Addiction

Addiction is the term many fathers and mothers in Egypt hear for the first time when they find a strip of pills in their son's pocket or notice that the husband's salary evaporates before the middle of the month. In this guide we explain the medical meaning of the word, answer the question of disease and willpower, trace the road a person takes from the first try to dependence, distinguish between its types, and touch on what goes on inside the brain; then we put in your hands the warning signs, the common myths, the road to recovery and prevention, with a map of all the articles in this section.

What is addiction in the medical sense?

Doctors today use the term "substance use disorder" in the American manual DSM-5, and the international classification ICD-11 issued by the World Health Organization uses similar terms. Behind the different names is one idea: compulsive behavior that continues despite harm, with an intense craving that dominates thinking, and sincere attempts to stop that end in failure.

DSM-5 sets eleven criteria for diagnosis, including using a larger amount or for longer than the person planned, spending a long time getting the substance, neglecting home and work, giving up hobbies that used to fill their life, and continuing despite obvious health problems. Meeting two or three criteria means a mild condition, four or five a moderate condition, and six or more a severe condition. These levels help the doctor choose the appropriate level of treatment.

The difference between a habit and addiction is simple to put: a habit you can postpone when it harms you, while addiction gets ahead of your decision. The employee who drinks tea every morning can do without it on a fasting day, while someone who has reached dependence on a painkiller such as tramadol arranges their whole day around the time of the next dose.

Is addiction a disease or a weakness of will?

The American National Institute on Drug Abuse (NIDA) describes it as a chronic, relapsing disorder, relying on brain images that show real changes in the areas responsible for judgment and impulse control. The first decision to try may be a choice, but continuing after dependence is no longer a free choice in the full sense.

This understanding doesn't lift responsibility from the person, but moves it to its right place: their responsibility is to ask for help and stick to the plan. And when the family stops repeating "if he were a man he would quit" and asks instead "what does he need to be able to quit?", the conversation in the whole house changes. We discussed in a separate article whether drugs can be quit without specialist help and when that is a risk.

How does use develop from the first try to dependence?

Not everyone who tries a substance will go all the way down the road, but those who reach dependence usually remember similar stops. The pace of these stops differs a lot from one person to another and from one substance to another.

1. 1The first approachCuriosity or going along

   A hash cigarette on a trip with friends, or a pill that "helps with studying" offered by a classmate. It seems passing and leaves no clear trace.

2. 2Repetition on occasionsA false sense of control

   Use becomes linked to certain nights out or people, and the person reassures themselves that they can stop whenever they want.

3. 3Use as a meansTo sleep or to escape

   The substance turns into a tool for calming anxiety, insomnia or boredom, and enters the weekly and then the daily routine.

4. 4Mounting lossesHarm everyone sees

   Absence from work, small debts, fights at home, and yet the use continues and the justifications multiply.

5. 5DependenceTolerance and withdrawal

   They need a larger amount for the same effect, and feel unpleasant symptoms if they are late, so use becomes about avoiding pain rather than seeking pleasure.

Some substances such as opioids and ice may shorten these stops to weeks, while with other substances they stretch over years. This also depends on age at the start and personal predisposition, factors we detail in the section The factors that raise vulnerability.

Use, dependence or disease? Three words with three meanings

These words get mixed up in everyday talk, and confusing them unsettles the family and delays the decision. The following table puts the differences side by side.

The important point is that physical dependence may happen without addiction, as in patients who take certain medicines for long periods under close supervision. And the opposite may happen: there is clear addiction to substances that don't cause violent physical withdrawal. The article The difference between psychological and physical dependence explains this point in more detail.

Types of addiction: substances, medicines and behaviors

Drugs and alcohol

This is the best-known form, and it includes hash, bango, opioids such as heroin and strong painkillers, stimulants such as ice and captagon, synthetic cannabinoids such as strox and shadow, as well as alcohol. Each family has its own nature, and you can get to know them in the guide to types of drugs, while the details specific to drugs you will find in the article Drug addiction: definition, signs and treatment.

Prescribed medicines

It often starts from a genuine prescription: a sleeping pill after a period of insomnia, a sedative from the benzodiazepine family after a panic attack, or a painkiller after an operation. The problem appears when the medicine continues without review, or is bought from the pharmacy without a prescription, or the dose is raised without the doctor knowing. That is why we always stress that any psychiatric medicine or painkiller is used and stopped under a doctor's supervision.

Behavioral addiction

The World Health Organization recognized gambling disorder and gaming disorder in ICD-11, and doctors discuss other patterns such as pornography and compulsive shopping. The mechanism is similar despite the absence of a substance, and we have dedicated to them a section on compulsive behaviors.

What happens inside the brain with repetition?

Simplifying the picture helps the family understand: the brain has a reward system that rewards us for eating, company and achievement with bursts of dopamine. Drugs release this substance with a force exceeding natural rewards, so the brain learns that the drug is more important than everything else. With repetition the brain reduces its sensitivity, so ordinary things lose their taste, and the person needs the substance to feel normal.

At the same time, the front areas responsible for judgment and planning weaken, so decisions become faster and less mindful of consequences. That is why you may find a clever young man who fully realizes what he is losing and then goes back the same night. For those who want to go deeper, the article The role of dopamine in the drug's takeover of reward explains this mechanism, the article GABA, sedatives and alcohol covers the other face of brain chemistry, and you will find the complete map of neurotransmitters in the section Brain chemistry.

General signs that deserve attention

No single sign is enough to judge, but several changes coming together and lasting for weeks deserve a calm pause. Here we present only the general picture, and the details for each substance are in the section Signs of drug use.

When use comes together with a psychological disorder

It is common for a patient to come with depression, anxiety, bipolar disorder or attention deficit hyperactivity disorder since childhood. Doctors call this dual diagnosis, and NIDA confirms that a large proportion of people with substance use disorder have an accompanying psychological disorder. Sometimes the substance is an attempt at self-treatment of undiagnosed anxiety, and sometimes use reveals a disorder that was latent.

The treatment rule here is clear: treat both sides together, because leaving one of them untreated raises the likelihood of relapse. The article The relationship between depression and use offers an example of this, and the dual diagnosis program explains how the two conditions are managed in one plan.

How does an addicted person think?

Denial is not deliberate lying most of the time, but part of the disease itself. The person convinces themselves that they "use less than their friends" or that they "will stop after the end-of-year exams". They play down the size of the losses, and blame pressures, the wife or the manager. These defensive tricks protect them from a painful confrontation, but they delay treatment.

Understanding this thinking changes the family's way of talking: confrontation with shouting and accusation increases defensiveness, while talking calmly about specific events at a time when the person is sober opens a door. To go deeper, read the article Why an addict denies needing treatment, and if you are looking for practical steps, the article How do I help an addicted person is written for you.

Common myths that delay seeking treatment

Other harmful myths include relying on herbal recipes or "locking him up at home" instead of a doctor, attempts that may be dangerous with alcohol and sedatives in particular. The article The social stigma linked to addiction covers how society's view prevents many from seeking help.

Can one recover from addiction for good?

Yes, recovery is possible and real, but it is understood in a way that resembles other chronic diseases such as diabetes and blood pressure: active treatment at first, then a lifestyle and follow-up that protect what has been achieved. NIDA points out that relapse rates in it are close to what happens in these chronic diseases, which makes follow-up part of treatment, not a luxury.

The details of each of these stages belong in the complete treatment journey guide, you will find an explanation of the programs and their types in the treatment programs section, and psychotherapy plays a central role in preventing a return.

Prevention starts at home

The strongest thing the family has is a warm relationship in which the son feels free to talk about his pressures without fear, clear rules everyone knows, and calm follow-up of friends and places. It is useful to delay the first try as much as possible, because the brain continues maturing until about the mid-twenties, and those who start early face a greater risk.

Prevention isn't limited to children; the mother who has taken a sleeping pill for years, and the father who relies on a painkiller for back pain, also need a periodic review with the doctor. The article Ways to prevent drug use by age offers a practical plan for each stage.

Emergencies that can't wait

Some situations linked to use threaten life, and in them it isn't right to wait for the morning or for the person's consent.

The addiction article guide: the brain, substances, medicines and the family

We have arranged the articles of this section into four themes, so you can start with what concerns your situation directly and then broaden.

When should you seek help?

If you notice that you or a member of your family is trying to stop and can't, or that use has started taking from work, home and health, this is the right time for a consultation, and there is no need to wait for further deterioration. At Riviera Life in Sheikh Zayed, licensed by the Egyptian Ministry of Health, consultants in psychiatry and rehabilitation have been receiving people for fourteen years in complete confidentiality, and the first consultation is free. Contact us on +201507999722.