One of the most important, difficult, and complex areas of mental health is the field of addiction. Research indicates that the vast majority of people who are addicted to drugs or alcohol have an underlying mental illness or significant emotional/psychological difficulty, and about half of people with mental illness will be involved with drugs or alcohol at some point in their life, usually as a form of self-medication. Addiction is difficult to treat, and there is a good deal of controversy about the causes and best approaches to treatment of addiction.

Signs of Abuse of Drugs and Alcohol

Drug and alcohol abuse may be difficult to define. Opinions vary with people’s values and beliefs. For some, any use of an illegal drug, and any use of alcohol with the primary purpose of intoxication constitutes abuse. For others, abuse is indicated by a negative impact in the individual’s life, for example, the presence of several of the following signs:

• Failing in school or routinely missing work
• Driving while under the influence
• Injuring oneself or others
• Developing physical illnesses
  
• Damaging relationships with friends and family
• Spending too much money
• Diminishing interest in other activities
• Getting in repeated legal trouble
• Overdosing

Signs of Dependence/Addiction to Drugs and Alcohol

Beyond substance abuse is substance dependence or addiction. Dependence is indicated by one or more of the following:

• Severe on-going abuse
• Inability to go without the substance
• Need for greater and greater amounts of the substance (tolerance)
• Complete lack of other activities
• Cessation of relationships outside of those the individual uses with
• Increasingly frequent use of the substance
• Withdrawal symptoms when not using the substance
  

"Hidden" Signs of Abuse/Dependence

For some,

• Hiding your use from friends and family
• Forgetting what happened last time you used (black outs)
• Trying to quit but not being able to
• Using more than you intended to, repeatedly
• Drinking yourself sick, repeatedly
• Using first thing in the morning
• Using several times a day
• Going on binges (long nights, or several days, of heavy using)
• Being told by others you have a problem

Psychotherapy for Drug and Alcohol Addiction

Psychotherapy for drug or alcohol addiction is focused on modifying maladaptive behavior. People who misuse drugs or alcohol usually do so as a way of coping with experiences, memories or events that emotionally overwhelm them. Even if they had developed the proper coping strategies, people who misuse rely on the immediate gratification of the drugs and alcohol rather than facing the issues at hand. A therapist who specializes in addiction recovery will help a client set achievable short term goals in order to empower the client. Once sobriety is achieved, healthy and adaptive skills can be taught and developed and the therapist and client can begin to explore the issues that led to the addiction, 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.

How the Medical Field Approaches Addiction

Quitting using a chemical substance can be extremely difficult. It can also be dangerous. Chronic users of alcohol and prescription drugs should not attempt to stop cold turkey without medical assistance. Opiate withdrawal can be temporarily debilitating, but not fatal. Other chemicals may lead to physical sickness, personality changes (temporary), loss of appetite, insomnia, nausea, mood swings and other disturbances when quitting is attempted.

Fatal overdose is possible with many commonly abused drugs. Marijuana – which can lead to diminished lung functioning, memory problems, mood and cognition impairment, and other health issues (while also being a potentially legitimate medicine in the eyes of mainstream medicine, if not the Drug Enforcement Agency) is the most prominent exception.

Drugs and alcohol can temporarily relieve the symptoms and feelings associated with psychological illness and distress, but in the long term will almost surely worsen any emotional or psychological condition. Chronic self-medication may be a sign that therapy warranted to address an underlying condition or difficulty. 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.

Alcohol Addiction after Death of Spouse - Case Example

Clara, 57, has been a heavy drinker of beer and vodka for almost 45 years. However, since the death of her husband of alcohol-related symptoms, 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 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 dangerous alone, and Clara agrees to enter a treatment facility. With medical help, she is able to maintain sobriety, and upon release, begins an intensive program of therapy and 12-step groups. 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.

High School Senior "Partying Too Hard" - Case Example

Billy, 17, has begun smoking marijuana frequently and experiments with harder drugs – cocaine, LSD, valium – ever sine 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.

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Last updated: 05-14-2013