Addiction for healthcare providers

Key points about addition

  • The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs.
  • The Australasian Chapter of Addiction has developed a set of recommendations that the Royal Australasian College of Physicians is encouraging physicians to implement in their work and health services
  • Find information on behavioural addition, online learning and CPD.
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From: DSM-5 criteria for substance use disorders(external link)

The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances. 

The activation of the brain’s reward system is central to problems arising from drug use; the rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favour of taking the drug. While the pharmacological mechanisms for each class of drug are different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

The DSM-5 recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders and that some people have lower levels of self-control that predispose them to develop problems if they're exposed to drugs.

There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders.

  • Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result.
  • Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorders.

See full article(external link)

From: Expanding the definition of addiction: DSM-5 vs. ICD-11(external link) 

Abstract: While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially ‘addictive’ qualities of repetitive behaviours, and whether such behaviours constitute ‘behavioural addictions’, is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, and compulsive sexual behaviour, and problem internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of ‘behavioural addictions’ has been handled by latest revisions of the Diagnostic and Statistical Manual (DSM) and International Classification of Disease (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.

Grant, J. E., & Chamberlain, S. R. (2016). Expanding the definition of addiction: DSM-5 vs. ICD-11. CNS spectrums21(4), 300–303. Retrieved on 2019, July 11 from link) 

The Australasian Chapter of Addiction has developed a set of recommendations that the Royal Australasian College of Physicians is encouraging physicians to implement in their work and health services. The recommendations are as follows:

1.    Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues

2.    Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored

3.    Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications

4.    While managing patients with Substance Use Disorder (SUD), exercise caution in the use of treatment approaches that are not supported by current evidence or involve unlicensed therapeutic products

5.    Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.

Read more: Australasian Chapter of Addiction Medicine(external link) Choosing Wisely, Australia

From Auckland Regional HealthPathways(external link) accessed August 2020:

The Substance Addiction (Compulsory Assessment and Treatment) Act 2017 enables people to receive compulsory treatment if they have a severe substance addiction that is posing a serious danger to their health or safety and their capacity to make decisions about treatment for that addiction is severely impaired. It should only be used as a last resort if voluntary treatment is unlikely to be effective.

Compulsory treatment aims to help stabilise the patient through medical treatment, including medically managed withdrawal, and, if possible, to restore the patient's capacity to make informed decisions about their own treatment and to give them an opportunity to engage in voluntary treatment.

The aims of the Act are to:

  • protect the person from harm.
  • allow their addiction to be assessed.
  • stabilise the person's health (including medically managed withdrawal).
  • protect and enhance their mana and dignity and restore their capacity to make informed decisions.
  • facilitate continued treatment and care on a voluntary basis.
  • provide an opportunity to engage in voluntary addiction treatment.

The compulsory status lasts for a maximum of 8 weeks (56 days) but that period may be extended for a further 8 weeks if the person has a brain injury.

Michael Bierer, MD, addiction specialist and assistant professor of medicine at Harvard Medical School, discusses the misconceptions around all types of addiction. (4 mins 30)

(Harvard Health Publications, US, 2016)

Behaviour change strategies for the reduction of addictive behaviours

(Goodfellow Unit Webinar, NZ, 2019)

Recovery capital

Recovery capital helps us better understand the process of recovering from a substance use disorder (SUD) and determine the success of recovery and treatment interventions, improve coping strategies, and enhance an individuals’ quality of life in recovery. Understanding how to measure and operationalize recovery capital can help criminal justice and healthcare professionals better serve justice-involved individuals with SUD.

A short paper about the recovery capital concept:

Best D, Laudet AB. The potential of recovery capital(external link) Royal Society of Arts, UK, 2010

In this webinar(external link), psychologist and criminologist David Best, PhD, discusses recovery capital, how and why it is measured, what to do with the results, and the present status of development work. 

Webinar link(external link)
Download webinar slides(external link)

Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Alistair Dunn, GP & Northland DHB addictions clinical lead

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