Drug & Alcohol Abuse
“Approximately 18-19 million people in the U.S. are dependent on, or abuse, alcohol and over 3 million people are dependent on drugs, especially pain killers, marijuana, and cocaine.”
Definition of Addiction
While not everyone agrees on what constitutes an addiction, in general it is recognized that an addiction can be to any substance (for example alcohol, amphetamines, cocaine, nicotine, opioids, sedatives, hallucinogens, inhalants, cannabis, phencyclidine, caffeine, and a wide variety of other substances), which, when ingested, cross the blood-brain barrier and alter the natural chemical behavior of the brain. It is also accepted that addiction includes dependency on "things" as well as substances, such things as gambling, eating and sex.
In general, the term addiction, describes a chronic pattern of behavior that continues despite the adverse consequences that result from engaging in the behavior. Many substances and behaviors that provide either pleasure or relief from pain pose a risk of addiction or dependency. One way to differentiate the types of addiction is to consider two categories of dependence. First is physical dependence, characterized by symptoms of withdrawal, and second is psychological dependence. Addictions often have both physical and psychological components.
Physical addiction and dependency on a substance is defined by the appearance of characteristic withdrawal symptoms when the drug is suddenly discontinued. Opiates, cocaine, barbiturates, hallucinogens, benzodiazepines, barbiturates, alcohol, nicotine, and a variety of more modern synthetic drugs are all well known for their ability to induce physical dependence and addiction. While physical dependency can be a major factor in the psychology of addiction, the primary attribute of an addictive drug is its ability to induce a ‘high’ while causing harm.
The speed with which a given individual becomes addicted varies with the type of addiction, the frequency of addictive behavior, and the individual himself or herself. For example, some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Because of this variation, some people hypothesize that physical dependency and addiction are in large part genetically moderated. Nicotine and caffeine are two of the most addictive psychoactive substances.
Psychological addiction, as opposed to physiological addiction, is a person's need to use a drug or engage in a behavior out of desire for the effects it produces, rather than to relieve withdrawal symptoms. Instead of an actual physiological dependence on a drug, such as heroin, psychological addiction usually develops out of habits that relieve symptoms loneliness, anxiety, depression and feelings of worthlessness. As the drug and/or behavior is indulged, it becomes associated with the release of pleasure and avoidance of pain, and a cycle is started that is similar to physiological addiction. This cycle is often very difficult to break. It is quite common for an addict to express the desire to stop the behavior, but find that they are unable to stop the addictive behavior.
Psychological addiction can theoretically form for any rewarding behavior or as a habitual means to avoid undesired activity. The most common of the psychological addictions include dependency on such things as gambling, eating, sex work, internet use and shopping and spending money. It is possible to be both psychologically and physically addicted at the same time.
Alcohol addiction, the powerful craving for alcohol which often results in the compulsive consumption of alcohol, is one of the most widespread and costly addictions in our society. The cause of this craving is heavily debated, but the most popular beliefs are that it is: (1) a chemical or nutritional imbalance; (2) a genetic predisposition; (3) a neurological effect caused by runaway learning mechanisms; or (4) an inability to curb one's own desire for enjoyment.
Psychological addiction is also involved in alcoholism since many alcoholics believe that they gain benefit from the use of the substance. They may believe that the alcohol improves their ability to socialize, helps them handle pressure, allows them to feel superior to others in that they can handle extreme intoxication, or that drinking allows them to fit into their peer group. These effects all contribute to a person's impression of the beneficial effects of alcohol in his/her life, and may result in a denial of the negative effects. It is important to recognize that many of these benefits can be real, not imagined. The person must be convinced of the net negative value of alcohol in their lives before any treatment can have meaningful lasting effects. An inability to stop drinking despite a clear understanding of alcohol's negative balance of effects on his or her life is a primary indicator that a person suffers from alcoholism.
Several explanations have been presented to explain addiction in general. The moral explanation states that addictions are the result of human weakness, and are defects of character. The disease explanation holds that addiction is an illness, and comes about as a result of the impairment of healthy chemical or behavioral processes. The genetic approach states that there is a genetic predisposition to certain behaviors. The cultural approach recognizes that the influence of culture is a strong determinant of whether or not individuals fall prey to certain addictions. The blended model attempts to consider elements of all other models in developing a therapeutic approach to dependency. It holds that the mechanism of dependency is different for different individuals, and that each case must be considered on its own merits.
Therapists often classify addicts and their dependencies as either interested in changing or not interested in changing. Treatment for those not interested in changing is typically wasted time and effort. Treatment for those interested in recognizing and changing involves planning for specific ways to avoid the addictive stimulus and therapeutic interventions intended to help the addict learn healthier ways to find satisfaction. As an experienced therapist, we will frequently use therapeutic interviews in an effort to discover factors which led a person to embrace unhealthy sources of pleasure or relief from pain.