In order to understand what addictions are and how they tend to develop, family members may be forced to learn a significant amount of vocabulary terms. Often, this can be a confusing experience, as some terms that mean radically different things to medical experts are used interchangeably by the media and the public at large. This can lead to a significant amount of confusion, and in extreme cases, it can lead to a delay in receiving needed care. Often, the confusion centers on the terms “substance abuse” and “addiction.” These two terms do not mean the same thing, but one can certainly lead to another. Read on to find out more about what substance abuse really means, and how it might lead to addiction.
Substance abuse is considered a mental health issue, and as a result, doctors can lean on a textbook known as the DSM-IV in order to define what the term means and how it might apply to the patient who appears and asks for care. According to the World Health Organization (WHO), the DSM-IV commonly defines substance abuse as a, “maladaptive pattern of use indicated by…continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physically hazardous.” This can be a complicated and dense explanation for some people to understand, but in essence, this definition suggests that people who abuse substances take them in ways that are counterproductive, and they continue to take them despite the consequences they face as a result of the use.
In order to be defined as abuse, the behavior must be ongoing for an extended period of time. People who binge on alcohol one weekend and then never drink again may have been using alcohol improperly one time, but they may not be considered alcohol abusers because they don’t continue to use the drug, and they don’t seem to feel compelled to repeat the behavior.
Confusion can set in, the WHO reports, because some experts use the term “abuse” to refer to any use of illicit substances, or any use of prescription medications without the supervision of a doctor. Under this definition, people who take a drug like heroin, even once, are considered drug abusers because they’re taking an illegal drug. This isn’t the medically accepted use of the term, however, so it’s not the usage that will be addressed in this article.
Typical Warning Signs
In order to merit a diagnosis of substance abuse, people need to demonstrate that their use of a substance is keeping them from meeting their life obligations in some way.
Common signs include:
- Repeated absences from work or school
- Reduced performance at work, or poor grades at school
- Neglect of household chores
- Poor supervision of children
- Arrests for intoxication
People who are abusing substances in this way are beginning to see a slow slide in their ability to live a healthy life. They cannot meet the demands their lives are placing on them, and this can be incredibly disheartening. These feelings of depression and despair might lead them to engage in even more substance use and abuse.
People who abuse substances might develop personality changes. Some seem incredibly low and depressed much of the time, while others might seem withdrawn, irritable and angry. When asked, many people who abuse substances will not admit that their use is problematic, or that their use is the reason behind the personality changes the family is observing. Some people attempt to hide their substance abuse in order to keep such questions from arising, and they may seem secretive or simply absent as a result.
Prevalence and Drugs of Abuse
Obtaining a clear figure that defines the number of people who abuse drugs can be difficult, as some organizations lump those who abuse substances into numbers of people who are addicted to substances. However, there are some alarming numbers that might indicate that many people abuse substances each year. For example, the National Institute on Drug Abuse (NIDA) reports that 8.7 percent of Americans 12 or older admitted using drugs the month prior to participating in the National Survey on Drug Use and Health in 2009. This may indicate that many people are at least dabbling with drug use, and perhaps many are dealing with substance abuse or addiction.
While almost any substance could be abused, these are the substances commonly associated with high levels of abuse:
- Opioids, including heroin and opium
- Stimulants, including cocaine, amphetamine and methamphetamine
- Club drugs, including MDMA, GHB and Rohypnol
- Dissociative drugs, including ketamine, PCP and salvia
- Hallucinogens, including LSD, mescaline, psilocybin
- Prescription medications
While almost anyone could develop a substance abuse issue, there are some people who have an increased risk of abuse, when compared to the population at large. For example, it’s well known that people who endure some sort of violence or trauma tend to develop an unhealthy relationship with substances. To provide a concrete example, the NIDA reports that 27 percent of Army soldiers screened three to four months after returning from deployment to Iraq met the criteria for alcohol abuse. These solders seem to be relying on alcohol to help them move past the horrors they endured while fighting in a war.
People who endure trauma often develop mental illnesses, including post-traumatic stress disorder. In a separate study, published in the American Journal on Addictions, 30 to 59 percent of women who abuse substances also have post-traumatic stress disorder, often stemming from a history of repetitive assault, both physical and sexual, endured in childhood. Going through something so terrible, and receiving no help for that trauma, can leave people looking for ways to calm their minds and forget what has happened. Substance abuse seems to fit the bill for these people.
Substance abuse can also develop in association with other mental illnesses such as schizophrenia, depression, and anxiety disorders. For some people, substance abuse seems like an appropriate way to help them deal with a mental illness that has been troubling them for quite some time. For other people, substance abuse leads to chemical changes in the brain that can trigger latent mental illnesses. People who have both mental illnesses and substance abuse issues can face a significant amount of difficulty in their lives. For example, a study in the journal Hospital and Community Psychiatry found that people who had both substance abuse and mental illnesses were less able to manage their own lives, and they showed greater signs of hostility and suicidal thinking when compared to people who did not have a substance abuse issue. It’s clear that these two conditions tend to influence one another and make one another worse.
Many people wonder if they can inherit addictions. The research on this is slightly unclear, as some children who live with addicts seem to develop addictions, even if the people aren’t related by blood ties. It could be that watching someone deal with stress or disappointment by abusing substances could lead children to behave in the same way when they grow up, so addictions are a matter of nurture rather than nature. On the other hand, some responses to certain substances do seem to be dictated by genes, so it’s at least possible that some types of addictions are at least influenced by the genes people are born with.
Moving to Addiction
People who abuse substances are well on their way to developing addictions. They are flooding their bodies with chemicals, and they may change their chemical makeup in such a way that they lose all control over their ability to regulate their intake. According to experts, this is the major defining point between substance abuse and substance addiction. Those who abuse substances may continue to use despite the knowledge that the substances do them harm, but people who are addicted are taking this abuse to an entirely different level. Due to the chemical changes that the abuse has caused, these people are no longer able to regulate their intake. They are chemically compelled to keep using. Put plainly, substance abuse can lead to an addiction, and an addiction can be defined as compulsive, chemically driven use.
People who abuse substances need to stop doing so, in order to avoid the terrible consequences that addictions can bring about. Thankfully, multiple studies have shown that addiction treatments work and that people who have addictions can heal from the problems they’re facing. For example, a study in the journal JAMA found that people who went through alcohol and drug abuse treatment demonstrated “significant and pervasive” improvements in a variety of measures, including substance use, employment, criminal behavior, and mental health. While living with substance abuse can be difficult, studies like this make it clear that people who have addictions can and do get better, if they get help.
At Michael’s House, we specialize in helping people who have both addictions and mental health issues. We use therapy techniques that can help people to understand the links between the two issues, and we work hard to ensure that those in our care can build up the skills they’ll need to stay sober for the rest of their lives. Please call us at 760-548-4032 to find out more.