Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder.
A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences. Addiction may involve the use of substances such as alcohol, inhalants, opioids, cocaine, and nicotine, or behaviors such as gambling.
Symptoms of addiction
Recurrent use of a substance, or engagement with an activity, that leads to impairment or distress, is the core of addictive disorders. The clinical diagnosis of an addiction is based on the presence of at least two of a number of features:
* The substance or activity is used in larger amounts or for a longer period of time than was intended.
* There is a desire to cut down on use or unsuccessful efforts to do so.
* Pursuit of the substance or activity, or recovery from its use, consumes a significant amount of time.
* There is a craving or strong desire to use the substance or engage in the activity.
* Use of the substance or activity disrupts obligations at work, school, or home.
* Use of the substance or activity continues despite the social or interpersonal problems it causes.
* Participation in important social, work, or recreational activities drops or stops.
* Use occurs in situations where it is physically risky.
* Use continues despite knowing it is causing or exacerbating physical or psychological problems.
* Tolerance occurs, indicated either by need for markedly increased amounts of the substance to achieve the desired effect or markedly diminished effect of the same amount of substance.
* Withdrawal occurs, manifest either in the presence of physiological withdrawal symptoms or the taking of a related substance to block them.
Causes of Addiction
Biological factors
Genes – Estimates vary but scientists find that genetic factors contribute about half the risk for developing a substance use disorder. For example, one factor linked to vulnerability is variation in a gene that determines the makeup of brain receptors for the neurotransmitter dopamine. Another factor appears to be the nature of the body’s hormonal response to stress.
Physiological factors
Variations in liver enzymes that metabolize substances are known to influence one’s risk of alcohol use disorder.
Gender – Males are more likely to develop substance use disorder than females, although the so-called gender gap may be narrowing for alcohol use disorder, and females are more subject to intoxication effects at lower doses of alcohol.
Psychological Factors
Personality factors
Both impulsivity and sensation seeking have been linked to substance use and gambling disorders. Impulsivity may be particularly related to the risk of relapse.
Trauma and abuse – Early exposure to significant adverse experience can contribute to the development of substance use disorders by overwhelming an individual’s coping ability, perhaps by sensitizing brain pathways of alarm/distress, or by adding to the burden of stress.
Mental health factors – Conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder (PTSD) increase the risk of addiction. Difficulties managing strong emotions are also linked to substance use.
Environmental Factors
Family factors – While strong family relationships have been shown to protect against substance use disorders, several aspects of family functioning or circumstances can contribute to addiction risk. Having a parent or sibling with an addictive disorder raises the risk, as does a lack of parental supervision or support. Poor-quality or troubled parent-child relations and family disruptions such as divorce also add to one’s risk, as does sexual, physical, or emotional abuse. Research shows that marriage and taking on child-raising responsibilities mitigate the risk of addiction.
Accessibility factors. Easy availability of alcohol or other substances in one’s home, at school or work, or in one’s community increases the risk of repeated use.
Peer group – As profoundly social animals, people are strongly influenced by their peers and, in generally seeking to be liked by them, may adopt many of their behaviors, particularly during adolescence. Positive social relationships, on the other hand, are known to strongly protect against substance use.
Employment status – Having a job, and developing the skills for employment, exerts pressure for stability and provides financial and psychological rewards that mitigate addiction risk.
Treatment of Addiction
Treatment can include any of a number of components, which are often deployed in combination and are likely to change over the course of recovery:
Detoxification, conducted under medical supervision, may be needed but is only the first stage of treatment.
Medications that reduce or counter use of illicit substances are suitable for some individuals, or medications may be used to target co-occurring disorders such as anxiety and depression.
Motivational Interviewing, which is a short-term counseling process to help a person resolve ambivalence about treatment and find and hold onto incentives for change.
Cognitive Behavior Therapy (CBT) can help a person recognize and cope with situations that trigger the desire to use substances.
Group therapy and other peer-support programs leverage the direct experience of many to support individual recovery and prevent the recurrence of substance use.
Family therapy helps individuals repair any damage done to family relationships and to establish more supportive ones.
Life skills training, including employability skills, may be part of an individual’s treatment plan.
Good treatment programs also feature the regular monitoring of individual progress.
