suffering from an addiction. A person who may have enjoyed painting or walking around the park will be able to think about nothing other than taking another hit of cocaine because their brains reward system is not happy until that is experienced. It takes a very strong individual to be able to overcome this and recognize it in their own brains. That is why there are programs such as Alcoholics Anonymous to help individuals process these changes in a step by step basis, because it is so hard to just quit something that has such a hold on the person. Clinical Issues
There are aspects of treatment that dominate in the field of treatment of a behavioral or chemical dependency. These aspects begin with the fact that medications are used more to treat addictions, there are many reasons that a drug may be used in the treatment process including; “drugs lessen the withdrawal symptoms, drugs lessen cravings, substitute medications that are less damaging than the primary substance of abuse, nutritional supplements, and antidepressants” (Inaba & Cohen, 2011). Some addicts do require drug use but some do not, it depends on how addicted to the substance or behavior the person was as well as how long they were using. Another issue in treatment is that new imaging techniques are being used to “visualize the structural and physiological effects of addiction on the human brain” (Inaba & Cohen, 2011). These techniques include CAT (computerized axial tomography) scans to show the damage to the brain tissues, MRI (magnetic resonance imaging), fMRI (functional MRI), PET (positron emission tomography), SPECT (single-photon emission computerized tomography, and DTI (Diffusion tensor imaging) (Inaba & Cohen, p. 9.5, 2011) These techniques allow doctors to study the brain as the addict goes through such things as the reward cycle when using a drug. These tests will help to better understand the processes of the brain and possibly be able to further combat the problem of addiction.
The more a process in understood, the more educated a doctor can be with their patient the better treatment process they can prescribe for the patient. Internet-based therapies involve “structured, treatment programs delivered via the internet that incorporate some degree of therapist interaction” (Blaszczynski, A., Gainsbury, S., 2011). The internet based therapy mostly occurs via e-mails, telephone or face to face between the client and the counselor; it can benefit a wide range of people including those with alcohol and drug addictions. It is also beneficial for those with behavioral addictions such as gambling. Internet based therapy has been largely successful with less than “25% of people with addiction-related problems ever entering formal treatment” (Blaszcynski, 2011). The internet based therapy could be widely popular as well because it is anonymous and they do not have to attend a meeting or go out of their way to a counselor’s office. The appointments are on the person’s own time when they are available. Treatment for individuals such as the elderly depends on patient placement after they are evaluated for abuse or addiction as well as physical or psychiatric problems. Treatment is then evaluated on the risks that could affect the elderly person.
There are six dimensions “established by the American Society of Addiction Medicine (ASAM): acute intoxication and/or withdrawal potential; biomedical conditions and complications; behavioral conditions and complications; treatment acceptance/resistance; relapse potential; and recovery environment” (Clay, 2010). An elderly individual struggling from addiction can also be placed in an outpatient treatment such as “brief intervention, motivational interviewing and pharmaceuticals” (Clay, 2010). It is recommended that the least intensive approach be considered first and then the condition be further assessed. Individuals who are addicted to heroin have a treatment that is called Opioid Substitution Treatment (OST) this involves prescribing opioids to those who are opioid dependent. A person who is addicted to heroin will go through “daily withdrawal symptoms, and are at increased risk of persisting in use of heroin and other drugs.” (Bell,2012). The idea is to prescribe low dosage methadone (30-60 mg a day) or buprenorphine (4-8mg/day) to help control the withdrawal symptoms.
Another reason for this approach is, “at higher methadone doses, people become more tolerant to opioids, and blocking the effects of heroin and suppressing continued heroin use” (Bell, 2012). Another approach to treatment is coerced treatment. Coerced treatment is when it is “mandated by the criminal justice system, through drug courts mandatory sentencing, probation/parole stipulations, and state or federal legislation requiring compulsory treatment” (Inaba & Cohen, 2011). The Drug Treatment Alternative-to-Prison program measured the effectiveness of the treatment programs that were mandatory and found reductions in the re-arrest rate, reconviction rate and return to prison rate. The downfall to the coerced programs is that there may not be space available for people who want to voluntarily get help before they are arrested or in trouble with the legal system. The reduction in the economy over the years has caused a lot of government funded programs to be closed due to funding issues, leaving less places for addicts to go for help. (Inaba & Cohen, 2011). Christian Worldview Implications
Addictions can come in many shape and forms to a Christian counselor. There are sexual addictions, gambling addictions, alcohol addictions, substance addictions etc. From a biblical standpoint a Christian counselor would want to introduce biblical morals and values so the person can rely on a higher power other than themselves to overcome the addiction. Addictions come straight from the devil when they are attacking a person and causing them to sin. A counselor should consider themselves to be warriors of God in the war against addictions. There are many in the Christian environments that consider addiction to be an act of will. A church congregation may not take an addiction as seriously as they would take someone who was diagnosed with cancer. It is important that the counselor help the client see that their addiction is important to overcome, confessing their addiction and the problem with it can be the first step when a person is struggling with an addiction. The person may feel that it is easier to hide the addiction rather than admit there is a problem, but to confess the sin is the most important first step.
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