Prof. Wulf Rössler, MD; MSc.
Seventy-two-year-old Wulf Rössler studied medicine and psychology in Heidelberg. For many years he was Director and Head of the Psychiatric University Hospital in Zurich and Professor at the University of Zurich. Now he is a Senior Professor at the Charité in Berlin, teaches at the University of São Paulo in Brazil and is Chief Medical Officer at the Kusnacht Practice near Zurich.
We sat with him and discussed drug addiction, its impact on the body and brain, and the best forms of treatments.
What is the difference between drug abuse and drug addiction?
Wulf Rössler: People wish to have clear distinctions between what defines health and what defines disease. But real life is not that easy. Health is located on a continuum where symptom severity and intensity increases over that continuum. There is no clear cut-off point, which separates health from disease. Nonetheless, in medicine we work with these categorisations as published e.g. in the American Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Mental Disorders issued by the World Health Organization. These classification systems describe no natural disease entities but mirror what experts in the field think is crucial to define certain diseases, in our case abuse or dependency.
What is drug abuse, and what are its symptoms? When does the addiction start?
WR: Drug abuse is defined by one or more the following problems during the past year:
- Inadequate behaviour under the influence of drugs
- Reduced ability to fulfil tasks at home, at school, or at work
- Ongoing harmful use of drugs despite of continuous problems associated with the drug use
- Legal problems caused by drug abuse
Drug addiction is characterised by three or more of the following problems during the past year:
- Onset of physical or psychological withdrawal symptoms when without the drug
- Using larger amounts of the drug of choice in order to achieve the same results as experienced initially
- Narrowing of interests and activities
- Withdrawing from friends and family
- Repeating patterns of behaviour around getting or staying high
- Multiple attempts to cut down or stop drug use without success
- Continued use of drugs and alcohol despite continued and growing problems related to their use
How do addictive substances influence the human brain, and why do we get addicted?
WR: Addiction is a chronic disease of the brain. The brain consists of billions of cells called neurons. The neurons communicate with each other by releasing so called neurotransmitters in the gap between the cells called synapses. Drugs interfere with the way neurons process the information via neurotransmitters in multiple ways.
What part of the human brain is responsible for addictions? What is the chemical process of getting used to substance and developing addiction?
WR: Drugs particularly impact on the neurons in certain brain areas, e.g. the basal ganglia, the amygdalae or the frontal cortex. These areas play an important role in pleasurable activities of all kind like eating, socialising or sex. Drugs activate these areas excessively and in case of repeated use adapt to the presence of this drug, which in turn increases the drug dose needed to reach a certain effect.
Who is the most vulnerable to drug abuse and addiction?
WR: There is a range of genetic and environmental factors contributing to the risk of developing an addiction. About half of the risk is attributable to genetic factors. But even if the genetic risk is low, long exposure to the drug can equally result in an addiction. A significant environmental factor is the availability of a drug. Further environmental factors are stress or peer influences. Separately, younger persons are also at risk, where often a combination of the named genetic and environmental factors hit a vulnerable, maturing brain.
What impact drug abuse and addiction can have on one’s mental health? What are the possible consequences?
WR: Drug abuse and mental health problems, e.g. anxiety or depression often co-occur, while the direction in which they influence each other can vary. Both directions are possible, i.e. people take drugs to alleviate their anxiety or depression symptoms or they develop these symptoms as a consequence of their drug use. Both syndromes need to be treated separately.
What is the best practice for drug addiction treatment? What are the successful therapy methods?
WR: Addiction can be treated and managed successfully to regain control over one’s life. There is a wide field of medical and psychiatric approaches in the treatment of substance use disorders. It begins with the detoxification process involving several pharmacological agents to ease the withdrawal symptoms. A special case is an approach called rapid detoxification, where a person is put under anaesthesia for several hours to “clean” the respective receptors in the brain with opioid antagonists, e.g. Naltrexone. Naltrexone can also be used in the further process to reduce craving for the substance. In a second step, behavioural-oriented psychotherapy following detoxification is an indispensable prerequisite for a successful therapy. And in a third step, relapse prevention needs to be provided.
How can people suffering from drug addiction get help? Where should they start and what is the way out?
WR: All help provided can only be successful when the addicted person has insight into their problems and wants to change. This needs support from all the family. Then help is available on various levels, depending on the national organisation of health care. In most cases, general practitioners are the gatekeepers to the help and care system. In many cases, an ambulatory detoxification is possible followed by a longer phase of psychotherapy.
Thank you very much Prof. Wulf Rössler
WR: Thank you, and please send in any other questions you may have.
If you have any additional questions for Prof. Wulf Rössler please send them to us. We will try to address them in the second part of the Q&A session with our expert.