Addiction, or dependence on a particular substance or activity, is one of the most complex areas of mental health. Addiction can often be difficult to treat, and there is a good deal of controversy surrounding the causes of addiction and the best approaches to treatment. Individuals who find themselves experiencing an addiction to drugs or alcohol often find the services of a mental health professional to be helpful in overcoming the addiction.
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.
- Impulsivity, such as spending money excessively.
- Diminished interest in other activities.
- Short-term memory loss or blackouts.
Substance abuse can lead to substance dependence or addiction when both the amount of substance used and the 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 deny or are unaware that they have a problem with addiction, and sometimes a person’s substance dependency and 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.
- Binging—using heavily—for many hours or several days.
- Feeling unable to quit.
Psychological, biological, social, and physiological factors might all play a role in whether or not a person comes to abuse drugs or alcohol. 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 often 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.
Alcoholism 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. Studies do show that genes, such as those that have an effect on the way a person responds to alcohol, may be responsible for about half of the risk of developing alcoholism. Some of these genes increase a person's risk, while some may instead decrease the risk of a person's developing alcoholism.
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. About half of all people with mental health diagnoses will face challenges with drugs or alcohol at some point in their lives, usually as a result of using drugs or alcohol to self-medicate.
People 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 substances rely on the immediate gratification of 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 in order to address an underlying condition or difficulty.
According to Jeremy Frank, PhD, CADC, a Philadelphia addiction psychologist, "The effects and consequences on substance use on families are devastating. Over 7 million children in the United States—more than 10%—live with a parent who has problems with alcohol, according to a 2012 Substance Abuse and Mental Health Services Administration report. These children and their families are at risk for other co-morbid mental health problems, such as depression, anxiety, low self-esteem, substance use issues, and addiction."
A parent who has become addicted to alcohol or uses drugs is statistically more likely to abuse or neglect his or her partner and/or children, and when parents of very young children are emotionally distant due to alcohol and drug use, the attachment bond between parent and child is likely to be weak. A family affected by addiction may also experience financial difficulties, and in some circumstances, a parent may be imprisoned as a result of drug or alcohol abuse, potentially leading to long-term separation from children and often putting further strain on the family unit. Some children of adults who are addicted may have difficulties in school due to anxiety and other stressors that may be experienced as a result of their parents' addictions. They might also find themselves acting as parents to any younger siblings as well as the parent who is addicted, which can make it more difficult for the child to have healthy relationships with appropriate boundaries, later in life.
It may also be difficult for parents to address the addiction of an adult child. Parents may feel responsible for their child's addiction or may be unsure of how to best help the child. In trying to help them overcome addictive behavior, they may at times end up enabling the child instead. In programs such as Alcoholics Anonymous, these parents can learn how to keep from enabling their child while still offering love. Often a counselor or social worker can provide assistance to parents in this area and help them find the best way to bring up the subject of substance abuse and addiction with their child.
It is likely that all members of a family until will be affected when one member of a family experiences an addiction. Early acknowledgment and treatment of the substance abuse or addiction may have significant benefit in promoting recovery and preventing long-term negative effects, both on the health of the person who is addicted and on the bonds between family members.
Currently, the U.S. is considered to be in the midst of an opioid epidemic, as the number of people using both prescription opioids (such as Oxycontin, Percocet, and Vicodin) and heroin is increasing. As these substances are more widely used, the number of deaths resulting from overdose has also increased. Drug overdose is the leading cause of accidental death in the U.S., and opioids are responsible for more than half of these deaths: In 2014, more than 28,000 people died from an opioid overdose.
Opioids affect the part of the brain that controls breathing, so large doses can slow a person’s breathing to the point of fatality. When an individual uses opioids over a period of time, a tolerance can develop, resulting in the need to use larger amounts of the substance to experience the same high. However, the body may not adapt quickly enough to the slower respiratory rate, and death may result. When opioids are mixed with other substances that have sedating effects, like alcohol, they can be even more dangerous. Sometimes, individuals are unaware of what the drugs they are using contain, such as when heroin is laced with fentanyl. In these cases, people intending to take a typical dose may unknowingly use a much higher and potentially fatal amount.
Because tolerance to a drug decreases after a period of abstinence, it is at this time that people have an increased risk of overdose. If a person who has not used the drug in some time resumes taking the same amount they did previously, the body may no longer be able to handle the dose, and death may result.
Opioid overdose deaths rarely happen instantly, and they can often be prevented if action is taken quickly. The symptoms of opioid overdose include:
- Breathing that is very slow or shallow, or breathing that has stopped
- Skin that appears grayish or ashen
- Fingernails and lips turning blue
- Loss of consciousness
- Choking sounds
- Slow or erratic pulse
- Limp body
- Lack of responsiveness to stimuli
In the case of an overdose, immediate action can often prevent death. The medication Naloxone (also known as Narcan) can reverse the effects of opioid overdose. Emergency responders, such as paramedics and police officers, typically carry this medication, but as overdoses become more prevalent, Naloxone is becoming more readily available and is now sold without a prescription in many states.
Therapists who specialize in addiction recovery can often help people who are addicted set achievable and empowering short-term goals as they work to overcome their addiction. Once sobriety is achieved, adaptive skills can be developed as the person works to regain physical and emotional health, and the therapist can begin to explore the source or cause of the addiction with the person in treatment as the person begins to employ the new coping strategies. Together, the therapist and the person being treated can work to set long-term goals that may include rebuilding damaged relationships, accepting responsibility for actions, and releasing guilt.
With therapy, a person who has become dependent on drugs or alcohol is often more likely to overcome an addiction, and 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 the person'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. Rehab, or inpatient treatment, is also an option for some of those who may experience difficulty achieving sobriety as an outpatient.
People sometimes fear seeking help for drug addiction due to concerns of legal consequences or, when the person who is addicted is a parent, the involvement of Child Protective Services. However, 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.
Chronic alcohol abuse can lead to 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. The abuse of drugs can lead to internal damage and can cause neurological issues such as memory and hearing loss and may have other neurological effects such as the increased likelihood of violence or aggression. Those who inject drugs are also at a higher risk for HIV and hepatitis and may be more likely to experience an unplanned pregnancy or contract a sexually transmitted infection. What's more, drug and alcohol use can cause an altered mood, exacerbating stress and depression as well as other symptoms of mental illnesses.
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 often considered to be an exception, as death from overdose is very unlikely. However, misuse or overuse of marijuana is associated with health issues such as diminished lung capacity, memory problems, and mood and cognitive impairment.
It can be difficult to stop using a chemical substance, and it can also be dangerous. Chronic users of alcohol and prescription drugs are typically encouraged not to stop abruptly without medical assistance. Quitting use of a substance may lead to withdrawal effects such as physical sickness, temporary personality changes, loss of appetite, insomnia, nausea, mood swings, and other disturbances. Opiate withdrawal, for example, can be particularly debilitating, but it is typically not fatal. Medications may be used to help avoid potential withdrawal complications, but 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 often necessary to stabilize the person.
- 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. Eventually, she is convinced by a friend that she needs to seek help. She knows that she cannot quit on her own, so 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 she is eventually able to break the habit of drinking and begins to restore 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, as his senior year of high school begins, he begins to experiment with harder drugs—cocaine, LSD, and Valium. 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 his mother, who experiences both anxiety and a depressive mood, and her son and husband. Therapy centers on enhancing communication and emotional expression, as well as the establishment of new boundaries that are 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 asks for help getting his drinking habit under control, his father enters into individual therapy for anger issues, and his mother, who is now in individual therapy and 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 in order to work with other students who are trying to stay healthy and abstain from drug abuse.
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