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Drug and Alcohol Addiction

Addiction—dependence on a particular substance or activity—is one of the most important, difficult, and complex areas of mental health. Addiction can be difficult to treat, and there is a good deal of controversy surrounding the causes of addiction and the best approaches to treatment.

Warning Signs of Drug or Alcohol Abuse

Drug and alcohol abuse or misuse—excessive or inappropriate use of a substance—can be difficult to define, and people’s opinions, values, and beliefs vary significantly on the topic. For some, any use of an illegal drug or any use of alcohol with the primary purpose of intoxication constitutes abuse. For others, abuse is indicated by recurring, negative consequences, such as:

  • Failure to meet social, work, and academic obligations
  • Physical injury or illness
  • Alcohol- or drug-related legal problems, such as arrest for driving while intoxicated
  • Relationship problems with intimate partners, friends, and family
  • Impulsivity, such as spending money excessively
  • Diminished interest in other activities
  • Short-term memory loss or blackouts

Signs that Substance Abuse Has Become Substance Addiction

Substance abuse can lead to substance dependence or addiction when both quantity and rate of use increase. People who experience drug or alcohol addiction feel unable to control the impulse to use, and they often experience withdrawal symptoms in the sudden absence of the substance. Alcoholism, for example, occurs when people become chemically dependent on alcohol, and those who are addicted may become ill if they suddenly stop drinking. People may also feel psychologically dependent on a substance and continue to use it, particularly under stressful circumstances or to alleviate other psychological problems. Some people are unaware or deny that they have a problem with addiction, and sometimes a person’s struggle with drug and alcohol abuse remains hidden from loved ones.


Signs of chemical dependence include:

  • Increasing tolerance, or the need to consume more of the substance to reach the desired altered state

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  • Requiring the substance throughout the day
  • Seeking the company of other users and cutting off social ties with non-users
  • Dismissing or resenting expressions of concern from loved ones
  • Avoiding other activities and failing to meet obligations
  • Experiencing withdrawal symptoms in the absence of the substance
  • Hiding use from family and friends
  • Bingeing—using heavily—for many hours or several days
  • Feeling unable to quit

What Leads a Person to Misuse Drugs or Alcohol?

There are a number of causes related to drug and alcohol abuse, including psychological, biological, social, and physiological reasons. A family history of substance abuse can make a person more vulnerable to addiction, and social factors, such as peer pressure and ease of availability can increase the likelihood of a person developing a problem with drugs or alcohol. In addition, once a person begins using heavily, physiological changes take place, and that person may then become physically dependent, requiring him or her to continually use the substance in order to avoid withdrawal symptoms.


Alcholism tends to run in families, although not all children of people addicted to alcohol become addicted themselves, and there is some debate among psychologists about the degree to which alcoholism is genetic. Some researchers are searching for an addiction or alcoholism gene, while others point out that simply witnessing a parent drink in response to stress increases a child’s likelihood of choosing to drink in response to stress. 


Research indicates that the vast majority of people who are addicted to drugs or alcohol have an underlying mental health condition or significant emotional/psychological difficulty, and about half of people with mental health diagnoses will face challenges with drugs or alcohol at some point in their life, usually as a form of self-medication.


Drinking a beer with burning cigarette in handPeople who misuse drugs or alcohol often do so as a way of coping with experiences, memories, or events that emotionally overwhelm them. Whether they are equipped with appropriate coping strategies or not, people who misuse rely on the immediate gratification of the drugs and alcohol as an alternative to facing the issues at hand. In the long term, however, reliance on drugs and alcohol will almost surely worsen any emotional or psychological condition. Chronic self-medication may be a sign that therapy is warranted to address an underlying condition or difficulty. 

Therapy Can Help Overcome Addiction

Therapists who specialize in addiction recovery help people set achievable and empowering short-term goals. Once sobriety is achieved, healthy and adaptive skills can be developed, and the therapist and client can begin to explore the source of the addiction while employing the new coping strategies. Together, the client and therapist will work to set longer term goals that include rebuilding damaged relationships, accepting responsibility, and releasing guilt. A skilled therapist can help someone dependent on drugs or alcohol overcome their addiction and set them on the path of achieving the life they truly desire.


Several types of therapy are helpful in this process. In particular, cognitive-behavioral therapy and motivational interviewing therapy—a person-centered therapy that relies on a client’s inspiration to change—have demonstrated effectiveness in this arena. Sometimes therapy provides a supplemental form of support for someone who is attending a self-help group, such as Alcoholics Anonymous; in fact, some therapies are specifically geared toward facilitating 12-step programs.


People sometimes fear seeking help for drug addiction. Be advised that privacy and confidentiality in substance abuse treatment is mandated not only by professional ethical guidelines and, usually, state law (like all mental health treatment), but also by special federal laws.

Medical Repercussions

Quitting the use of a chemical substance can be extremely difficult, and it can also be dangerous. Chronic users of alcohol and prescription drugs should not attempt to stop cold turkey without medical assistance. Many substances lead to physical sickness, temporary personality changes, loss of appetite, insomnia, nausea, mood swings, and other disturbances when quitting is attempted. Opiate withdrawal, for example, can be temporarily debilitating, but not fatal. Chronic alcohol abuse can cause a number of health conditions, including cirrhosis of the liver, heart and circulatory problems and premature death. Long-term alcohol abuse can also cause mental health problems and brain damage. 


When a person’s dependence on drugs or alcohol is so severe that withdrawal symptoms may be life-threatening, an inpatient detoxification program in a hospital or treatment facility is essential for stabilizing the person. Medications may be used to help avoid potential withdrawal complications.


Fatal overdose is possible with many commonly abused drugs; in fact, pharmaceuticals such as opioid analgesics are the most common cause of drug overdose deaths. Marijuana is an exception, although misuse of marijuana is associated with a host of health issues, including diminished lung capacity, memory problems, and mood and cognition impairment, among others.

Case Examples of Drug and Alcohol Abuse

  • Self-medicating with alcohol: Clara, 57, has been a heavy drinker of beer and vodka for almost 45 years. However, since her husband’s alcohol-related death, her drinking has increased dramatically: instead of weekend binges and a few daily cocktails after work, she has taken to drinking throughout each day, and she recently lost her job for missing days while hungover. She was also arrested for driving drunk and lost her license as a result. She is estranged from her two children, who, she believes, blame her for their father’s death. Clara recognizes her problem, but her anxiety and depression compel her to continue self-medicating. Quitting would be a dangerous undertaking alone, and Clara agrees to enter a treatment facility. With medical help, she is able to maintain sobriety, and she begins an intensive program of therapy and 12-step groups after she leaves the facility. Soon, she begins to deal with her grief, not just over the death of her husband, but also over the many losses and regrets that come from a life spent intoxicated. Facing these realities tempts Clara to drink, and she suffers several relapses, but eventually kicks the habit and restores her relationships with her children, which brings her a great sense of healing, accomplishment, and peace.
  • Family problems and teen drug use: Billy, 17, has begun smoking marijuana frequently and experiments with harder drugs—cocaine, LSD, valium—ever since his senior year of high school began. He has already been accepted to college and verbalizes that he sees “no reason to do anything but party.” His parents are very concerned and admonish him constantly to quit, but he meets their pleas with disdain and derision. Family sessions reveal deep hostility between Billy and his strict father, and a growing distance between the anxious, depressive mother and her son and husband. Therapy centers on enhancing communication and emotional expression, as well as establishing boundaries more appropriate to Billy’s transition from youth to adulthood. When Billy’s parents back off, his drug use curtails, though he still smokes marijuana and drinks alcohol at parties. Soon, Billy is asking for help getting his habit under control, his father enters into individual therapy for anger issues, and his mother, now taking an antidepressant, files for divorce. Billy leaves home with a great sense of relief and continues therapy in college, eventually becoming a peer counselor and working with other students trying to stay healthy and abstain from drug abuse.


  1. Alcoholism. (2012, August 09). Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/alcoholism/DS00340/DSECTION=treatments-and-drugs
  2. Drug Overdose in the United States: Fact Sheet. (2014). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html
  3. Fonseca, F., Gilchrist, G., and Torrens, M. (2012). Integrating addiction and mental health networks to improve access to treatment for people with alcohol and drug-related problems: A qualitative study. Advances in Dual Diagnosis, 5(1), 5-14. doi:http://dx.doi.org/10.1108/17570971211225127
  4. Understanding Alcohol Use Disorders and Their Treatment. (2012). American Psychological Association. Retrieved from http://www.apa.org/helpcenter/alcohol-disorders.aspx


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Last updated: 12-15-2014