Understanding addiction — a chronic brain disorder

Dear doctor,

My brother is addicted to alcohol and bhang, and he doesn’t seem to care that he is taking his family through hell. He also doesn’t think he has a problem. How can he be helped?

Dear reader,

Addiction is a condition where there is uncontrollable use of a substance or taking part in an activity in spite of harmful effects or other negative consequences. There are two main types of addiction: substance addiction — addiction to alcohol, marijuana, among others, and behaviour addiction such as gambling.

Addiction is considered a chronic disease because the brain actually changes, causing a “hijacking”, or, in some cases, destruction of critical areas of the brain, and a lot of work is required to change this.

There are many substances that have addictive potential including alcohol, nicotine, caffeine, marijuana, hallucinogens, inhalants and prescription and non-prescription opioids, amphetamines and sedatives. These substances activate the reward system in the brain. There are behaviours that also have the potential to be addictive such as gambling, eating, sex, exercise, dieting, shopping, internet use, viewing pornography, sex, video gaming, and risky behaviours like shoplifting among others.

Normally, the brain reward system is activated by healthy behaviours like eating, bonding with others, exercise, among others, making the experience feel pleasurable; and this motivates the person to repeat these behaviours. This response, however, is regulated by the brain to avoid over-indulgence. The healthy brain also responds fast to anything that could pose a danger, to remove you from it. There’s a part of the brain that is able to weigh the pleasure versus the consequences and make a decision, for instance, deciding on buying something you want but cannot afford.

With addiction, the substance (or behaviour) “hijacks” the pleasure centre, causing an excessive activation of the reward system and production of a flood of the feel-good chemicals, which makes the individual want to indulge more and more. In addition, the system that senses danger may also be activated when you do not use the substance, leading to negative psychological and physical effects, and this leads to the individual taking the substance just to avoid the negative consequences of not taking it. To add to this, the decision making centre may be impaired, which affects self-control.

All these add up to someone taking a substance in an uncontrollable way, even when they experience or are aware of the negative consequences.

Initially, the person will start taking the substance voluntarily. The next step is developing a substance use disorder, where the person experiences the negative effects of a substance without being addicted, for instance taking excessive amounts of alcohol that leads to accidents or an illness; or taking alcohol in inappropriate situations. Addiction (or dependence) is the most severe form of substance use disorder. With addiction, the person is unable to stop, even when they try. They need more of the substance to feel the same “high”; they experience negative effects when they don’t use the substance; they feel that they have lost control and spend a lot of time thinking about or using the substance despite experiencing the negative consequences of the addiction. Development of addiction is complex and may include an interplay of genetics, other mental health conditions, and environmental factors e.g. adverse childhood experiences, and exposure and/or access to the substances e.g. alcohol use in the home or by friends, or access to prescription drugs.

Addiction is managed by a team that includes the individual themselves. This works best if the individual has accepted that they have a problem and is willing to go through the process of change. There may be hospital management to address physical concerns and withdrawal symptoms. There is also the rehabilitation process that may be in a residential facility or outpatient scheduled sessions. It is also vital for the individual to participate in personal, group and family therapy. The process may take time and it includes relapses. There may be some consequences that cannot be reversed such as some brain changes and physical illnesses.

Dr Flo,

I have noticed that my handwriting has been getting worse over the past few weeks. I don’t need to write a lot, but the few times I do, it is a real struggle. What could be happening?

Nicholas

Dear Nicholas,

The writing process is complicated and it involves the brain, the spinal cord and the nerves and muscles of the upper limb and fingers, which means that when there’s a problem with writing, it may include one or more of these components. The problem with writing could be an indicator of a much bigger problem such as stroke.

It is advisable for you to be reviewed by a doctor for examination and relevant tests. The management will depend on the diagnosis. You may also benefit from occupational therapy to address the function of the hand.

Dear doctor,

About two years ago, I was told I had a cyst in my testicle and that it was nothing to worry about. I can still feel it and I am still worried. What can be done?

Mwangi

Dear Mwangi,

Most likely the cyst in your testicle is an epididymal cyst, also known as a spermatocele or spermatic cyst. The epididymis is a tightly coiled tube where sperms mature and are stored. A spermatocele is a fluid-filled sac in the epididymis, with dead sperm in it. The cyst is usually painless and may cause swelling and heaviness of the affected side. It is quite common, affecting about 30 per cent of men aged between 20 and 60 years. Follow up should be done by a urologist. Diagnosis is made through physical examination and ultrasound scan. The cyst is not cancerous and it does not affect fertility, and therefore does not require treatment.

Temporary relief by needle drainage can be done, though the fluid will re-accumulate. Permanent removal can be done through surgical removal of the sac or removal of the testicle, if the sac is very large. Another option is removal of the sac followed by sclerotherapy, which causes scarring of the area. This process means that sperm maturation cannot happen within that epididymis.

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