Substance Abuse

The goal of this section of the website is to help you learn to recognize the warning signs of alcohol and drug abuse and understand how abuse and dependency/addiction issues are diagnosed and treated.

WHY DO PEOPLE ABUSE ALCOHOL AND DRUGS?

People use substances like alcohol, tobacco, prescription or over-the counter medications, or illicit drugs (such as marijuana, cocaine, methamphetamine or heroin) in an attempt to alter the way they feel. Initially, substance use can begin as a way of avoiding physical or psychological pain, or to fill a perceived void in life, which helps to explain why individuals suffering from depression and related illnesses frequently turn to these substances to try and escape their symptoms. But instead of improving their situation, individuals frequently become dependent on the substance used, creating an additional and often more serious problem to overcome: addiction.

WHAT IS ADDICTION?

Addiction to alcohol or drugs refers to a chronic brain disease resulting in a compulsion to seek out and use these substances despite the many risks – physical, legal, social and financial – involved. Addiction, or dependency, changes the structure and function of the brain, so although at first an individual may voluntarily choose to drink alcohol or use drugs, eventually, changes to brain chemistry render the person unable to control their desire for the substance.

Addiction is also frequently characterized by an ever-increasing tolerance, meaning that the individual requires more and more of the substance, and requires it more frequently, in order to achieve the same level of pleasure or “high.”

ALCOHOL

Alcohol is among the most frequently abused substances. It is socially acceptable, affordable, and easily and legally available. Ongoing alcohol use or abuse can alter brain chemistry, leading to alcohol dependency or alcoholism.

How much is “too much?”
When it comes to determining the line between “acceptable” and “at-risk” drinking, public health and safety experts often focus on the quantity of alcohol consumed. Although that is an important consideration, it is not the amount alone that counts, but the pattern of use and the emotional and behavioral changes that result from drinking. These are the most reliable indicators of an alcohol problem.

There are genetic underpinnings for all addictions, including alcohol. For some people, any amount of drinking might be hazardous. Others may begin using alcohol to improve their mood or enhance their sense of wellbeing, only to develop a habit over time that actually worsens their emotional state, increases their stress level and complicates their relationships and life circumstances.

Nonetheless, when looking for the warning signs of an alcohol problem, the following are generally accepted guidelines regarding quantity and frequency of use. These guidelines are based on defining a standard serving of alcohol as one 12-ounce can or bottle of beer, one five-ounce glass of wine, or one-and-one-half ounces of distilled spirits:

For men, more than four drinks on one occasion or more than 14 drinks weekly is commonly considered at-risk drinking.
For women, more than three drinks on one occasion or more than seven drinks weekly is commonly considered at-risk drinking.
What is alcoholism?
Alcoholism (also known as alcohol dependence) refers to an addiction to alcohol. Alcohol becomes the central focus of the individual’s life, and he or she is unable to stop using alcohol, despite genuine attempts to quit. These attempts may fail due to the physical symptoms of alcohol withdrawal, such as shakiness, nausea, severe hangovers, or because of the emotional symptoms, such as nervousness, serious cravings for alcohol, or worsening depression.

DRUGS

Like drinking alcohol, using other drugs routinely alters brain chemistry. Although the immediate sensation from using drugs may be positive (ranging from calmness to euphoria, depending upon the substance), often these sensations are followed by feelings of guilt, shame and, in many cases, an insatiable appetite for more of the substance. Sleep and appetite regulation in the brain often change.

It is the brain’s desire for more that defines drug abuse, and explains why, like alcoholism, drug abuse is a disease, not a lack of willpower.

What is drug addiction?
Drug addiction is a chronic brain disease that results in a compulsion to seek out and use substances despite the many risks – physical, legal, social and financial – involved. Drug abuse changes the structure and function of the brain, so although at first an individual may voluntarily choose to use drugs, eventually, changes to brain chemistry render the person unable to control their desire for drugs, while increasing the intensity of their desire to use, use more, and use more frequently.

Why do some people who use drugs become addicted, while others don’t?
Scientists believe that several factors can increase a person’s risk of developing an addiction, including:

Genetics – Hereditary factors may account for up to 60% of a person’s propensity to become addicted.
Other brain illnesses – Individuals with depression or bipolar disorder face a significantly increased risk of addiction.
Environment – A person’s family life and social interactions can be contributing factors. If exposed to drug or alcohol abuse of a parent or older sibling as a child an individual is at greater risk of developing their own drug problem as an adult. The same is true of people who are exposed to drug use by friends or peers in adolescence.
Age of first use – Research also indicates that the earlier a person begins to use drugs, the more likely their use will progress to abuse.
Method of use – Even the way a person’ uses drugs can have an impact on their vulnerability to developing an addiction. For example, drugs that are injected or smoked impact the brain within seconds, and their initial impact can fade quickly. Scientists believe this “roller coaster” effect produces greater risk of subsequent drug abuse by creating a constant cycle of trying to bring back the initial pleasure and avoid the subsequent discomfort, or by changing gene expression more dramatically.
WHAT ARE THE SYMPTOMS OF SUBSTANCE ABUSE?

The person abusing alcohol or drugs may be the last one to see his or her behavior as a problem, even when others express concern.

Any of the following behaviors can signal an alcohol or substance abuse problem:

Using drugs or drinking frequently to the point of intoxication or impaired function
Engaging in binge drinking, which for average adults is defined as consuming five+ drinks (for men) or four+ drinks (for women) in a short period of time
Drinking alcohol or drugs to the point of “black-out”
Using drugs or alcohol to the point of interference with functioning at home or work
Using drugs or alcohol despite dangerous consequences (such as driving while intoxicated)
Using drugs or alcohol despite recurrent legal or interpersonal consequences (such as arrest or domestic violence)
Individuals suffering from a substance abuse problem may also display one or more of the following behaviors:

Preoccupation with obtaining or using alcohol or drugs
Consuming more alcohol or drugs than intended
Building a tolerance for alcohol or drugs – requiring increasing amounts of the substance to achieve the desired effect
Giving up other activities because they might interfere with the ability to drink or use drugs
Experiencing a sense of shame or guilt, or a feeling of being flawed or damaged
HOW IS SUBSTANCE ABUSE TREATED?

Established methods for treating substance abuse have been shown to be effective in individuals who are motivated to recover and are committed to getting the support they need. Success in recovery from addiction requires a significant lifestyle change, and constant daily vigilance to remain sober and drug-free. It also is essential to treat all co-occurring conditions.

There are several options available to address dependence on alcohol or other substances:

Intensive hospital treatment, either inpatient or outpatient, may be recommended to break the cycle of dependence.
Individual or group psychotherapy may also be helpful.
Many people find 12-step groups such as Alcoholics Anonymous or Narcotics Anonymous to be extremely beneficial in overcoming substance abuse and living in recovery.
There are some medications available to help patients overcome the symptoms of substance dependence. Most often, medications are used in combination with behavioral therapy to yield the best results.
Alcoholism and drug addiction are chronic diseases, meaning that they must be managed over a lifetime. As is the case with other chronic illnesses such as diabetes, asthma or depression, there is always the possibility that the disease will relapse, even if the individual remains sober and drug-free for a long period of time. It is important not to associate relapse with failure. Instead, relapse indicates that the individual’s treatment program should be reevaluated and perhaps revised to ensure ongoing recovery.