Causes
The reasons people abuse drugs and alcohol are innumerable. Some become addicted to a drug after the first recreational use. Others find comfort in the escape that the effects of drugs and alcohol provide them: They become numb to any physical or emotional pain and memories of past trauma and are distracted from any thoughts or emotions that may be causing them stress. Still others abuse medications that doctors prescribe for particular ailments or illnesses.
One of the most common reasons people abuse drugs is to escape reality. Research has shown that a high percentage of drug are survivors of past emotional and/or physical trauma and have resultant PTSD (post-traumatic stress disorder). Many have memories of being physically, verbally, or sexually abused as children or adolescents. Others recall violent households and quarreling parents who were not able to meet their emotional needs as children. Women in physically or sexually abusive marriages are more likely to seek comfort in drugs and alcohol than are women in healthy relationships.
Men who are domestic violence offenders also are more likely to abuse drugs and alcohol—and act violently toward others while intoxicated—than men who are not violent. It is important to note, however, that drug and alcohol abuse is not a proven cause of domestic violence and that domestic violence is not a proven cause of drug and alcohol abuse. These situations are known as correlated rather than causal.
Lesbian, gay, bisexual, and transgendered (LGBT) men and women are more likely to use drugs—and continue to use them throughout their lifetime—than are heterosexual individuals. The drug use is often in response to the frequent and perceived discrimination and abuse that LGBT individuals may face because of their sexual orientation or gender expression.
When a person abuses a drug too frequently, he or she can become addicted to that substance. Another cause of drug addiction is genetics. It is true that some people are predisposed to addiction because of family history and genetics. Abuse also may lead to addiction if the person has a mental illness, such as antisocial personality disorder, bipolar disorder, or schizophrenia. Drugs may ease the symptoms of these conditions or can make living with them more bearable. Thus, people may become addicted to drugs or alcohol as they attempt to self-medicate their disorders.
People also are more likely to abuse drugs if they enjoy the effects the substances have on their brains. Opioids, for example, block the nerve receptors in the brain that help the body to sense pain. Opioids also engage the receptors in the brain that detect pleasure. The drug causes users to enter a euphoric state in which they experience stress relief and a carefree emotional state. People who enjoy this sensation may come to think they need the drug to be happy. Users report feeling an intense desire to use the drug again after their first encounter with it, despite the fact that their body is not physically addicted to it at that point. Repeated and ongoing use of opioids causes significant and detectable changes in the brain and the brain's chemistry. Chronic use requires a period of one to three years of abstinence for the brain to heal.
Risk Factors
As discussed, risk factors to drug abuse and addiction, specifically addiction, include a genetic predisposition to addictive behavior. According to the National Association for Children of Alcoholics, children of addicted parents are in the highest risk group of individuals with the potential to become addicted themselves.
Considering the argument of nature versus nurture, both play a crucial role in the development of an addiction. Genetics are extremely important, but so is the environment in which a child is raised. If a child witnesses uncorrected addictive behavior, he or she is more likely to adopt that behavior at a later point in life. However, not all men and women who become drug abusers and addicts grew up in a household with a drug or alcohol addict. Witnessing a parent with a behavioral addiction, such as to gambling or sex, also may influence a child’s later addiction to a substance, and not to a behavior.
Other factors that lead to drug and alcohol abuse and addiction include peer pressure and drug use at a young age. The earlier one starts smoking cigarettes and marijuana or drinking alcohol, the more likely that person will become addicted to those drugs in the future. Also, persons who start abusing drugs during adolescence are more likely to experiment with harder drugs.
The diagnosis of a mental disorder of various types—anything from anxiety to multiple personality disorder—also increases the chances that a person will begin abusing (and possibly become addicted to) drugs or alcohol. Persons who are prescribed medications for mental illnesses or for pain relief may become addicted to their prescriptions. Persons who wish to ignore treatment of their mental conditions may fall into the habit of smoking, injecting, snorting, or drinking substances that offer relief from their present stresses.
Social risk factors for drug and alcohol abuse include being between the ages of eighteen and forty-four years, being of low socioeconomic status, and being single (not married). According to the US Department of Justice, men are more likely than women to abuse or become addicted to drugs and alcohol.
Symptoms
The difference between drug abuse and drug addiction lies within the physical and psychological symptoms of each condition. Medical professionals use guidelines defined by the
Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) to diagnose substance use disorder (SUD). When diagnosing SUD, clinicians utilize the criteria put forth in the DSM-5 to diagnose the level of substance us disorder from mild to severe.
The key features of the abuse facet of the disorder are patterns of repeated problems in individual functioning in roles at work, school, or home; legal status; use of the substance in hazardous situations; or the consequences of the use on interpersonal relationships. For the substance dependence category, the key features of the disorder are patterns of repeated problems in several areas that are distinct from those considered for abuse. Diagnosis of dependence relies on factors such as tolerance; withdrawal; new or worsened physical or emotional problems directly resulting from the use of the substance; loss of control over the use of the substance; unsuccessful efforts to cut down or quit coupled with intense desire to quit; excessive periods of time spent obtaining, using, or recovering from using the substance; and the displacement of social or occupational activities to use the substance.
When persons are physically addicted to a substance, they may feel as though they cannot live without that substance in their system. People can become physically ill, and emotionally and mentally unstable, if their bodies crave a substance and do not receive it. This experience is called withdrawal. Withdrawal from alcohol or benzodiazepines are potentially fatal. Individuals withdrawing from these substances should do so under medical supervision. Withdrawal from opiates such as heroin, although extremely painful and long-lasting, is not usually fatal, but individuals have been known to die from dehydration during the withdrawal process.
Symptoms of drug abuse include some or all of the following:
• failure to meet obligations, such as missing a meeting with a family member or friend, purposely skipping classes at school, or neglecting to arrive on time for work or to show up at all
• engaging in reckless activities, such as driving under the influence of drugs or alcohol
• developing legal or financial troubles, such as getting arrested, being accused of a serious crime, or failing to secure or keep track of personal funds
• continuing to use drugs even after encountering personal difficulties or issues or severe consequences, such as imprisonment or fighting with family members, friends, or coworkers
When a person becomes addicted to the substance, he or she will experience withdrawal without the drug and an increased tolerance for the drug in addition to some or all the following behavioral symptoms:
• inability to stop using
• failure to follow self-imposed limits
• decreased time spent on other activities that do not include drugs
• spending an excessive amount of time consuming drugs or alcohol
• continuing to consume a substance despite the presence of other illnesses or poor health
These symptoms will be present along with the symptoms belonging to the individual substances the person is using. If someone is addicted to opioids, for example, that person may exhibit slurred speech, itching, paranoia, depression, confusion, low blood pressure, and excessive sleeping.
Screening and Diagnosis
The first step in treating drug abusers and addicts typically involves their loved ones—people who take notice of their behavioral changes, physical appearance, and drug use. These persons may convince or force the substance abuser to seek treatment, which is usually first in the form of calling call his or her primary physician or family doctor. After an initial screening in which the doctor runs a series of tests and asks the patient questions about his or her drug use, the doctor may refer the patient to a specialist for an accurate diagnosis. If the individual requires detoxification from the substance, they are referred to a medical facility or specialized detox and recovery program.
Another important part of the screening and diagnosis process is the discovery of other physical ailments, coexisting drug addictions or mental health issues, which is referred to as comorbidity. Specific medications and methods used in addiction treatment may counteract other drugs the patient is using or interfere with other conditions the patient may have; it is crucial to discover all illnesses, diseases, and dependencies before treatment begins. Often times, mental health issues cannot be addressed unless and until the individual is free from drugs and alcohol for a period of time.
Diagnosing comorbidity is a critical step in addictions treatment; treating a patient addicted to cocaine requires a different approach than the one taken to treat a patient addicted to prescription painkillers who is simultaneously struggling to overcome depression, anxiety, or a personality disorder. According to the National Institute on Drug Abuse, 60 percent of substance abusers also have a mental illness. A mental illness may be present before a person starts using drugs, or a person might start using drugs before becoming mentally ill. Both conditions also may be the result of similar risk factors, such as genetic predisposition and environmental triggers (such as high stress or trauma).
Through laboratory screenings, medical professionals may discover that vital organs such as the lungs, liver, or heart have been damaged by repetitive drug abuse. They also may discover conditions such Hepatitis C or HIV, which are common among individuals who share needles used for intravenous drug use.
Research has found that people living with mood disorders have a greater likelihood of becoming addicted to drugs than do individuals without such mental health conditions. In addition, patients with drug disorders are two times as likely to be diagnosed with a mood or anxiety disorder. Men seeking help for drug abuse are often diagnosed with antisocial personality disorders while women are likely to exhibit behavior indicative of depression, anxiety, or post-traumatic stress disorder.
Treatment and Therapy
Ideally, a person who is abusing or addicted to a substance and who is also dealing with an additional addiction, physical illness, or mental illness should be treated for these issues by the same health professionals at a single facility, often referred to a duel-diagnosis facility. This does not often occur in the United States, however. Patients’ conditions are viewed as unrelated, and patients are sent to multiple facilities to speak to a variety of medical professionals, from physicians to psychotherapists to drug and alcohol counselors.
A common course of treatment is to assign an individual to an Individual Outpatient Programs (IOPs) where they attend group therapy sessions, individual counseling, and psychiatric medicine consultations daily for an average of six hours a day, five days a week for anywhere from three to six weeks, depending upon what the individual's insurance will approve. In group therapy sessions, individuals speak about their drug use in front of other persons who understand what they are going through. If they are uncomfortable with—or in are in need of supplementing—group therapy, a drug and alcohol counselor or psychologist may counsel them independently. Therapy helps patients learn to deal with their cravings, the issues that led them to drugs in the first place, and to learn to begin to live a drug-free life. It enables them to set goals for the future and to repair strained or broken relationships with friends and family members.
After an addict’s body is free of all drugs and alcohol, the patient may begin treatment for his or her conditions. This treatment may be similar to therapies embraced by drug abusers—either group therapy or individual meetings with drug and alcohol counselors. Doctors also can choose to place some patients on medications to help calm cravings, fight depression, or reduce anxiety. Naltrexone, acamprosate, and disulfiram are common drugs administered to alcohol addicts. Naltrexone also can be distributed to opioid addicts. Even those addicted to nicotine can use bupropion or varenicline in addition to nicotine gum, patches, and nose sprays.
Each year about 40 percent of people who have become dependent on drugs or alcohol seek help for their problems. Research has found that the majority of those seeking help are men, as women are less likely to admit that they have substance abuse problems. They also, in general, have to ensure their children are cared for, which often keeps them from leaving home and joining treatment groups. Most rehabilitation facilities or drug and alcohol centers are not equipped to care for children and do not offer babysitting or daycare services.
To prevent relapse, people recovering from substance abuse and addiction are reminded to pay attention to their bodies and minds and to ask for help when they need it. The relapse process includes three stages: emotional, mental, and physical. If a patient feels anxious, defensive, or angry and misses group meetings or doctors’ visits, he or she could be in the first stage of relapse. Combined with poor sleeping and eating habits and mood swings, this first stage may lead a patient to postacute withdrawal. Patients are instructed to reach out to medical professionals, friends, or family members if they feel they are in danger of relapse.
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