Addiction

ADDICTION

Addiction, otherwise known as Substance Use Disorder (SUD) is a chronic illness in which a person uses drugs and/or alcohol to cope with unpleasant emotions. SUD is considered a relapsing disorder, as many people in recovery have an increased risk of turning back to their substance for support.

The disorder also operates through a reward pathway in the brain: 

  • Drugs trigger surges of neurotransmitters
  • Dopamine, a chemical influencing one’s mood and motivation 
  • The body responds by craving the drug more due to receiving an energetic or elevated mood. 

Dopamine is released during pleasurable situations such as sex, enjoying yummy food, and any other leisure hobbies. When experiencing challenging emotions, the fastest route to relief is through suppression with drugs and alcohol mimicking an altered mood state. When a reward pathway is established between drugs and pleasure, dopamine interacts with another neurotransmitter, glutamate, and it overloads the reward circuit making the drug seem very desirable and motivating the person to use it in order to get pleasurable effects. 

When a person is using the drug irregularly/low-frequency or experimenting, this is known as substance use. However substance use can lead to substance abuse, which is when a person continues using drugs, despite the consequences or risks and uses on a frequent basis. One may also develop dependence with substance abuse, which is when the body is physically dependent on the drug and used to its effects. Someone who is dependent on a drug will typically experience withdrawal symptoms when they stop using the drug. Substance abuse can also lead to tolerance, which is when the body requires more of the drug to attain the desired effects. 

While every person’s experience with drugs is different, some similar experiences and characteristics of addiction include:

✅ hiding drug use from family and friends
✅ spending most of one’s money on drugs
✅ always thinking about the next time they will be able to use the drug
✅ having trouble doing normal, daily activities 
✅ sleeping too much or too little compared to one’s past sleeping habits
✅ eating too much or too little compared to one’s past eating habits
✅ having trouble getting along with family, friends, co-workers more than usual

Causes of Substance Use Disorder

Substance use disorder can be caused by many factors such as medical history, environmental/developmental concerns, trauma, and co-occurring mental health disorders.

💡Medical history: Biologically, genetics play a role in developing an addiction, as researchers have linked DNA sequences to identify chromosomal or gene patterns  associated with the disorder. A family history of substance use will increase the risk of development. 
💡 Environment/Development: Environmental causes such as peer pressure, family use of substances, abuse, stress, and an early exposure to substances can influence the likelihood of developing a substance use concern. Early exposure to substances, at a young age, can lead to the onset of addiction during a critical stage of development. Youth engaging in substance use can affect the brain’s development in sensory perception.   
💡Trauma: Traumatic events throughout a person’s life can increase the risk of developing a disorder. When experiences with trauma are not managed through psychotherapy, there is an increased need to soothe restless emotions quickly, usually through substances. Those with trauma may use drugs to reduce anxieties and avoid dealing with the root of concern. 
💡Co-occurring Mental Health Disorders: Mental health disorders may lead to the development of a substance use disorder. As discussed prior, substances may be used to alleviate symptoms of mental health or distract from physical and mental tension.

Addiction is a very complicated and complex disorder occurring at any point in life. Addiction does not discriminate and can affect any individual differently. Many misconceptions about the cause of addiction include:

❌ A Single Gene- there is no single “addiction gene.” 
❌ Route of entry- “certain substances, such as cocaine, are only addictive if they are injected.” Drugs are addictive, regardless of the entry route. Different routes of entry can cause stronger, faster surges of dopamine though all have potential to lead to addiction.
❌ Age- “the younger one is, the less likely they are to develop an addiction,” which in turn is not the case as younger ages are more likely to become addicted
❌ Only Street DrugsPeople can also become addicted to prescription drugs such as certain painkillers, amphetamines, benzodiazepines and over the counter drugs like cough syrup. More people die from prescription drug overdoses than recreational overdoses emphasizing the severity of both forms.

Misconceptions About Substance Use Disorder

There is a lot of false information about addiction that can lead to stigmas and distorted perceptions of people who have addictions. Here are some common myths about addiction:

🚫 addiction is curable
🚫 addiction is a choice
🚫 addiction medications are just replacing one addiction for another
🚫 addiction only affects certain types of people
🚫 people have to hit “rock bottom” before they can get better
🚫 all addicts are homeless and unemployed
🚫 prescription drugs will not lead to addiction
🚫 addicts can stop anytime they want
🚫 addiction is a matter of willpower
🚫 people who have addictions are weak
🚫 once they are out of rehab they can be around substances again

Signs and Symptoms of Substance Use Disorder

There are several signs or effects one may notice when they suspect they may have an addiction. If you believe you or a loved one may be experiencing an addiction, here are some signs and symptoms to be aware of:

🚩 needing more of the substance to get the desired effect as if just first starting the substance(s)
🚩 one cannot stop themselves from using the substance, even if they want to 
🚩 spending a lot of time thinking about the substance and using the substance
🚩 having a lack of interest in activities once enjoyed
🚩 disrupted eating and sleeping patterns

There may also be some physical signs associated with addiction, though should not be a telling suspect of addiction. Instead, physical signs can also be contributed to several other medical conditions. These include:

🚩 bloodshot eyes
🚩 weight loss or gain
🚩 shakes or tremors
🚩 frequent bloody noses
🚩 bad breath
🚩 dark circles under eyes
🚩 dry or scaly skin

Diagnosing Substance Use Disorder

Diagnoses for substance use disorders usually require an evaluation and assessment by a psychiatrist or psychologist. A diagnosis requires a certain number of symptoms found in the Diagnostic Statistical Manual of Mental Disorders (DSM-5). Lab tests may be conducted as well to monitor substance use and withdrawal concerns. Substance use disorder can be diagnosed according to the following symptoms:

⚠️  taking the substance in larger amounts or for longer than you’re meant to
⚠️  wanting to cut down or stop using the substance though unable to control craving
⚠️  spending a lot of time getting, using, or recovering from the use of the substance
⚠️  cravings and urges to use the substance
⚠️  not managing tasks at work, home, or school because of substance use
⚠️  continuing to use, even when it causes problems in relationships
⚠️  giving up social, occupational, or recreational activities due to substance use
⚠️  using substances again and again, even when it puts you in danger
⚠️  continuing to use with known risk of harm caused 
⚠️  needing more of the substance to get desired effect (tolerance)
⚠️  withdrawal symptoms that are relieved when using more of the substance

Conditions Commonly Mistaken for Substance Use Disorder

Substance use commonly occurs with other mental health diagnoses. Mental health diagnoses can either lead to the development of an addiction or as a result. Drugs may also counteract specific mental health symptoms causing worsening effects from the disorder. Due to the commonality between the two comorbidities, anyone seeking treatment for a substance use disorder should also be evaluated for any mental health diagnoses. 

Some common comorbidities with addiction include:

✳️ depression- drugs used as a way to cope to alleviate symptoms of sadness and avoid negative thoughts, however depressant drugs can also lead to depressive episodes, as they can trigger feelings of sadness and hopelessness
✳️ anxiety disorders-  feelings of worry and stress may cause an individual to use drugs to help reduce these feelings. For example, someone with social anxiety may use alcohol to help them feel at ease around people.
✳️ bipolar disorder- people may turn to drugs to help offset the discomfort of symptoms. Using drugs can also trigger episodes and worsen symptoms.
✳️ attention deficit hyperactivity disorder (ADHD)- untreated ADHD increases the risk of developing a substance use disorder. ADHD causes changes in the brain’s circuits, which are also associated with drug cravings.
✳️ schizophrenia- drugs used to help ease symptoms such as lack of concentration, low mood, and stress.
✳️ post traumatic stress disorder (PTSD)- drugs used to help avoid trauma events and symptoms of dealing with the trauma.

Treating Substance Use Disorder

The treatment for addiction can depend on the substance one is utilizing as well as the severity of use, as safety is the most important factor. Treatment can involve different types of therapies, such as inpatient and/or outpatient care, detoxification, and strategic techniques and approaches to uncover the root.

Treatment often starts with inpatient rehabilitation as it is the highest level of care for those with severe substance use concerns. Individuals stay in residential facilities with structured activities throughout the day with individual therapy, assigned jobs, and support group therapy. Inpatient settings assist with substance as well as mental health. As inpatient is usually the start of treatment for most patients, detoxification tends to occur, which is safely monitored while a person withdraws from substances. Please consider not every individual is fortunate enough to withdraw in a safe environment. 

For some, withdrawal may be forced due to legal violations, such as being sentenced to jail due to substance use or poverty due lack of insurance. These factors make withdrawal life threatening as someone withdrawing from a substance should always be monitored.  As one transitions out of inpatient or a rehab program, referrals to support groups and therapeutic interventions are offered to assist in recovery. 

Outpatient therapy and support groups such as Al-anon and AA are individual and family therapeutic groups where communities in recovery can gather together. Outpatient offers an individual, weekly, 45 minute session with a therapist solely focusing on the individual and their recovery. While support groups and family therapy assist in change within an individual’s system such as the family, emphasizing successful recovery is met when everyone in the system adapts to changes for a substance free life.

🧬 inpatient therapy
​🧬 outpatient therapy
​🧬 detoxification
​🧬 medication therapy

​🧬 psychotherapy
​🧬 family therapy 
​🧬 peer support groups 

Healthcare Professionals Who Treat Substance Use Disorder

When one is seeking treatment for their addiction, there are several different providers and professionals playing active roles in the recovery/treatment process. These individuals can help with therapy, locating resources, prescribing medications, and supporting the family during this journey. Natural supports such as friends and family can play a vital role in recovery by implementing their own therapeutic services, educating themselves, and making changes to avoid relapse. Seeking direction on services from a substance use treatment center can provide on-site care with referrals to appropriate professionals. Below are different types of professionals in the recovery process:

🧠 Interventionist– a professional supporting an individual and family in making the decision to seek treatment for substance use. Professionals such as therapists often stage an “intervention” or group therapy session with friends and family members present. Therapists may act as a coach or mediator for family and friends, teaching them how to address concerns and manage reactions. This may be the first step in addiction treatment
🧠 Addiction counselor/ therapist- a professional supporting an individual through recovery and offering therapeutic service to assist in developing tools to manage emotions and the root of addiction. 
🧠 Medical Physician- treating and related health issues from chronic substance use. They have the ability to evaluate patients, diagnose patients, and aid in a recovery treatment plan by assessing physical and biological needs.
🧠 Psychiatrist- a medical doctor focusing on psycho pharmaceutical therapy in recovery. This professional is typically involved in co-occurring disorders and offers medication to individuals in recovery managing a mental health diagnosis. 
🧠 Psychologist- is also considered a diagnosing practitioner and can provide psychotherapy as a form of treatment usually when mental health diagnoses are present. 

Recognizing Immediate Need for Substance Use Disorder

Substance abuse and relapse is serious and can be deadly. If you or someone around you starts to show concerning symptoms, please seek support immediately. Substance use can be deadly and is not a matter taken lightly. Below on potential concerns warranting professional advice:

🚨 Use has led to risky behaviors such as sharing needles or unprotected sex
🚨 Cannot stop using the drug, no matter how hard one tries to stop
🚨 Stealing from others in order to pay for the drug
🚨 Intentionally hiding drug use from friends and/or family
🚨 Several absences of work due to your drug use 
🚨 Hostility towards friends/family and tension in close relationships

Substance Use Disorder Professional Organizations

There are several organizations supporting the recovery journey. There may be organizations that are more local to your city or area though her are national resources: