Kevin Stevenson, LMHC, MCAP

Substance Abuse

Drug abuse can lead to drug dependence and addiction.
Drug dependence means that a person has grown used to or adapted to the amount of the drug in question that is being taken and that the individual needs the drug to function normally. Abruptly stopping the drug leads to withdrawal symptoms. A person may have a physical dependence on a substance without having an addiction. For example, certain blood pressure medications do not cause addiction but they can cause physical dependence. Other drugs, such as cocaine, cause addiction without leading to physical dependence. Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Addiction is comprised of tolerance and/or psychological dependence to the substance in question. Tolerance is when a person must take more and more of the particular drug to get the same desired effects over time. Psychological dependence and drug addiction involves the compulsive use of a substance, despite its negative consequnces or dangerous effects. Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Stages of drug use that can lead to dependence and addiction
  • Experimentation: When a person voluntarily decides to use alcohol or other drugs for the first time or recreationally. There are many reasons a person may choose to use alcohol or drugs such as: out of curiosity, peer pressure or social reasons, depression, anxiety or boredom, to relieve or control pain or to escape a problem. If the alcohol or drug use has a desireable outcome, the person will likely try it again.
  • Regular use: The person enjoyed their early experientation with alcohol or drugs and has now started to use substances regularly. At this stage the person may or may not have experienced any negative consequences associated with their alcohol or drug use however, over time and with continued use the likelyhood of this decreases. Some people may never go beyond this stage or develop any problems, however others will escalate to the next stage.
  • Risky Use: This is when the person’s alcohol or drug us and behaviors associated with their use put them or other people’s health or safety at risk, examples include: using alcohol or drugs and driving, operating other types of machinery, unprotected sex. Risky use is a slippery slope and can easily lead to further stages.
  • Abuse: The person’s repeated use of alcohol or drugs leads to the inability of the person to fulfill personal, social, school or work responsibilities. Abuse refers to habitual use of a substance or substances. The user loses motivation; does not care about school and work; has obvious behavior changes; may use drugs to “fix” or “cope” with negative feelings or issues. Thinking about or using alcohol or drugs becomes more important than all other interests, including relationships; the user may become secretive and lie about use. Repeated use of the substance becomes hazardous to ones physical health or safety and repeated negative consequences occur whether legal, social, work, school or finanical. Dangerous behavior, dangerous choices under the influence, and the build-up of dangerous effects on the body can add up and lead to severe and or permanent damage.
  • Dependence: The person now feels they need the substance in order to make it through the day. The person experiences an uncontrollable compulsion to use the substance and experiences cravings, increaed tolerance and withdrawl symptoms if the use of the substance is stopped. The negative consequences of the person’s alcohol or drug use will have increased and likely will their reluctance to give up the substance.
  • Addiction: The person is now unable to function without the substance and will exhibit physical dependence, psychological dependence, increased tolerance and will suffer withdrawl symptoms should they try to stop. Addiction is a chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Characteristic behaviors of addiction include: impaired control over drug use, compulsive use, continued use despite increased negative consequences, increased damage to body systems and organs as time passes, cravings, tolerance and withdrawl symptoms. Addiction is a progressive disease that if left untreated will get worse and can be life-threatening and end in death.
Addiction is a chronic and progressive disease and the road to recovery is long and can involve frequent relapses. Addiction if left untreated, will get worse and can be life-threatening. A point is reached where in abuse becomes an addiction, a relapsing illness wherein the individual cannot stop by themselves. Treatment becomes necessary for the person to stop his or her compulsive behavior but, it can be treated. If you think you have a problem with using substances, please seek help from your doctor or a counselor.
Substance Abuse Treatment and Recovery
In order to understand the treatment that is needed for addiction, it is important to emphasize that medical experts today generally consider alcohol and other drug addiction to be a disease that, while treatable, is chronic and relapsing. Because dependency on alcohol and other drugs creates difficulties in one’s physical, psychological, social, and economic functioning, treatment must be designed to address all of these areas. Addiction and its related problems can be treated successfully, but no single treatment works for all substances, nor for all substance abusers. It is important to note that not all persons in recovery for substance abuse relapse. Nearly one-third achieve permanent abstinence from their first attempt at recovery. An additional one-third have brief periods of substance use but eventually achieve long-term abstinence, and one-third have chronic relapses that result in premature death from chemical addiction and related consequences. These statistics are consistent with the life-long recovery rates of any chronic lifestyle-related illness.
Substance abuse treatment refers to a broad range of activities or services, including identification of the problem (and engaging the individual in treatment); brief interventions; assessment of substance abuse and related problems including histories of various types of abuse; diagnosis of the problem(s); and treatment planning, including counseling, medical services, psychiatric services, psychological services, social services and follow-up for persons with alcohol or other drug problems.
Substance abuse treatment may be based on one of several traditional approaches: the Medical Model which focuses on the recognition of addiction as a bio/psycho/social disease, the need for life-long abstinence, and the use of an ongoing recovery program to maintain abstinence; the Social Model which focuses more on the need for long-term abstinence and the need for self-help recovery groups to maintain sobriety; and the Behavioral Model which focuses more on diagnosis and treatment of other problems or conditions that can interfere with recovery. Many programs use a combination of some aspects of the various models in order to facilitate the most appropriate treatment for the individual and to give patients options. Others also include innovative non-traditional models of treatment such as acupuncture and traditional healing practices associated with specific cultural groups.
Treatment may occur in various settings, such as inpatient, hospital-based programs; short- and long-term residential programs; or outpatient programs; and may be augmented by self-help/12-step and other support groups. Treatment may also use a combination of therapies, such as pharmacological therapy to treat certain addictions (for example the use of methadone for heroin addiction or the use of antabuse to treat alcoholism); use of psychological therapy or counseling, education and social learning theories; and non-traditional healing methods such as acupuncture. Treatment may extend over the course of weeks, months, or years, depending on the severity of the problems and the level of burden created by clients’ multiple disorders such as alcoholism, other drug addiction, HIV/AIDS, mental illness (especially depression), and serious physical illnesses. The type and intensity of treatment depend on the patient’s psychological, physical, and social problems; the stage (or severity) and type of addiction; personality traits; and social skills before the onset of addiction.
The concepts of treatment and recovery are not one and the same. However, treatment is a very important part of the recovery process. When the formal treatment component (s) are completed, whether it be outpatient, inpatient or short- or long-term residential treatment, this is not the end for anyone with an addiction problem. Recovery is a lifelong process that takes place over time and often in specific stages. In addition to abstinence, recovery includes a full return to bio/psycho/social functioning.
The Developmental Model of Recovery, identifies 6 stages that addicted individuals must undergo for long-term recovery
  1. Transition: The period of time needed for the addicted individual to come to grips with the realization that safe use of alcohol or other drugs for them is not possible;
  2. Stabilization: During which the chemically dependent person experiences physical withdrawal and other medical problems and learns how to separate from people, places and things that promote substance abuse;
  3. Early recovery: When an individual faces the need to establish a chemical-free lifestyle and build relationships that support long-term recovery;
  4. Middle recovery: Seen as time for the development of a balanced lifestyle where repairing past damage is important;
  5. Late recovery: during which the individual identifies and changes mistaken beliefs about oneself, others and the world that caused or promoted irrational thinking; and
  6. Maintenance: The lifelong process of continued growth, development, and managing routine life problems.
Recovery is very complex, is not exempt from vulnerabilities, and requires a long-term commitment. This important part of the treatment continuum must be taken into account in the design of training programs for providers of substance abuse treatment and those of child welfare services. The complexities of recovery must be understood as well as the compelling need to address the issues of children and addicted parents and other family members. It is often said in the recovery communities that the whole family is in recovery because many changes affecting the entire family system will necessarily occur as the recovering person embarks on this lifelong journey of well being.
With respect to women in particular, additional problems emerge in early recovery, including problems related to parenting, to trauma resulting from physical or sexual abuse, or to mental illness. Together with the model described above, a woman’s recovery will only be successful to the extent that the other issues which precipitate or relate to the abuse of alcohol or other drugs are also ameliorated. That is to say, if a woman who is newly drug-free returns to a hostile, abusive environment, to high levels of stress in raising one or more children alone, to unsafe housing and insecurity in the employment arena, and with minimal resources for physical and mental health care and other basic needs, recovery will be difficult. Under such circumstances recovery will require ongoing counseling, attendance in self-help and other support groups and accessibility to other available resources. Child welfare workers must become aware of the implications and critical importance of these factors to overall treatment for women, in particular as they relate to identifying proper services for them and their children.
Understanding Relapse and Factors Associated with Relapse
Relapse is not an isolated event, but rather a process whereby an individual becomes dysfunctional or unable to cope with life in sobriety, and thus can no longer avoid using alcohol or other drugs. This process of becoming dysfunctional may lead to renewed alcohol or other drug use, physical or emotional collapse, or even suicide. The process is marked by predictable and identifiable warning signs that begin long before the return to use or collapse occurs. Progressively increased distress levels in any one of the problem areas — physical, psychological or social — can lead to physical or emotional collapse, resulting in relapse. These symptoms increase and intensify unless the individual returns to the use of alcohol or other drugs. One particular warning in early recovery occurs when a recovering person begins to seek out situations involving people who use alcohol or other drugs.
Given that addiction can be a chronic, progressive disorder often characterized by relapse, and given the fact that women who relapse may be in particular need of intensive treatment and continued support, the opportunity to reenter treatment must remain open. Continued relapse may point to a more serious disorder that was not initially diagnosed, such as post traumatic stress syndrome resulting from past sexual or physical abuse or current abuse. In order to address these and other issues in women’s lives, such as stress connected with being a single parent, low income, being identified as a maltreating parent, and having few social resources, any or all of which may bring about relapse, separate attention to these issues is needed — attention that extends beyond the substance abuse treatment process. In order to prevent relapse, the client may have to continue addressing these issues for years after leaving treatment. Formal relapse prevention components that offer means for early detection of relapse and tools for intervention should be included in every persons treatment plan.

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                    Kevin Stevenson, LMHC,CAP