Identifying and Treating Addiction and Substance Abuse Problems

Over the ages, there has been a vast array of different understandings and explanations for the phenomenon now known as addiction. Prior to the mid 1950’s, addiction was looked upon by most as either a moral failure or a mental disorder. Reactionary, inappropriate responses to those exhibiting symptoms of alcoholism or addiction include persecution, imprisonment and commitment to institutions for the mentally ill. Even still, many believe addiction to be a matter of will. If this is indeed the case, who in their right mind would, based upon your understanding and knowledge of the pain and misery which comes from being an addict, will to be an addict? As a therapist whose daily challenge is blindness, I have told many addicts and their families that I would much prefer my blindness over their addiction, hands down!

In today’s world of substance abuse treatment, the Diagnostic and Statistical Manual IV classifies substance-related disorders into eleven different areas: alcohol; amphetamines; caffeine; cannabis; cocaine; hallucinogens; inhalants; nicotine; opioids; PCP; sedatives, hypnotics and anxiolytics. The DSM-IV differentiates between substance-use disorders and substance-induced disorders. Substance-use disorders include dependence and abuse. Examples of substance-induced disorders include intoxication, withdrawal, delirium, dementia, psychotic disorders, mood disorder, anxiety disorders, sexual dysfunction and sleep disorders. “The essential feature in substance dependence is a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of continued self-administration that can result in tolerance, withdrawal and compulsive drug-taking behavior.” (DSM-IV, p. 192)

In order to meet the criteria for substance dependence, there must be a maladaptive use pattern causing some type of impairment in at least 3 of the following all occurring in twelve months:

1. Tolerance – “the need for greatly increased amounts of the substance to achieve intoxication or the desired effect or a markedly diminished effect with continued use of the same amount of the substance.”(DSM IV, p. 192)

2.Withdrawal – “maladaptive behavior change with physiological and cognitive concomitants that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance.” (DSM IV, p. 194). Such withdrawal symptoms are often followed by a return to use of the substance in order to avoid further withdrawal symptoms.

3.  More or longer use than planned – The individual uses more of the substance than originally intended or continues the use of the substance for a period longer than initially planned.

4. Desire without ability to cut down or control usage – The individual finds it difficult to reduce the amount used or the length of time spent using the substance.

5. Time spent obtaining, using or recovering from the substance – The individual finds that he or she is experiencing increasingly greater amounts of time in activities focused around the use of substances.

6. Impact on social, occupational or recreational activities – Substance dependence often begins to have such a consuming effect that increasingly less time is spent in social, recreational or vocational activities.

7.  Continued use in spite of physical or psychological problems related to use – This is one of the most predominant characteristics of a substance dependence disorder.  Despite the presence of negative consequences resulting from the use of the substances, the dependent substance user will often continue his use.

Theories of substance abuse treatment:

1. Moral model – addiction results from a moral weakness and punishment rather than treatment.

2. Psychological models – change psychological traits which might play a part in addictive behavior.

3. Behavioral learning theory – change reinforcements.

4. Socio-cultural model – change social and cultural environmental factors that encourage substance abuse.

5. Medical model – physiological dysfunction.

6. Bio-psycho-social model – biological aspects that impact psychological aspects that then impact social aspects of the substance user.

7. Harm reduction model – merely attempt to reduce the amount of harm that might come from the use of substances.

Future articles will be devoted to these methods of assisting those who struggle with substance use and abuse.

© Copyright 2011 by J. D. Murphy, LMFT, therapist in Pineville, Louisiana. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • vickie l

    vickie l

    April 11th, 2011 at 3:11 PM

    While I think that it is important to recognize that there are some patterns with addiction I also think that it is important to note that in some people addictions will manifest themselves in a number of different ways. It is so important to remember that addiction is not a one size fits all type of disease, and neither is the cure.

  • Kristin

    Kristin

    April 11th, 2011 at 7:27 PM

    You can build up a resistance to almost anything so you can endure it. In fact, in the past, a handful of royals drank small doses of poison just in case someone tried to assassinate them. Unfortunately, the body treats alcohol as a poison.

  • Dan

    Dan

    April 11th, 2011 at 7:43 PM

    And then the guy’s drinking more and more of it to get the buzz. Before you know it, the liver packs it in and you’re in hospital for alcohol poisoning. I knew a guy like that once. It was very sad how low he sunk.

  • Ellie

    Ellie

    April 11th, 2011 at 9:31 PM

    I think a good way to curb binge drinking amongst teens would be to charge alcohol only to a credit card. That would help keep it out the hands of kids.

  • Joseph

    Joseph

    April 11th, 2011 at 10:25 PM

    If I remember right from what I’ve read, the last time they tried alcohol prohibition, crime skyrocketed. It will cause more problems than it will resolve. Unless you get behind the wheel of a car or any other machine, your drinking seldom directly affects another.

  • ANGELO

    ANGELO

    April 12th, 2011 at 2:22 AM

    Addiction issues are a complicated lot and there is no one-size-fits-all for it. What is required is to study the lifestyle and familial organization of the addict and an appropriate deaddiction technique if you ask me!

    And for heaven’s sake, stop treating drug addicts as criminals and treat them as victims. I’m sure there will be a marked level of success with such an approach.

  • Kyle

    Kyle

    April 12th, 2011 at 3:08 PM

    Having grown up in a family with serious addiction problems and having lived in fear of developing addictions of my own I am always thankful that this is something that is not going to be allowed to be pushed under the rug. Help is out there and the resources are out there. Now it is all about making the right diagnoses in the right people and helping them to find the help that they need. I have lived firts hand how this can really make a terrible mark on a family and I would never wish the same experiences on anyone.

  • sue

    sue

    April 12th, 2011 at 4:59 PM

    @Joseph: “…and unless you get behind the wheel of a car or any other machine, your drinking seldom directly affects another.”

    Spoken like a man that’s never lived with an alcoholic. What a dumb comment. Go to an al-anon meeting and say that why don’t you.

  • Lisa

    Lisa

    April 12th, 2011 at 5:43 PM

    I don’t get what the moral model thing means. “Addiction results from a moral weakness and punishment rather than treatment” makes absolutely no sense to me. It sounds like it’s saying treatment ironically causes addictions.

  • Elizabeth

    Elizabeth

    April 12th, 2011 at 6:17 PM

    I am not sure myself and I have read that part twice. I thought it was saying that you deserve to be punished instead of treated but I don’t think that’s right.You’re not the only one that’s unclear on that.

  • Colin

    Colin

    April 12th, 2011 at 7:37 PM

    When a man or woman does something harmful to themselves repeatedly, even when they know full well it’s not good for them, that’s when it’s classed as an addiction in my book. I believe it’s possible to have an addictive personality where you go through life swapping one addiction for another, always looking for the next big thrill.

  • Patty

    Patty

    April 12th, 2011 at 8:13 PM

    @ANGELO I agree, especially people hooked on drugs. A guy is addicted, big deal. It’s not like he’s a murderer. Get them cleaned up and back into society. It’s not against the law to have an illness that needs treatment last I heard.

  • Travis

    Travis

    April 14th, 2011 at 4:46 AM

    Being able to recognize and identify addiction is something that is important. But I do think that we all need to remember that just because we see that behavior in a person does not mean that he is ready to see that in himself. We cannot give help to someone who is not ready to accept it.

  • J.D. Murphy, M.A., LMFT

    J.D. Murphy, M.A., LMFT

    May 1st, 2011 at 1:41 PM

    Thanks to all who have chosen to comment on this article. It’s encouraging to hear the comments regarding the significant need for assisting individuals who struggle with this challenge. Treatment is indeed what is needed. And, if the treatment is good, there’s a high probability that the person will benefit. Please, don’t buy into the myth that has resulted in hundreds of thousands of unnecessary deaths of alcoholics and addicts: the thought that you can’t help someone with this problem unless they want help and they’ve “hit their bottom.” We don’t take that approach in the treatment of any other illness such as cancer or heart disease. Why do it with addiction? Perhaps it is true that you can lead a horse to water but not be able to make him drink. But you can add salt to his oats to help make him thirsty.

    My regrets for the lack of clarity on the statement made about the moral model of treating addiction. Those who adopt the moral model approach to the treatment of addiction contend that substance use and abuse and addiction results from a moral weakness present within the user himself. Individuals who approach this problem from this perspective are more inclined to respond with punishing the substance abuser rather than attempting to treat him.

    It is so true that the consequences of substance abuse and addiction are far reaching! Indeed, I contend that it is likely our nation’s greatest epedemic contributing to the ruin of countless jobs, relationships, marriages, families, bank accounts, livers, brain cells and lives! It impacts not only the substance user but all too often also has marked negative consequences for the families and friends of the user. It is thus referred to by many as a family disease.

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