Substance Abuse and Addiction

Ask 10 different people what substance abuse or addiction is, and you are likely to get 10 different answers.  Some will insist these problems are a weakness of people who won't take responsibility for their behavior.  They believe that if someone wants to self-destruct,  let them.  They choose to abuse.

Other answers will range from heredity, to the "disease" model which views addiction as progressive and irreversible.  Some will say that the only treatment is total avoidance of the substance or behavior.  In this model, one is forever "in recovery" from the addiction.

Most experts view addiction from a bio-psycho-social model, which incorporates biological, psychological, cognitive, social, and environmental variables.  For example, it could be said that a person's alcohol addiction is due to a combination of factors:  perhaps one or both parents were alcoholic; maybe the person has a mental health problem that they are self-medicating with alcohol; the alcohol use is reinforced by the temporary feeling of relief from stressors; and their environment normalizes the use of alcohol.

This helps to explain the causes of addiction, but what exactly defines abuse or addiction?  A common definition is the compulsive and continued use of a substance or participation in a behavior, exhibiting little if any control over the behavior.  Often there are associated negative consequences.  The key characteristics that move abuse into the category of addiction are the presence of tolerance and withdrawal. Tolerance occurs when increasing amounts of the substance or behavior are required to achieve the same "high."  Withdrawal symptoms occur when the substance or behavior is stopped. When referring to addicition, we ten to think of alcohol, drugs, smoking, or caffeine, but people can also be addicted to gambling, eating, sex, and even exercise.

For many people, negative consequences are enough to make them change their behavior.  For many others, treatment is vital to their recovery.  The most common treatments include outpatient therapy, medications, and 12-step groups.  Inpatient, or residential, treatment is now only considered as a last resort after attempts at outpatient treatment have not been successful.  This is due to the expense, lack of availability, and time commitment required.

No single treatment is appropriate for all individuals, and effective treatment addresses the multiple needs of the individual, not just the addiction.  Recovery from an addiction can be a long-term process and may require multiple "episodes" of treatment.  However, it is possible for people to resume a high level of functioning, managing their lives in a healthy way.