Prescription drug abuse has reached epidemic levels not only in the United States but in…
From Use to Abuse to Addiction
How does anyone go from use to abuse to addiction? Is it a rarity or more like a given, depending on circumstances? How can a person tell what stage they’re in, if there is a stage? Does it matter what type of substance it is, or behavior pattern? These are all excellent questions and deserve careful attention.
First of all, let’s be clear about one thing: No one chooses to be addicted – whether it’s to alcohol or drugs or compulsive behavior. With that out of the way, let’s take a look at how a person might progress from use to abuse to addiction.
Not Everyone Becomes Addicted
While it’s true that there are a lot of people in the United States that are classified as having a substance abuse problem or being dependent on substances – 22 million, in fact, according to the 2009 National Survey on Drug Use and Health (NSDUH) – but that statistic doesn’t mean that each of those estimated individuals is a down-and-out addict. There are many millions who try alcohol or drugs for the first time that do not progress to either problems with the substances or addiction.
So, first thing foremost: not everyone who tries or uses alcohol or drugs will become addicted.
But many will. Let’s look at some contributing factors.
Age at First Use
Research studies show that the earlier a person tries alcohol or drugs for the first time, the more likely they are to experience problems with the substances as adults. Figures published by the Substance Abuse and Mental Health Services Administration (SAMHSA) show that children who drink alcohol before the age of 15 are five times more likely to have problems with alcohol as adults than those who don’t start drinking until after age 21. In fact, alcohol is the number one drug of choice for children and adolescents.
Once use of alcohol has become habitual, individuals may turn to alcohol as a first-line defense against unpleasant feelings, anxiety, stress, and to numb out, fit in with peers, lose inhibitions, and overcome shyness.
Key findings from the 2009 Monitoring the Future Study (//www.monitoringthefuture.org/pubs/monographs/overview2009.pdf) reveal that 72 percent of students have consumed alcohol by the end of high school, and more than a third (37 percent) have done so by the end of 8th grade. In fact, more than half (57 percent) of 12th graders and one-sixth (17 percent) of 8th graders report having been drunk at least once in their life. These trends mirror those with illicit drugs, among which marijuana is the most popular. Other drugs used by adolescents and teens include crack, cocine, ecstasy, heroin, Vicodin, OxyContin, amphetamines, methamphetamines, crystal methamphetamine, tranquilizers, Rohypnol, and ketamine.
Bottom line: if children begin experimenting with and using alcohol or drugs before the age of 15, they are at greater risk for having problems with substances as adults (going from use to abuse to addiction).
Behavior and Personality Factors
Although there are mutiple risk factors which may converge and result in children initiating substance use, behavior and personality factors are often important predictors of later problems. These include:
• Antisocial and other problem behaviors such as conduct disorder, attention deficit hyperactivity disorder (ADHD), and aggressiveness (especially in boys)
• High tolerance of deviance and a strong need for independence
• Rebelliousness and alienation
• Favorable attitudes toward drug use
• High-risk personality factors, including poor impulse control, sensation seeking, and low harm-avoidance
Family Risk Factors
The family dynamic is extremely important in the risk factors for children developing substance abuse later on.
• Family behavior and attitudes toward alcohol and drug use
• Parenting practices and family management: low parental educational aspirations for children, poor discipline (inconsistent, lack of, or excessively harsh), unclear or unrealistic parental expectations for children’s behavior
• Maternal risk factors: low attachment and involvement, use of guilt to control children’s behavior, and cold, unresponsive,
underprotective attitudes on the part of the mother
• Family conflict
• Physical abuse
Environmental and Social Risk Factors
Environmental and contextual factors influencing the risk of substance abuse in children include:
• Influence of the children’s peers – particularly in the early school grades
• Trends in social norms and laws governing substance abuse
• Extreme poverty
• Disorganized neighborhood – high crime rate, deteriorating neighborhood, poor visibility of public places, high mobility, and transience
• Academic failure – especially in elementary grades, increases the risk of substance abuse in adolescence
The single-most protective factor is a strong, cohesive, and loving family structure. Even when children are exposed to some risk factors, most do not go on to become abusers or addicted to substances. Researchers studying the resiliency of children and their families have determined several protective family characteristics that appear to protect children from engaging in substance abuse.
• Individual personality characteristics – including positive disposition or temperament, good social coping skills, belief in self-efficacy and ability to adapt to changing circumstances, and a positive social orientation
• Protective family characteristics – cohesion, warmth, and attachment with one or both parents during childhood, and parental supervision of daily conduct and activities
• Protective environmental factors – including a positive external support system, formal and informal family resources and supports, beliefs, behavioral standards, and norms against substance abuse, and commitment to school and successful school achievement
Addictive Potential of Various Substances
Knowing that the earlier a person begins using alcohol or drugs is a warning sign that they may later experience problems with substances is important to keep in mind. But as already stated, not every child who tries alcohol or drugs will later go on to be an abuser or addicted to them.
Still, some substances have more addictive potential than others. While this is not an all-inclusive list, it is instructive to show that some substances are far more risky (in terms of addictive potential) than others. This is, therefore, a general overview of the addictive potential of certain drugs (both illicit drugs and prescription drugs used nonmedically) and alcohol.
Alcohol – Alcohol use can become abuse and then addiction, depending on various contributing factors. Treatment consists of detoxification, potentially some medication to ease withdrawal symptoms and curb craving, and various behavioral therapies. In addition, participation in 12-step groups is generally a part of the overall treatment plan that continues following successful completion of a treatment program.
Marijuana – In 2008, 25.8 million Americans aged 12 and older had abused marijuana in the past year, making the illegal drug the most commonly abused drug in this country. More than 4 million met the criteria for abuse or addiction. While there are currently no FDA-approved medications to treat marijuana addiction, behavioral therapies have been shown to work.
Cocaine – A powerfully addictive central nervous system stimulant, cocaine may be snorted, injected or smoked. Crack cocaine is usually smoked. Treatment for cocaine/crack cocaine addiction involves behavioral interventions. There are several promising medications for use in treating cocaine addiction that are currently being tested and await FDA approval.
Crystal Meth – Crystal meth is considered to be America’s most dangerous drug by many in the field of law enforcement and substance abuse treatment. Just a single first-time use may result in the person becoming hooked. Beyond the addictive potential, crystal meth is illegal, causes numerous serious psychological and physical conditions that may prove life-threatening (alone or in combination). There is also no FDA-approved medication for treating meth addiction, and treatment requires extensive and long-term cognitive-behavioral therapy.
Heroin – Heroin, including the more potent and black tar heroin, is an illegal and highly addictive drug. It is also the most abused and rapidly acting of the opiates (painkillers). Injected, sniffed/snorted, or smoked, all forms of heroin use are addictive. Treatment for heroin addiction involves detoxification, medication, and counseling.
Tranquilizers – Used to medically treat anxiety and sleep disorders, the nonmedical use of tranquilizers can lead to addiction. Treatment consists of detoxification and behavioral therapies.
Opioids – OxyContin and Vicodin are two of a few opioids that are prescription drugs used nonmedically – and are highly addictive. Opioids may be taken orally, or the pills may be crushed and the powder snorted or injected. Treatment for opioid addiction involves detoxification, possibly medication, and behavioral intervention (counseling). Medications currently used in treating opioid addiction include buprenorphine, methadone, naltrexone, and naloxone. In 2009, nearly one in 10 high school seniors reported nonmedical use of Vidodin, while one in 20 reported abusing OxyContin.
Multiple Addictions Compound the Treatment Process
When individuals progress to the point where they are abusing or addicted to a particular substance, it’s not uncommon for them to have problems with other substances at the same time. Alcoholics may abuse prescription drugs as well as use illicit drugs of varying kinds. Individuals with co-occurring substance abuse and mental health disorder require comprehensive, coordinated, and long-term treatment in order to give them the best opportunity to achieve stable, drug-free lives.
Multiple addictions, and co-occurring substance abuse and mental health disorder basically compound the treatment process. The latest thinking is that a comprehensive, integrated overall treatment plan must be individually created for each patient, and that each disease or disorder should be simultaneously treated, not separately.
In some cases, mental health disorders may be caused or exacerbated by substance abuse. Other times, persons with mental health disorders may turn to using substances as a means of coping with their disorders.
Signs Use is Going Too Far
It’s hard to generalize about all substances – alcohol, drugs of street or prescription drugs used nonmedically – and come to a single conclusion about signs to look for that indicate use is veering into the territory of abuse or on to addiction. There are, however, some overall characteristics or behavior patterns that should cause alarm.
• Increasing frequency of use – The more times an individual resorts to drinking or doing drugs, the more likely a problem is developing. A once-a-week get-together with friends and having a couple of beers is not abuse. But occasional use that becomes daily use may signal trouble brewing.
• Increasing quantities used – Pounding down shots and a beer, taking alcohol in combination with drugs (street or prescription), consuming more substances on a single occasion all point to a growing problem with substance abuse trending toward addiction.
• Secretiveness and lies – When the individual starts becoming secretive about his or her actions, and starts telling elaborate stories or lies to justify behavior, this may indicate there’s a problem with substance use that’s becoming more than just casual.
• Increased aggression – The deeper an individual sinks into substance abuse, the more likely he or she is to display increased aggressiveness toward others, including family members. Family violence, child and sexual abuse are other outward displays of aggression that are characteristic of addiction to substances (although such aggression may also signal a mental health disorder).
• Financial difficulties – Having trouble with finances isn’t limited to problems with substances, but it is another sign that there may be a link between alcohol or drug use and money. Financial difficulties are often prevalent with process addictions such as compulsive gambling, compulsive sex – but also occur when the individual starts laying out increasing amounts of money to finance his or her drug habit.
• Loss of interest in normal activities – When a person is becoming abusive or or dependent on substances, there’s a tendency to lose interest in activities that used to be considered enjoyable. The individual’s sole pursuit seems to be drug-seeking behavior. All he or she thinks about is getting the drug, using the drug, coming down from the drug, and using the drug again. This takes a toll on everyone concerned, especially family.
• Missing work or losing employment – The more an individual is consumed with drug-seeking behavior, the more likely that employment problems will start occurring. Missing work is usually the first sign, as hangovers or inability to function due to drug withdrawal causes loss of interest in tending to work-related responsibilities. Over time, chronic work absences may result in demotion, loss of promotion, or suspension. Showing up for work impaired (drunk, high, unable to function) may result in the individual being fired.
• Isolation from family members – When the person becomes all-consumed in drug-seeking behavior, he or she withdraws from other family members. There may be a gradual period of distancing, followed by distinct separation from family-related activities.
In the end, the best defense against progression from use to abuse to addiction is to exercise moderation in any alcohol consumption, careful monitoring of any required prescription use, and complete abstinence from all illicit drug use.
If there is a problem that develops, seek help to overcome it. This may be as simple as talking with a family doctor, or attending 12-step groups, or may involve going into a treatment facility for a formal alcohol or drug rehab program.
In any case, healing from substance abuse or addiction doesn’t occur alone. Strong support networks, in addition to counseling, are the key to an effective and sustained long-term recovery. Family and 12-step groups are the two most important elements of a strong support network.
Overcoming substance abuse and addiction take time. It’s not an easy process, and it requires total commitment on the part of the individual in order to achieve lasting success: sobriety.
Once an individual makes the transition from use to abuse to addiction, it’s only when he or she acknowledges that there is a problem and commits to doing everything possible to overcome it that sobriety can be achieved. While there is no cure for addiction, the disease can be managed. Individuals are not defined by their addiction. In the end, they choose the life they wish to live.