September is National Recovery Month. Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), its observance is intended to increase public awareness of mental and substance use issues, as well as to celebrate people in recovery.
I was reminded of the ongoing need for increased public awareness of substance use issues while following the media coverage of and social commentary about Prince’s death due to an accidental overdose of the opioid drug fentanyl. “How could he have professed to be a Jehovah’s Witness and have a drug addiction?” “What about all that talk about his healthy diet?” “Was he taking the drugs out of medical necessity or was he just a junkie?” “He had everything. Why didn’t his people make him go for help?” These questions reveal many of the misconceptions and lack of general knowledge about addiction that many people have.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guide used by mental health professionals to categorize mental health conditions, refers to addiction as a “substance use disorder.” While the specific substance—alcohol, opioids, cannabis, or others—may vary, substance use disorders are generally characterized by continued use of a substance and unsuccessful attempts to stop using despite negative social, occupational, legal, and/or physical consequences. Symptoms of substance use conditions can also include:
- The need for larger amounts of the substance to obtain the same effect (tolerance)
- Cravings for the substance
- Symptoms such as anxiety, nausea, and seizures in its absence (withdrawal)
There is an interesting human tendency: when something undesired happens to us, we tend to attribute the cause of it to something situational or outside our control. However, when the same undesired event happens to someone else, we tend to attribute the cause of it to some internal characteristic. This is referred to as the fundamental attribution error, and it helps explain why so many people have the misconception that the inability to stop using a substance is evidence of a character or moral defect or lack of willpower.
Holding on to this, as well as other misconceptions about addiction, allows many of us struggling with our own sense of inadequacy, for whatever reason, to feel better about ourselves. Instead of feeling compassion for their struggle, we may feel disdain or disgust. This stigma has far-reaching negative implications, including increased shame and guilt that make it more difficult to reach out for help. Family members of people who use also may struggle with their own guilt and shame as well as anger, believing their loved one “just won’t quit.”
Substance use issues are so prevalent that it is likely you know someone who is struggling with or in recovery from one. If you are a close friend or family member, you have probably experienced the negative impact problematic substance use can have on relationships. Here are some facts about substance use issues that may help you understand the challenges of asking for help, getting sober, and beginning the journey of recovery:
1. While there are factors such as age, gender, and socioeconomic status which influence the type of substance an individual is likely to use, addiction can happen to almost anyone—for many reasons and at any point during the lifespan.
Instead of feeling compassion for their struggle, we may feel disdain or disgust. This stigma has far-reaching negative implications, including increased shame and guilt that make it more difficult to reach out for help.
Research has found that the type and number of adverse childhood experiences can have a profoundly negative impact on later development. Individuals whose parents separated or divorced or who experienced physical, sexual, and/or emotional abuse are more likely to develop many physical illnesses, mental health conditions, and substance use issues. Other research has consistently shown that individuals who struggle with depression and/or anxiety are at greater risk for substance use issues. Individuals with high levels of stress and inadequate coping skills are also more likely to begin using drugs and alcohol as a coping mechanism.
Individuals diagnosed with attention-deficit hyperactivity (ADHD) or learning disorders such as dyslexia are also at greater risk for developing a substance use issue. LGBTQ teens also have an increased risk for challenges with substance use, as do individuals who feel lonely due to recent social changes. This is one of the reasons cited by SAMHSA in a January 2010 press release as a reason for the increase in nonmedical prescription drug use among older adults.
2. The inability to stop using a substance that leads to negative consequences is better explained by immediate and long-term changes in the brain caused by the substance used rather than a character defect or lack of willpower.
Substances such as alcohol, marijuana, cocaine, opioid medications, and LSD are all mood-altering. They affect levels of the chemical dopamine, so that reward pathways of the brain are stimulated more intensely and for longer periods than with other pleasurable activities, such as sex. At the same time, the substances decrease one’s awareness of internal feelings as well as events happening around them. These effects are what make the person want to use again despite possible consequences.
The use of mood-altering substances also affects other chemicals in the brain, such as serotonin and GABA. Chronic substance use can physically alter the brain capacity for memory, learning, and making sound decisions—even after the individual stops using. This makes it more difficult for the individual to recognize the severity of their substance use and the need for treatment. It also makes it difficult to make decisions that decrease the likelihood of relapse. All of these chemical changes in the brain also help explain the intense cravings that users often experience and make relapse even more likely.
Also, some drugs, such as the opioid medications hydrocodone and oxycodone, commonly prescribed for pain, work in such a way that a person may need a higher dosage of the medication to obtain the same level of pain relief after a short period of time. While not everyone who takes opioid medications as prescribed has problems, a review of the literature on opioid abuse in people with chronic pain, published in the July 2010 journal Pain Physician, found that individuals with a low pain threshold and risk factors mentioned above, depression, and/or a high level of psychosocial stressors were more likely to abuse the prescribed opioid medications.
3. Overcoming addiction isn’t as simple as stopping the substance use.
Many individuals believe that all the problems created by the substance use issue will disappear once the use stops. But this is likely the time when cravings will be more intense and the individual experiences withdrawal symptoms. People who use should never be encouraged to “go cold turkey” without appropriate medical supervision. In fact, while withdrawal from opioid drugs, including heroin, can be especially uncomfortable, withdrawal symptoms associated with alcohol are often more life-threatening.
In addition, once the individual stops using, the feelings that had been numbed—such as shame and guilt, depression, or anxiety—while using may begin to resurface. It is also the time family members who have been negatively impacted by the user’s behavior may confront the individual. For this reason, a recovery treatment program is needed to help the individual deal with these challenges, as well as learn more adaptive ways to deal with life’s stressors and how to avoid situations that increase the likelihood of relapse.
4. Recovery is an ongoing process.
There are many different types of recovery programs—short-term and long-term residential rehab, intensive outpatient, 12-step meetings, and more. The programs offer the degree of immersion in counseling and structure needed at different times during the recovery process. An individual in recovery should periodically reevaluate their needs and modify their recovery program accordingly.
It is important to know that while not inevitable, relapse may be a part of the long-term recovery process.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders(5th ed.). Washington, DC: Author.
- Centers for Disease Control and Prevention. (2016, April 1). Adverse Childhood Experiences. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/
- Genetic Science Learning Center. (n.d.). The Science of Addiction: Genetics and the Brain. Retrieved from http://learn.genetics.utah.edu/content/addiction/.
- Sehgal, N., Laxmaiah, M., & Smith, H. S. (2012). Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse. 15:ES67-ES92. Retrieved from http://www.thblack.com/links/RSD/PainPhys2012_15_ES67_RxOpioidAbuseInChronPain-26p.pdf
- Substance Abuse and Mental Health Services Administration. (2010, January 8). Increasing Substance Abuse Levels among Older Adults Likely to Create Sharp Rise in Need for Treatment Services in Next Decade [Press Release]. Retrieved from http://www.samhsa.gov/newsroom/press-announcements/201001080530
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