Addiction Medicine

Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to.


In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will.


Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.



What is the definition of addiction?
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.


Addiction is characterized by: A B C D E
a. Inability to consistently Abstain
b. Impairment in Behavioural control
c. Craving; or increased “hunger” for drugs or rewarding experiences
d. Diminished recognition of significant problems with one’s behaviours, interpersonal relationships, Health, Occupation, Financial and Family problems.
e. A dysfunctional Emotional response.


What happens to the brain when a person takes drugs?
Most drugs affect the brain’s “reward circuit,” causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviours needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviours like taking drugs, leading people to repeat the behaviour again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, work, friends, family, hobbies or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include: Learning, judgment, decision-making, stress, memory, behaviour etc Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.


Why do some people become addicted to drugs while others don’t?
No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.

Biology: The genes that people are born with account for about half of a person’s risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction Environment. A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.

Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviours, including trying drugs.


Symptoms of Addiction?
The signs and symptoms vary from one addiction type to another, but some common symptoms of addiction include:
An inability to stop, Urge to take the substance regularly, repeated thoughts about the substance, Changes in mood, appetite, and sleep, Decreased social interactions, Decreased emotional life, Occupation dysfunction, Decline in education, Unable to concentrate,Memory disturbances, wasting time, sometimes feeling depressed, low, anxious, guilty, suspicious, fearful, irritable, anger outburst, being stubborn, change in personality, Continuing use despite negative consequences, Denial, Engaging in risky behaviours, Feeling preoccupied with the substance, Legal and financial problems, Losing interest in other things you used to enjoy, Putting the substance or behaviour ahead of other parts of life including family, work, and other responsibilities, Secrecy, Using increasingly larger amounts of a substance to get the , Taking more of the substance than you intended, Withdrawal symptoms.


What do you mean by withdrawal symptoms?
Withdrawal symptoms are the various physical and psychological effects that occur after reducing or ceasing drugs or alcohol.
Each and every substance (Alcohol or Drugs) have their unique withdrawal symptoms.Most common withdrawal symptoms are sleep disturbances, anxiety, restlessness, tremors or shivering, mood swings, irritability, sweating, increased heart rate, nausea, vomiting, change in appetite, loss of interest, feeling incomplete, depressed, nightmares, hallucinations, confusion, headaches, body cramps, weakness, watering of eyes, chills, diarrhoea, abdominal pain, dry mouth, unable to concentrate, feeling lethargy and even withdrawal seizures etc Don’t worry, withdrawal symptoms can be successfully treated and usually symptoms subside within 1 to 2 weeks.


Criteria for Substance Use Disorders DSM 5?
Taking the substance in larger amounts or for longer than you’re meant to. Wanting to cut down or stop using the substance but not managing to. Spending a lot of time getting, using, or recovering from use of the substance. Cravings and urges to use the substance. Not managing to do what you should at work, home, or school because of substance use.Continuing to use, even when it causes problems in relationships.Giving up important social, occupational, or recreational activities because of substance use. Using substances again and again, even when it puts you in danger. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance. Needing more of the substance to get the effect you want (tolerance). Development of withdrawal symptoms, which can be relieved by taking more of the substance.


2 or more= Mild
4 – 5 = Moderate
6 or more = Severe



Principles of Effective Treatment?
Addiction is a complex but treatable disease that affects brain function and behaviour. No single treatment is right for everyone. People need to have quick access to treatment. Effective treatment addresses all of the patient’s needs, not just his or her drug use. Staying in treatment long enough is critical. Counselling and other behavioural therapies are the most commonly used forms of treatment. Medications are often an important part of treatment, especially when combined with behavioural therapies. Treatment plans must be reviewed often and modified to fit the patient’s changing needs. Treatment should address other possible mental disorders. Medically assisted detoxification is only the first stage of treatment.


What are the Treatments available?
Treatment always starts with Detoxification. Advanced scientific research has introduced many tablets in the field of Addictions. Few to name are Naltrexone, Acamprosate, Baclofen, Disulfiram, Buprenorphine, Bupropion, Varenicline, Nicotine gums, implants and patches etc Psychoeducation, Cognitive behavioural therapy, Motivational enhancement therapy and Relapse prevention strategies along with medical management will give the best results. Family intervention is the vital part in treatment of Addictions.  Craving management, Trigger management, Time table management, Stress and Anger management, personality development, coping strategies, Life style modification, Exercise, Relaxation techniques, regular follow up program plays an important role in treatment of Addictions. Transcranial magnetic stimulation (TMS) is a very safe and a non-invasive procedure approved by FDA for Addictions. Treating associated Depression, Anxiety or Psychosis is very essential. Treating associated medical comorbidities is also important. For the best results, it is always advised for a long-term rehabilitation program for at least 30 to 45 days after the initial management.


Does relapse to drug use mean treatment has failed?
No. The chronic nature of addiction means that for some people relapse, or a return to drug use after an attempt to stop, can be part of the process, but newer treatments are designed to help with relapse prevention. Relapse rates for drug use are similar to rates for other chronic medical illnesses. If people stop following their medical treatment plan, they are likely to relapse.
Relapse rates for substance use disorders is 40-50%, Relapse rates for hypertension are 50-70%, Relapse rates for diabetes are 60-70%.


Important facts?   

  1. Tobacco kills more than 8 million people each year. More than 7 million of those deaths are the result of direct tobacco use while around 1  million are the result of non-smokers being exposed to second-hand smoke.
  2. Every year, worldwide, alcohol is the cause of 5.3% of deaths (or 1 in every 20).
  3. About 300 million people throughout the world have an alcohol use disorder.
  4. 180 thousand deaths were directly related to substance use in 2019.
  5. Tobacco smoke contains more than 7000 chemicals, of which at least 250 are known to be harmful and at least 69 are known to cause cancer.
  6. On average, smokers die 10 years earlier than nonsmokers.
  7. Lung cancer is not the only malignancy you can get from smoking. Others include cancer of the bladder, blood, bone marrow, cervix, colon, esophagus, kidneys, larynx, liver, mouth, pancreas, rectum, stomach, and throat.
  8. Smoking and Drinking Alcohol can lead to Sexual Dysfunction.
  9. There is enough nicotine in five cigarettes to kill an average adult if ingested whole.Most smokers take in an average of 1 to 2 milligrams of nicotine per cigarette, of which 0.03 milligrams is absorbed into the bloodstream.
  10. Marijuana can cause permanent IQ loss of as much as 8 points when people start using it at a young age. 1-in-6 people who start using the drug before the age of 18 can become addicted. Cannabis will lead to poor academic performance, decreased concentration, decreased emotional life, decreased time with family, College dropouts, decreased motivation and focus in life, Irritability, Anger, Anxiety, Depression, Paranoia, stubborn, demanding behavior, personality change, poor judgment, risk taking behavior, altered sense of time, hallucinations, delusions, mood fluctuations, sleep – appetite changes etc

                                  Asha Deaddiction Clinic and Asha Deaddiction Centre promises a holistic treatment for Addictions and its related problems.


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Dr. Ramana Cherkuri

Dr. Ramana Cherkuri

Director, Consultant Psychiatrist

Dr. Sandeep Kondepi

Dr. Sandeep Kondepi

Consultant Psychiatrist

Dr. K. Chaitanya Laxmi Reddy

Dr. K. Chaitanya Laxmi Reddy

Consultant Psychiatrist