Substance Abuse FAQs

What is addiction?

There are a plethora of definitions for addiction, but all encompass the concept of a strong compulsion to engage in a behavior that has no real survival benefit in today’s age, acquired from prior positive experience engaging in that behavior, with significant potential for harm.

Gabor Mate (2015) has provided a succinct definition: “any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.”

Such a definition need not be limited to substance addiction, but also encompasses process addictions, such as gambling, shopping, or working.

Other definitions:

In 7 Tools to Beat Addiction, Peele characterizes addiction in the following ways in order to increase understanding:

  • “…think of addiction as a powerful, sometimes overpowering involvement to which you turn for security and gratification when you fail to find better gratifications in the rest of your life.”
  • “When people turn to an experience, any experience, for solace to the exclusion of meaningful involvements in the rest of their lives, they are engaged in an addiction.”

Addiction is a global health problem adversely impacting the lives of millions annually.

In the United States alone, 40 million Americans over the age of 12 (16%) suffer from addiction to nicotine, alcohol, or other drugs. Another 80 million Americans are “high-risk” substance users, in which substance use threatens their health or safety.

Addiction is an illness affecting more Americans than other highly prevalent public health problems, such as heart disease, diabetes, or cancer (CASA, 2012).

In Sex, Drugs, Gambling, and Chocolate (a workbook on addiction), Horvath describes there are three central components to addiction as seen in the following statement: “Addiction is repeated involvement with anything, despite excessive costs, because of craving.” The three main factors in that statement are:

  • Craving: thoughts, feelings, sensations, images that express desire towards a substance or activity.
  • Excessive: repeated use leads to costs outweighing benefits.
  • Anything: addiction is not limited to substances and can include gambling, sex, relationships, and other behaviors.

What are the signs of addiction?

The essential feature of addiction is the maladaptive pattern of substance use (or other behaviors), manifesting in cognitive, behavioral, and physiological symptoms, in which the individual continues using the substance despite problems or negative consequences associated with use.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a list of diagnostic criteria for a Substance Use Disorder (SUD). Those suffering from an SUD will show at least 2 of the following:

  • Higher frequency or amount of use than intended.
  • Desire to stop using but previous unsuccessful attempts to do so.
  • Large amounts of time spent getting or using the drug (or recovering from the effects of use).
  • Continued use even when social, personal, or professional problems arise as a result.
  • Prioritization of use above social, occupational, or recreational activities.
  • Use even in situations that may cause a physical hazard, such as driving.
  • Continued use in the presence of another physical or psychological problem and knowing that problem is either caused or exacerbated by use (e.g. diabetes in the context of heavy alcohol use).
  • Changed perception of benefit to risk associated with use.
  • Perception that use-related problems stem from other causes.
  • Craving, or an intense desire or urge to use. Craving is associated with activation of specific reward structures within the brain (APA, 2013).
  • Tolerance, which can manifest as 1) needing more and more to get the same effects or 2) decreased effects when using the same substance.
  • Withdrawal syndrome upon cessation of use or taking the drug to avoid or stop withdrawal.

How should addiction be diagnosed?

Substance use disorders manifest on a continuum from mild, moderate, to severe.

The DSM-5’s list of diagnostic criteria will guide how a substance use disorder will guide how the condition falls on the continuum. For example, someone presenting with 2-3 symptoms from the list seen above will typically be diagnostic with a “mild” SUD, while 4-5 signifies a “moderate” problem and 6 or more symptoms indicates a “severe” problem.


What is the difference between physical dependence and addiction?

man-with-physical-effects-from-abuse

Physical dependence occurs through the process of neuro-adaptation, in which the brain and body begin become accustomed to the changes the substance effects and normalize to them so that the user begins feeling abnormal in the absence of the drug. It is often accompanied by tolerance, in which higher doses of a substance are needed to achieve the desired effect.

An individual who is physically dependent on a substance will experience withdrawal symptoms when the substance is abruptly discontinued.

Different substances bring different withdrawal symptoms, experienced on a continuum from mild to severe. The substance causes one effect, adaptation occurs, and an abrupt discontinuation of substance use creates the opposite effect.

For example, when alcohol, which has a depressant effect, is discontinued, there is a rebound effect in which the central nervous system becomes hyperactive. For stimulants, such as cocaine, depression is common withdrawal effect.

While physical dependence is an aspect of addiction, it need not be experienced to have what is diagnostically labeled a “substance use disorder.”


Are prescription drugs as addictive as street drugs?

Many prescription medications have the potential to become addicting.

Tolerance can develop over time, and withdrawal symptoms can occur when abruptly stopping the medication. Withdrawal symptoms vary depending on the class of substance. Physiological withdrawal signs are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics.

If an individual, in the course of medical treatment, experiences tolerance and withdrawal in the absence of other symptoms, and medications were taken as prescribed, then the diagnosis of a “substance use disorder” would be inappropriate. However, if medications were not taken as prescribed and are coupled with other behaviors associated with compulsive use or drug-seeking, then a diagnosis of a substance use disorder may be appropriate.

Unfortunately, abuse of controlled prescription drugs (CPDs) is the fastest growing drug problem in the United States, with prevalence rates of abuse second only to marijuana.

Opioid pain relievers are the most commonly abused CPD and most often seen in cases of overdose. Between 2007 and 2010, CPD-related treatment admissions rose 68%, and between 2006 and 2010 opiate-related treatment admissions rose 98% (DEA, 2013).

Easy access to CPDs is contributing to this increase, with legitimate pharmaceutical distribution to pharmacies, hospitals, medical providers, and teaching institutions, thereby increasing risk for illegal diversion. To address this epidemic, efforts are being made to increase public awareness about risks associated with non-medical prescription drug use.


What causes addiction?

stressed-out-man-at-workThere are many influences in one’s environment, including:

  • Social network.
  • Socioeconomic status.
  • Stress.
  • Parental involvement.
  • Personal history, such as:
    • Physical or sexual abuse.
    • Neglect.
    • Trauma.

Three main attributes influence the likelihood that someone will engage in a specific behavior:

  • Capability: the physical or psychological capacity to engage in behavior (e.g. the ability to understand health messages).
  • Motivation: the mental process that guides behavior, both automatic (e.g. euphoria after ingesting cocaine) and reflective (e.g. attitude that marijuana is harmless).
  • Opportunity, referring to environmental factors that either promote or constrain behavior, includes:

    • The physical environment (e.g. how easy is is to get the substance).
    • Social factors (e.g. attitudes of friends and family).

The question “what causes addiction” is an extremely complicated one. While the above factors are known to influence one’s propensity for addiction, the reasons behind each individual’s substance use are varied and complicated.


What is addiction treatment?

Without treatment, addiction can result in premature death or disability. Unfortunately, only about 1 in 10 individuals needing treatment receive it (CASA, 2012).

Effective treatment addresses not only the substance use but also other associated problems, such as:

  • Medical issues.
  • Co-occurring psychological issues.
  • Social, legal, and vocational concerns.

Two Main Treatment Components

Behavioral Therapies

These therapies address:

  • Motivation to change.
  • Skill development for problem-solving and coping with urges.
  • Promotion of alternative activities.
  • Facilitation of improved interpersonal relationships.

Pharmacological Treatments

This type of treatment will help:

  • Counter substance effects.
  • Relieve withdrawal symptoms.
  • Reduce cravings.

It’s important to understand that not all treatment centers are alike, and what may work for one may not be desirable to another. For this reason, it’s important to know what’s important to you if you’re seeking treatment. Consider duration of stay, amenities, type of facility, etc.

Also, note that treatment centers vary to include individual considerations, such as:

  • Age.
  • Gender.
  • Ethnicity.
  • Sexual orientation.
  • Culture.

Doing research ahead of time and ensuring that the treatment provider can address your needs will help ensure success and reduce the risk of relapse.


Does addiction treatment work?

For those who do not subscribe to the spiritual nature of AA, alternative self-help groups, such as Smart Recovery, are available.

These support groups enhance one’s sober social network while fostering hope and confidence that recovery is possible.

Research indicates that treatments combining both behavioral and pharmacological components may be optimal. Effective treatment extends beyond medically assisted detoxification and encourages individuals to remain in treatment for an adequate period of time and develop the skills necessary to maintain sobriety after treatment terminates.

Addressing other co-occurring mental health conditions is also critical success factor.

Mutual support groups, such as Alcoholics Anonymous, have been a cornerstone of addiction treatment.


How do I help someone I love who is struggling with addiction?

Treatment begins with an individual recognizing that a problem exists and then taking action to change.

Family, friends, and even employers can play a pivotal role in helping motivate individuals to seek and remain in treatment.

In the context of loving, compassionate connections, individuals can recover.

Addiction, however, affects the entire family system. Couples or family therapy may be beneficial to improve overall family functioning. Self-help groups, such as Al-anon or Alateen, may be a good source of support for afflicted family members.

Many employers provide Employee Assistance Programs (EAPs) that can assist individuals in accessing resources to address problems of addiction.

To learn more, visit our How to Help an Addict guide.


Sources:

  • Peele, S. (2004). 7 Tools to Beat Addiction. Three Rivers Press: New York, NY.
  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Washington, DC: Author.
  • American Society of Addiction Medicine (2011). Definition of Addiction. Retrieved from: http://www.asam.org/for-the-public/definition-of-addiction.
  • Brewer, J.A. & Potenza, M.N. (2008). The neurobiology and genetics of impulse control disorders: relationships to drug addictions. Biochemical Pharmacology, 75, pp 63-75.
  • Drug Enforcement Agency (2013). 2013 National Drug Threat Assessment Summary Retrieved from www.dea.gov/divisions/hq/2013/hq11813.shtml
  • 1Horvath, A. T. (2004). Sex, Drugs, Gambling, and Chocolate: A Workbook for Overcoming Addiction: Second Edition. Impact Publishers: Atascadero, CA.
  • Leshner, A. I. (2014). Addiction is a Brain Disease. Retrieved from: http://www.addictionrecoveryguide.org/articles/
  • Mate, G. (2015). Taming the Hungry Ghosts: A Biopsychosocial Approach to Addiction. Presented at the BFI Summit For Clinical Excellence, Chicago, Illinois.
  • Miller, W., Forcehimes, A.A. & Zweben, A. (2011). Treating Addiction: A guide for professionals. NY: Guilford Press.
  • Neff, J.A., & MacMaster, S.A. (2005). Spiritual mechanisms underlying substance abuse behavioral change in faith-based substance abuse treatment. Journal of Social Work Practice in the Addictions, 5(3), 33-54.
  • National Center on Addiction and Substance Abuse at Columbia University (2012). Addiction Medicine: Closing the Gap between Science and Practice. Retrieved from: http://www.casacolumbia.org/addiction-research/reports/addictin.medicine
  • National Institute on Drug Abuse (2011). Prescription Drug Abuse and Addiction: Research Report Series. U.S. Department of Health and Human Services. Washington, DC: US Government Printing Office.
  • National Institute of Health (2010). NIH Fact Sheets-Drug Abuse and Addiction. Retrieved from: www.report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=38
  • National Institute on Drug Abuse (2013). Principles of Drug Addiction Treatment: A research-based guide. 3rd ed. Retrieved from: http://www.drugspubs.drugabuse.gov.
  • Peele, S. (2004). 7 Tools to Beat Addiction. Three Rivers Press: New York, NY.
  • Roberts, A.J. & Koob, G.F. (1997). The neurobiology of addiction: an overview. Alcohol Health Research World. 21(2), 101-106
  • Tinsley, J.A. (2011). Assessment and Treatment of Substance Use Disorders. Focus, 9 (1), pp 3-14. Retrieved from http://focus.psychiatryonline.org/article.aspx?articleID=114898.
  • Van Wormer, K. & Davis, D.R. (2013). Addiction Treatment: A Strengths Perspective. (3rd ed). Belmont: Brooks/Cole.
  • West, R. (2013). Models of Addiction. European Monitoring Centre for Drugs and Drug Addiction Insights Series 14. Lisbon: Publication Office of the European Union.
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