Substance Abuse

There are many definitions of ‘addiction’, but it has been described as a habit that is very difficult to break and which produces a positive feeling, at the same time getting rid of a negative one. Abuse of substances; including pharmaceutical drugs and alcohol, may lead to someone becoming substance dependant or, addicted. Many people with these types of severe addiction will stop only when it is perceived that the abuse is threatening their life.Substance abuse is often a life style choice that people move in and out of over time but there is no single pathway to its development. It is a combination of risk factors and there are no simple answers to the question of ’cause’. Some experts say that use is due to social influences but abuse is due to psychological influences.

Obviously, the effects of drugs, alcohol or other substances vary but they tend to share the following pharmacological properties:

Pleasurable psychic effects
The effects are rapid in onset
These properties make psychological dependence likely
With repeated exposure, tolerance happens requiring an increased dosage to obtain similar effects
Withdrawal symptoms occur on reducing or ceasing use

Substance abuse falls into ‘The three C’s of addiction’:

Behaviour ranging along the Craving-Compulsion spectrum
Continued use despite adverse consequences
Loss of Control

Reasons for taking Drugs/Alcohol:

Emotional factors – to increase self esteem, reduce anxiety, avoid making decisions or to assert independence
Physical reasons – to block pain, increase energy, attempt to feel relaxed, to reduce sensations or to get a ‘buzz’
Social reasons – to be ‘one of the gang’, overcome shyness, escape loneliness and to aid communication
Intellectual reasons – to reduce boredom, to satisfy curiosity, to understand self or the world better
Environmental reasons – the popular acceptance of a drug & alcohol culture, difficult family situations, poor role models or a pressure to mature early

Risk factors

There is no single cause for substance abuse leading to addictive behaviour, but there are 5 main factors usually involved:

Genetics – only a small role
Gender – more males than females are addicted to substances or gambling but more females develop eating disorders
Family factors – e.g. discipline or bonding issues, parental addictive behaviour and/or attitudes towards the issue
Childhood assault/ trauma – a very clear link, resulting in low self image, shame, guilt and a feeling that the world is unsafe

When one or more of these factors are involved, the person is certainly more at risk, but other issues also affect the possibility of addiction; such as availability, cultural acceptance, underlying psychiatric disorders and general personality traits of impulsiveness, risk taking and rebelliousness.

How is Substance abuse treated?

As there is no one ’cause’, there is no one treatment and it is found that different individuals respond best to different treatments. However, there are three main models of treatment.

Emphasising the drug – temperance models e.g. A.A, G.A, N.A
Emphasising the person – spiritual, educational and disease models e.g. abnormalities in personality, dysfunctional family structures
Emphasising the environment – looking at social learning, modeling and sociopolitical models e.g. social inequality, powerlessness and marginalization

To stop the excessive use of drugs, alcohol etc, it is often necessary to ascertain the person’s positive aspects of the substance, (see above), before any changes can be made. Generally, therapists have found that there is a high relapse rate and resistance to change but never the less, it is possible for a motivated person to stop substance abuse, usually with the help of therapy.

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