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.
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