Substance use and misuse seem to engender a great deal of debate. Clinical researchers have explained why some people develop an addiction to legal or illegal drugs, which is at the heart of the discussion. The explanations typically follow a medical or social model. However, no matter the model, the consequences of substance abuse have far-reaching implications for the user, the user's family, and the community. In addition, addiction constitutes a public health concern.
Whatever the school of thought, the choice to consume an alcoholic beverage or other drugs differs from an addiction to these substances (e.g., prescribed narcotic medications, cocaine, inhalants, amphetamines). The term addiction is used interchangeably with substance dependence or substance use disorder. Indeed, a person can drink alcoholic beverages or use mood-altering substances "casually" without developing an addiction. However, "casual" users of mood-altering substances can experience withdrawal symptoms and build a tolerance.
However, some individuals will lose control and develop obsessive thoughts about alcohol and drug use. Their obsessive thoughts fuel cravings for drugs and alcohol. The loss of control over substance use and misuse is not about whether the individual can or cannot manage their substance intake. At this point, they are consuming increased amounts of these substances. While they suffer negative consequences or deny the severity of their alcohol or mood-altering substance use. This loss of control significantly impacts the person's quality of life.
A definition of addiction?
The American Psychological Association (APA) defines addiction as "a state of psychological or physical dependence (or both) on the use of alcohol or other drugs."
Diagnosing a substance use disorder
The substance one decides to ingest is a choice. However, the distinction between choice and substance use disorder changes should the person develop a "psychological or physical dependence" on a particular substance. There is no specific reason people use mood-altering substances. For example, some people use alcohol or drugs to socialize, do religious rituals, and get pleasure. Others use substances to relax, self-medicate, deal with mental illness, and manage life stressors.
According to the Diagnostic and Statistical Manual for Mental Disorders, substance use dependence develops from a problematic pattern of substance use leading to clinically significant problems. For example, a behavioral health professional diagnose a substance use disorder by assessing the frequency, duration, symptoms, and precipitants of the person's substance use.
The clinician assesses:
The person's tolerance for the substance determines if the person needs increased amounts of the mood-altering substance over time or gets a decreased effect from the substance with repeated use.
If the person experiences withdrawal symptoms or uses a mood-altering substance to prevent the effects of withdrawal symptoms.
Ingests more of the mind-altering substance for a longer duration than intended.
If the person experiences problems reducing or controlling their substance use.
Invest significant time obtaining, using, or recovering from the use of the mood-altering substance.
The mood-altering substance decreases participation in important social, occupational, or recreational activities.
Continued use of the substance even with knowledge of the negative consequences.
As a person's substance use spirals, the associated actions are identified as addictive behaviors. According to the APA, addictive behaviors are "actions, often obsessive and destructive, that are related to one's abuse of or dependence on a substance and that dominate one's life. Addictive behaviors may include drug-seeking behavior, risk-taking, and breaking laws in the course of sustaining one's drug habit."
These addictive behaviors include but are not limited to stealing from family and friends. Selling or pawning valuable possessions to obtain money to support their drug habit. Some addicts who end up in the criminal justice system have charges and convictions for shoplifting, possession of and dealing in stolen goods, burglary charges, grand theft, and DUI.
Others addicted to prescription drugs may go doctor shopping by visiting multiple doctors to get narcotic medication. They may request specific pain medications. For example, suppose they are in pain management, and the recommended treatment does not include the prescription of narcotic medications; they refuse to comply with care. Still, some addicts think it wise to become drug dealers to support their drug habit.
The addictive behaviors are likely at their peak during active addiction. The person's addiction dominates their life and those who live with them and care about their well-being. The person usually does not see a problem with substance use. Although there is evidence of a decline in their overall well-being.
Interacting with a family member or friend addicted to alcohol and drugs can be incredibly frustrating. Sometimes requiring, drastic measures to create healthy boundaries between yourself and the addicted person. For example, you may struggle to see the individual and focus on the addiction. Addiction is a disorder that affects the entire family. Therefore, it is of utmost importance if you or someone you know is struggling with excessive alcohol or drug use, encourage them to seek help. You can find substance abuse providers in your local area by visiting the SAMHSA.gov treatment locator.
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American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders 5th edition.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders 5th edition.
Maremmani, I., Perugi, G., Pacini, M., & Akiskal, H. (2006). Toward a unitary perspective on the bipolar spectrum and substance use: Opiate addiction as a paradigm. Journal of Affective Disorders, 93, 1-12.