Abstract

This research paper will address Substance Use and Addiction, and the psychosocial implications associated with it.  This paper will also address the prevalence, incidence, symptoms, signs, investigations, and ethical considerations of substance use and addiction.

Introduction

Substance addiction can be defined as a behavior that creates physical and psychological pleasure; however, the cost to the individual visibly outweighs the benefits. Substances, such as psychoactive drugs, that affect the brains pleasure zones will often result in dependence; these substances include anything from alcohol and nicotine, to a variety of legal and illegal drugs (Fleury et al., 2014; Babor, 2011).

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There is a numerous amount of psychological information on substance use and abuse, however, there is not one individualized theory focused on addiction.  Addiction is defined as a condition of being habitually or compulsively occupied with, or involved in something (Pinel, 2014). Substance addiction is often described as an unmanageable, compulsive act that is carried out even when it threatens the individual’s health and wellbeing; the individual often negates to see the potential harmful social consequences that follow the addictive behavior (Matusow & Rosenblum, 2014). The word addict carries with it a negative stigma that is born from the perception of society. Addicts are often perceived as uncaring, unreliable and unstable individuals; this perception does not necessarily apply to all addicts. Some individuals can function and manage their lives in such a way that no one is aware of their substance dependence; these individuals are referred to as functioning addicts (Smith, et al., 2014).

Theoretical Underpinnings

The Disease Model of Addiction

Psychological research has resulted in a theoretical model of addiction as a disease. The addiction model has neutralized the negative connotations associated with substance addiction and helps to encourage substance users to partake in addiction treatments and self-help meetings (Smith, et al., 2014). Consequently, the disease model has a limited view on the various treatment methods; it does not take into consideration the reality of the everyday life that substance users face. Moreover, the disease model neglects to address the social issues that arise from substance use and addiction (Fleury et al., 2014 and Smith, et al., 2014). When deciding on a treatment plan individualized for the substance user it is important that all treatment and intervention methods are thoroughly examined. Another psychological theory on substance use is the psychodynamic model. The psychodynamic model implies that addictive behavior is brought on due to the relationship between external events and the unconscious psychological processes of which the user stays oblivious (Klostermann & O’Farrell, 2013). The psychodynamic model has been successful in shedding light onto the importance of early childhood development and parental influences as possible origins of addictive behavior (Klostermann & O’Farrell, 2013).

The Behavioral Model of Addiction

Unlike the previously discussed theories on substance use, behavioral models of addiction base themselves upon the theory that the continued use of a substance will create elation, which in turn will intensify the need for the substance use to continue (Babor, 2011;Fleury et al., 2014;Goodwin & Sias, 2014). The need to ease withdrawal symptoms can be explained by reinforcing contingencies, however, the substance user will experience negative reinforcement due to taking the dose to help ease the pain (Fleury et al., 2014). Although the feeling of elation explains the continued use of the substance, it does not explain why some individuals are able to stop while other individuals become addicted. The social learning theory delves into this issue by explaining how social and psychological factors influence the emotional quandaries individuals find themselves in when they are using the substance (Fleury et al., 2014). Psychologists argue that the social learning theory explains human behavior by analyzing the continuous collective interaction between behavioral, cognitive and environmental factors; this theory looks at how an individual’s self-control and decision processes are affected (Babor, 2011; Fleury et al., 2014; Goodwin & Sias, 2014).

The Social Model of Addiction

The social learning theory focuses on an individual’s personal experiences from families, friends and other individuals. How individuals learn and perceive substance use, whether positive or negative, will affect the learning process and this in turn affects their behavior (Babor, 2011). Cognitive behavioral treatment, a popular addiction treatment bred from both the social learning theory and other behaviorist theories, helps substance user’s deal with wanting to make new life changes, managing their cravings, thoughts and develop new problem solving skills (Babor, 2011;Fleury et al., 2014;Goodwin & Sias, 2014).

The social model also takes into account the comorbid psychopathologies associated with addiction. These psychopathologies include depression, major depressive disorder, generalized anxiety disorder, panic disorder, trauma, oppositional defiant disorder, and conduct disorder, (Goldston, et al., 2009). These comorbid psychopathologies are categorized into internalizing and externalizing, with the former being more strongly connected to addiction (Verona & Javdani, 2011).

Numerous studies indicate that depression and hopelessness are directly linked to adolescent substance use; depression was present in 90% of the cases in which there was comorbidity (Goldston, et al., 2009). Substance use acts emerge as a result of a vulnerable personality (psychopathology, increased traumatization, high harm avoidance, etc.) and additional stressors, as well as the presence and interaction between internalizing and externalizing factors. Stressors can precipitate an individual’s emotional distress, which may be alleviated by their social support, family connectedness, and coping behaviors. Comorbid psychopathologies, as well as substance use, weakens these effective coping behaviors and increase exposure to stressors, ultimately increasing the risk of substance use (Ruchkin, et al., 2003).

Substance Use and Abuse

Illegal substance use and underage alcohol consumption is a prevalent issue within society today. Early experimentation with drugs and alcohol have an influencing role on how individuals view substance use in the future; individual that have a positive experience will be more susceptible to use again. Individuals who are social, or recreational, substance user also have the potential to become addicts due to their psychological state and what substance they are using. Individuals who are deemed “social users” can control what substances they take and the amount they use, however, social users still share the risk of having their substance use interfere with their home and work lives. When the individual begins to lose control of their consumption and how much they are consuming, they begin to become less of a social user and more of an addict. Once the individual cross the line from social user to addict, their primary focus is on how and when they can use again. Addiction is no different whether you are addicted to a substance, alcohol, or food (Pinel, 2014).

All drugs affect the brain chemical balance, no matter what the substance, this is known as the brains reward system. When analyzing the brain of a non-addict it is different from that of an addict. When an individual uses a substance there is a surge of dopamine and other pleasure messengers, however, these quickly desensitize due to the adaptivity of the brain; this adaptation results in withdrawal symptoms.  Short-term substance use does not affect the brains chemical makeup contrary to long-term substance use (Pinel, 2014). If an individual continues to abuse substances permanent neurological changes begin to affect the chemical makeup of the brain; these changes in the brain affect behavior and/or the ability to make rational decisions (Pinel, 2014). These chemical changes in the brain results in the individual’s persistent substance usage in hopes to achieve the “high.” Individuals may become addicted primarily to help deal with withdrawal symptoms (physically dependency), stress issues or simply to avoid everyday reality (psychological dependency) (Pinel, 2014).

Research suggests that addiction runs in families; however, it may not be merely a function of the parent-child relationship or imitation, but rather an inherited trait. In 1998, Statham and colleagues conducted a twin study in which the heritability quotient was 55%. Serotonin metabolism and receptivity is the focus in the attempts to pinpoint the mechanism through which genes affect behavior (Wenar & Kerig, 2006). Others argue that an individual’s biological genes make up may have a role to play regarding a person’s addiction. If this is the case, then if an individual’s parents were alcoholics or drug addicts then they would be at a greater risk of following the same path resulting in the individual becoming an addict them self. This could possibly prove that in a minority of cases addiction could be genetic. The individual will not necessarily be born a drug addict or alcoholic, but is however, more at risk of becoming involved in substance use later in their life.

Additionally, research suggests that genetics plays a role in an individual’s susceptibility to addiction (Fleury, et al., 2014).Once a substance user decides to cross over the line of being in control of their thoughts and actions to achieve the “high” they become addicts; they have no self-control and the chemical effect on the brain has made the “high” unachievable. The individual’s lack of ability to control their substance use is now looked at as the disease of addiction. It is, however, achievable for the brain to recover from long-term substance use. For this to be achieved it involves long term abstinence from the use of chemical changing substances (Matusow & Rosenblum, 2013).

Implications

If there is to be progress in the disease from the abuse of drugs and alcohol, continuing to educate society about the possible dangers using can have not only to themselves, but also to their family and friends. By continuing to do this we will have a better chance of witnessing a decline in the abuse of drug and alcohol substances and by large an improvement in everyday living. Abstinence as previously mentioned is the only viable treatment program regarding the disease model of addiction. However, there are suggestions that in the process of recovery relapses are all too common (Matusow & Rosenblum, 2013).

Ethical Considerations

To help fully appreciate addiction there must be a more integrated approach which will take the different processes into consideration. Smith, et al. (2014) states that there are five stages that individuals will go through when experiencing behavioral changes. The first stage is when the individual is ignorant or unaware that they have a problem and have no wish to change. Stage two looks at the individual and how they begin to consider changing their behavior but have not yet made any attempts to do so. Stage three focuses on the acceptance that there may be a problem and begins to make changes. The fourth stage is when the individual begins to put their plans into action to help change their behavior. The final stage is when the changes made are maintained and the individual is dedicated in making lifestyle changes to allow this to be maintained (Smith, et al., 2014). A successful addiction treatment should encompass both the biological factors as well as the behavioral and social factors that influence individuals. Although there is no concrete theory and treatment on substance use and addiction, much improvement has been made in understanding this complex disease.

References

Babor, T. F. (2011). Substance, not semantics, is the issue: comments on the proposed addiction criteria for DSM-V. Addiction, 106(5), 870-872.

Fleury, M. f., Grenier, G., Bamvita, J., Perreault, M., & Carón, J. (2014). Predictors of Alcohol and Drug Dependence. Canadian Journal Of Psychiatry, 59(4), 203-212.

Goodwin, J. g., & Sias, S. M. (2014). Severe Substance Use Disorder Viewed as a Chronic Condition and Disability. Journal Of Rehabilitation, 80(4), 42-49.

Klostermann, K., & O’Farrell, T. J. (2013). Treating Substance Abuse: Partner and Family Approaches. Social Work In Public Health, 28(3/4), 234-247.

Matusow, H., & Rosenblum, A. (2013). The Most Critical Unresolved Issue Associated With: Psychoanalytic Theories of Addiction: Can the Talking Cure Tell Us Anything About Substance Use and Misuse?. Substance Use & Misuse, 48(3), 239-247.

Pinel, J. (2014). Biopsychology Plus NEW MyPsychLab with eText-Access Card Package (9th ed). Upper Saddle River, NJ: Pearson

Smith, J. L., Mattick, R. P., Jamadar, S. D., & Iredale, J. M. (2014). Deficits in behavioral inhibition in substance abuse and addiction: A meta-analysis. Drug And Alcohol Dependence, 1451-33.