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What is a substance abuse or addiction?

 

Substance abuse or addiction (dependence) can include any one or more of a long list of substances --- alcohol, amphetamines, cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, sedatives, even commonly used substances such as caffeine or nicotine.

 

Substance dependence (or addiction) is a cluster of cognitive (thinking), behavioral, and physical symptoms indicating that a person continues to use the substance despite significant substance-related problems. Symptoms include increased tolerance of the substance; unpleasant withdrawal when the substance is no longer present in the body; continued use even when the person has set limits for him or herself; numbers of unsuccessful attempts to decrease or discontinue use; focusing increased time and effort to obtaining the substance; cessation or reduction of important social, occupational, and recreational activities; and continued use even in the face of evidence of the problem(s) it is creating for the individual.  These symptoms are often accompanied by a “craving” for the substance.

 

Substance abuse is diagnosed when there is a pattern of substance use that results in recurrent and significant adverse consequences (for example, DUI’s; multiple legal problems; job loss, etc.) 

 

In 2012, an estimated 23.9 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey, or 9.2% of our population aged 12 and older.  The Riverside County death rate due to alcohol and drug use increased slightly between 2000 and 2007. and for each of those years Riverside County’s alcohol and drug-related mortality rate was higher than the state average for each of those years. (Source: http://www.ca-cpi.org/docs/County_Data_Files/Riverside_10.pdf.)

 

What things put a person at higher risk of experiencing substance abuse or addiction?

 

There can be a genetic predisposition to substance abuse or dependence, especially among sons of alcoholics.  There is much scientific evidence about the role of brain chemistry in abuse and addiction.  Psychological factors can include depressive disorders and sensation-seeking tendencies.  Social variables can include peer and family pressure and mush work has been done on the role of :gateway” drugs (tobacco, alcohol, and marijuana) on later development of abuse and/or addictive behaviors.

 

It is also well documented that there is a high correlation between substance abuse and mental health problems, that is, what is called co-occurring disorders where an individual is experiencing both substance abuse and mental health problems.  While one does not cause the other, they are correlated.  Public mental health programs report that 60% or more of inpatients also present with substance abuse problems.  In psychiatric emergency rooms those figures often rise above 80%.

 

Can substance abuse and addictions be treatedHow?

 

  • Medication.  Medications can play several roles in treating overdoses and acute intoxication; withdrawal symptom relief; treatment of co-occurring psychiatric illnesses; or reduction of drug craving.

  • Counseling, including inpatient, residential, and outpatient services; behavioral approaches such as relapse prevention therapy; and replacing harmful habits.

  • Peer Support (12-step and other programs)

  • Complementary Care such as exercise, stress reduction classes and other activities

     

 

How does substance abuse or addiction progress?

 

The natural history of substance dependence (addiction) usually follows the course of a chronic relapsing disorder.  Nevertheless, the course of substance dependence is variable and may involve full or partial remission.  Population surveys have increasingly recognized cultural differences in the course of substance use, abuse, and dependence.  It is also well documented that there is a high correlation between substance abuse and mental health problems, that is, what is called co-occurring disorders where an individual is experiencing both substance abuse and mental health problems.  While one does not cause the other, they are correlated.  Public mental health programs report that 60% or more of inpatients also present with substance abuse problems.  In psychiatric emergency rooms those figures often rise above 80%.

 

 


 

Do people with substance abuse or addiction get better?

 

For many individuals with bipolar disorder a good prognosis results from good treatment, which, in turn, results from an accurate diagnosis.  Because bipolar disorder can have a high rate of both under-diagnosis and misdiagnosis, it is often difficult for individuals with the condition to receive timely and competent treatment.

 

Bipolar disorder can be a severely disabling medical condition.  However, many individuals with bipolar disorder can live full and satisfying lives.  Quite often, medication is needed to enable this.  Persons with bipolar disorder may have periods of normal or near normal functioning between episodes.

 

Teaching patients coping strategies when noticing symptoms has shown encouraging results.

 

Bipolar disorder can cause suicidal ideation that leads to suicidal attempts. One out of three people with bipolar disorder report past attempts of suicide or complete it, and the annual average suicide rate is 10 to 20 times that of the general population

 

Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes. Patients with the disease may experience symptoms in very different ways. A typical patient with bipolar disorder averages 8 - 10 manic or depressive episodes over a lifetime. However, some people experience more and some fewer episodes.

 

Sources and Links

 
·         If you were in physical pain, you’d see a doctor to find out what’s wrong. Your mental health is just as important.  Learn more here about how to check yourself, from getting a mental health screening to visiting a counseling center. You can use the anonymous Self Evaluator to learn if a treatable mental health problem, including alcohol or drug abuse or dependence, could be affecting you or a friend. Be proactive about your mental health: it’s the first step to feeling better. http://www.ulifeline.org/check_yourself
·         United States Substance Abuse and Mental Health Services Administration (SAMHSA). http://www.samhsa.gov/treatment/
·         Riverside County Substance Abuse Program. http://rcdmh.org/opencms/english/Substance_Abuse/
·         The United States National Center for Complementary and Alternative Medicine (NCCAM) mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.  They do that by advancing the science and practice of symptom management; developing effective, practical, personalized strategies for promoting health and well-being; and enabling better evidence-based decision making regarding CAM use and its integration into health care and health promotion.  Information available there about complementary and alternative treatments for alcoholism, for example, can be found at http://nccam.nih.gov/research/results/spotlight/022609.htm
 
 
02/25/2014