SUBSTANCE-RELATED DISORDERS

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What constitutes substance addiction?

Addiction involves compulsive substance-seeking behaviour and a loss of control over substance use. Once addiction develops, it is very challenging to quit, not only because of the pleasurable feelings associated with the use but also because of the withdrawal symptoms. Withdrawal symptoms involve negative physiological effects (shaking, headaches) and negative psychological effects (irritability, emotional distress) that occur as soon as use of the substance is discontinued (Sue et al. 2016). The use of substances (drugs and/or alcohol) is considered a disorder when there is a maladaptive pattern of consistent use over a 12-month period, and the person is unable to cease or even reduce the use of the substance even though the person has experienced occupational, social, medical, psychological and/or safety and security problems.

What is the difference between substance abuse and substance dependency?

Substance abuse and substance dependency are often used interchangeably, however, they are two different conditions. Substance abuse is considered a modest or early stage of substance addiction that leads to dependence. Substance abuse is marked by a pattern of alcohol or drug use that produces negative consequences such as problems with employment, negatively impacts relationships with family and/or friends and may even introduce dangerous or life-threatening situations, such as driving intoxicated. Dependence is thought to be a more severe problem than substance abuse. Dependence is a mental and physical reliance on substances (drugs or alcohol). Withdrawal occurs when the chronic use of a substance results in physiological dependence whereby our bodies adapt and we need the substance to feel normal. So when we are accustomed to using a substance regularly, and we suddenly stop, we will experience adverse physical symptoms. Different substances will produce different withdrawal symptoms, and the experience of these negative withdrawal symptoms is an indication of substance dependence. Tolerance of a substance involves a decrease in the effectiveness or desired effect that occurs after chronic use, which in turn makes the person feel the need to consume more of the substance. The Diagnostic Statistics Manual (DSM-5) incorporates all of these variables into the criteria in order for clinicians to diagnose substance-use disorder.

Substances associated with Abuse and Dependency

Many people often use chemical substances that alter their level of consciousness, mood and /or behaviour. Examples include but are not limited to:

  • Alcohol
  • Marijuana
  • Prescription Medications
  • Cocaine
  • Opioids
  • Opiates
  • Hallucinogens
  • Inhalants
  • Methamphetamine

Signs associated with Substance-Related Disorders

Substance-Use Disorder is a medical term for drug or alcohol misuse that continues even after severe issues have arisen due to its use. Signs can include:

  • Pattern of problem behaviours or psychological changes associated with use or abuse of a substance;
  • A strong desire or craving for the substance is present;
  • Substance use interferes with major role obligations, i.e. home, work, school;
  • Higher tolerance for the substance;
  • Increased doses of the substance needed to achieve the desired effect;
  • Withdrawal symptoms when not using the substance;
  • Withdrawal from social and daily activities;
  • Continued use of the substance despite the awareness of its negative impact

There are also numerous behavioural and physical indications of substance-use disorders. Behavioural symptoms can include:

  • Lethargy
  • Depression
  • Anxiety
  • Personality changes
  • Social changes
  • Habit changes
  • Criminality or delinquency
  • Aggression
  • Irritability

Physical signs can include:

  • Bloodshot eyes
  • Dilated pupils
  • Rapid weight gain or weight loss
  • Dental changes
  • Skin changes
  • Insomnia
  • Changes in sleeping patterns
  • Hygiene changes
  • Muscle weakness
  • Body aches
  • Sweating
  • Nausea and vomiting

How are Substance-Use Disorders treated?

Treatment and supportive intervention takes place in a variety of settings and can include a combination of medication and a host of different psychotherapeutic approaches. The settings can include self-help groups, mental health care clinics and inpatient or outpatient drug and alcohol treatment centres. A multi-disciplinary and integrated care approach that addresses underlying emotional difficulties improves the treatment outcome (Kuehn, 2010).

1When do Substance-Use Disorders typically begin?
Today, many consume vast amounts of alcohol, tobacco, prescription medication, and illegal drugs (Sue etc. al., 2016). In 2012, an estimated 22.5 million adolescents and adults met the criteria for substance use disorder. During this study, it was found that alcohol was the most abused substance. Marijuana is the most frequently abused drug, followed by pain relievers and cocaine (SSMHSA, 2013a). Substance abuse is twice as prevalent in males, although abuse rates are almost equal for females and males aged 12-17. Substance dependency can thus occur at any point in life, it can start in early adolescence or during middle adulthood.
2Are Substance-Use Disorders caused by genetics?
Genetic factors play an important role in the development of substance-use disorders. There is strong evidence that substance abuse runs in families based on analyses of family patterns of addiction and twin studies (Edenberg, 2012). Kendler and Prescott (2006), using data from more than 4500 pairs of identical and fraternal twins to isolate genetic and environmental factors involved in substance abuse, concluded the following:
1. Genetic factors accounted for 56% of risk of alcohol dependents and 55% of the risk of nicotine dependence.
2. Genetic factors accounted for 75% of the risk of illicit drug abuse, with cannabis dependence having the strongest genetic risk.
Although research findings support the importance of heredity in the etiology of substance use, the manner by which specific genes or gene combinations influence addiction is complicated. For example, genetics can influence personality traits such as risk-taking, impulsivity and sensation-seeking that increase the likelihood that someone will experiment with alcohol or drugs as well as protective qualities, such as self-control (Kendler and Prescott, 2006). Evidence has indicated that genes affect individual responses to specific drugs and risk of drug dependence. For example, one person may be susceptible to alcoholism whilst another has a genetic risk of marijuana dependence. Moreover, some gene combinations produce risk of addiction to multiple substances (Agrawal et al., 2012).
3Is there a difference between substance addiction and substance dependence?
Both addiction and dependence are measured on a larger scale of substance use disorders. When a person develops an addiction to alcohol or drugs, abusing these substances becomes the person's main priority. Despite the harm that long-term substance abuse can cause, individuals are unable to control their use when they have reached the point of addiction. In relation to the topic of addiction, dependence can be both physical and mental and refers to the use of a substance as a condition response to a certain feeling or event, also known as “triggers”. Triggers can be anything from driving to stress which can set off the desire to drink alcohol or use drugs. Dependence can also be characterised as the body's adaptation to the substance, its increasing need for more of the substance, i.e. tolerance and the presence of symptoms if the substance is stopped suddenly, i.e. withdrawal. In conclusion, the main difference between addiction and dependence is that addiction refers to the compulsive and uncontrollable need for the substance, while dependence refers to the growing mental and physical tolerance or “attachment” to the drug or substance the person has developed over time.

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