Historically, most clinicians have believed that the chemical properties of a particular substance, or the pleasing nature of a particular activity such as gambling, directly cause addiction. This conventional wisdom suggests that the use of intoxicating substances or stimulating activities lead directly to abuse, dependence, addiction and impairment. A basic presumption is that physical dependence is necessarily related to addiction. The result is that, over the years, treatment has tended to focus on specific substances or activities in the belief that elimination of the specific cause of addiction will eliminate the problem of addiction.
New research indicates there are common underlying characteristics to many different manifestations of dependency, including substance and/or activity addictions. In recognizing that activities such as gambling or excessive shopping are not physically addicting, a new model for interpreting dependency has arisen. This new perspective encompasses a broader definition of addiction to include both substances and behaviors. In 2004, a syndrome model for classifying addiction was brought forward. In this situation, a syndrome is defined as a cluster of symptoms and signs related to an abnormal underlying condition.
In the past, various manifestations of addiction, such as opioid dependence, alcohol addiction or pathological gambling have been treated as separate illnesses. Today, it is believed that there seems to be a broader, underlying condition/syndrome that permits these various manifestations of addiction to develop. In the same way that a compromised immune system can leave a person vulnerable to developing a variety of opportunistic illnesses, there is a basic set of circumstances/syndrome that increase the likelihood that an individual will develop one or more expressions of addiction. It is suggested that a person’s risk for developing addiction depends on a combination of three factors: personal vulnerabilities (such as genetics or psychological factors), exposure to an object or activity, and personal experience with the potentially addictive matter (like or dislike).
In support of the thesis that addiction is a syndrome, studies have shown that both genetics and brain function contribute to a person’s vulnerability to addiction. Researchers have also observed that the presence of particular psychiatric disorders might make a person more vulnerable to addiction. For example, there has been cited a higher degree of anxiety, depression, and post-traumatic stress disorder among people who seek treatment for addiction. Also, it is interesting to note that various types of addiction seem to follow similar patterns of improvement, relapse and remission. Furthermore, similar but varied stimuli can encourage addiction to differing substances or behaviors among different people. For those who receive consistent reward/gratification from certain stimuli, research indicates those individuals become at risk of addiction to those stimulating substances or behaviors.
A syndrome involves recurring behavior. The model of addiction as a syndrome means recurrence of addiction can occur. This explains the common clinical observation of an individual struggling with a relapse addiction to a different substance. This basic, underlying syndrome nature of addiction may explain why certain therapies or treatment programs (such as AA and its many variations) are recognized as effective with people involved with various addictive substances or behaviors. As a result of this new paradigm of addiction as syndrome, therapists and clinicians have a fresh new model for preventing, diagnosing, and treating addiction.
One result of this new perception of dependence is that now relapse can be viewed not as a failure of will or character, but rather as a probable expression of the fundamental addiction syndrome. The implications of this model are large for the diagnosis of addiction. Usually, therapists have relied on anecdotal reports of the individual’s behavior to diagnose addiction. Now, with the concept of a syndrome, the attributes and symptoms of the syndrome will become the basis for diagnosis of the disease in an individual. With time, clinicians will become more sophisticated in the usage of this model for diagnosis. This diagnostic methodology is only in its infancy currently, but it is anticipated that diagnostic tests will be developed for a more analytical understanding of addictive individuals.
As the means of diagnosis and assessment improves, it will encourage the advancement of treatment. To treat addictions more successfully, the professional clinician might assume the role of primary mental healthcare provider, and will take the responsibility of managing the treatment for addiction. Under these circumstances, the clinician might perform the following tasks: 1) recognize signs and symptoms of addictive behaviors, 2) refer patients to appropriate specialists, 3) follow up to monitor patient progress and to provide necessary support. In turn, insurance companies would need to recognize multiple diagnoses of addiction, and especially behavioral addictions such as gambling.
It is hoped that recognizing addiction as a syndrome will allow a more accurate portrayal of the addict and his/her condition. Through this paradigm, addiction becomes a behavior that has certain basic, recognizable characteristics regardless of the substance of choice, or the compulsive behavior. Knowledge of the attributes of the syndrome will allow for better diagnosis of the disease, and will assist in developing more effective means of treatment and recovery of the addict.
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