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There's only one corner of the
universe you can be certain of improving, and that's your own self.-
Aldous Huxley
No one ever sets out to become a substance abuser. As in most things
in life, substance abuse is a process and not an event. In keeping with this line of thought, the reasons why people become
dependent on substances remain unclear. Some people begin to use substance at an early age and over time increase their reliance
on chemicals to deal with the stresses of living. Others turn to substances after some type trauma, while others slowly become
dependent on prescription medications such as vicodin, oxycontin or benzodiazepines such as ativan or klonipin. Chemical
dependency does not discriminate based on age, race, gender, gender identity, ethnicity, sexual orientation or socioeconomic
status.
Chemical
dependency and substance abuse do appear to cluster in families. It is not uncommon for an individual struggling with chemical
dependency to report that parents, grandparents, siblings and other family members also have substantial histories of substance
abuse. It is also not uncommon to find other compulsive, or addictive, behaviors within these family systems such as sexual
compulsivity, compulsive gambling, eating disorders and other out of control behaviors. While there is research suggesting
a genetic predisposition towards the development of chemical dependency, the genetic predisposition model does not adequately
explain why some individuals born into families in which substance abuse is an issue do not become substance abusers or chemically
dependent.
The
model, which, at this time, best accounts for the development of substance abuse and chemical dependency is an integrated
transtheoretical framework, referred to as the biopsychosocial theory. This model posits that chemical dependency evolves
from the interaction of ones biology, genetics and psychology as well as the influence of environment and social learning.
The complexity of this model reinforces the perspective that substance abuse and chemical dependency, in addition to other
behavioral compulsions, are complex, multidimensional phenomena that are only partially understood. With this acknowledgement,
the information presented here represents a reductionist sketch of the process that leads to substance abuse and chemical
dependency.
Stage
1: Learning / Experimental Use • The
user learns they can produce a good feeling by using substances. • The
individual uses at parties, under peer pressure, or on weekends. • He
/ she finds it easy to get drunk or high, due to a lack of tolerance for the substance. • The user learns that substances provide a reliable alteration in mood and perception
resulting in euphoria and trusting the outcome of using.• The user begins to control their use of
the substance, learning to regulate the frequency and quantity of the substance to control the mood swing.• The
user feels good, with few consequences. • No
adverse behavioral effects may be present as the user is in the early stages of developing a relationship with substances.
Stage 2: Social Use and Alteration of mood and emotions • The user starts to actively seek an alteration
in mood through the planned use of drugs and alcohol.• Planned use results in buying substances –
the first investment of resources towards securing access to the drugs and alcohol.• Tolerance begins
to develop; the user needs more of the drug to get the same effect as before. • Individuals begin using at inappropriate times and places. • Individual develops self-imposed rules about use; e.g.,
"I won't drink before 5:00 p.m.," "I won't drink around my family," etc. • Problems may begin to manifest in the users life such as
spouse, friends and family sharing concerns about their loved ones use of substances, blackouts, or lapses in memory due to
substance use, begin to occur, work and school commitments may begin to suffer, broken promises, etc.• The
individual may begin to experience periods of binge use and long periods of abstinence. • At this point the individual has progressed from the realm of substance use
to substance abuse. For some individuals these complaints and concerns are enough for them to cut back on their ruse of substances
and return to a moderate form of use. For others, this begins the process of chemical dependency.
Stage
3: Substance Abuse becomes Chemical Dependency • The
individual becomes preoccupied with the mood swing. • Periods
of binge use and abstinence from the substance become shorter in duration.• The individual may become
sneaky about getting, using, and hiding substances.• The individual begins to dedicate greater financial
resources towards substances due to an increasing tolerance for the substances used.• There is an
increase in the frequency and quantity of substance use. • Solitary
use occurs. • The individual
uses to cope with feelings, such as anger, guilt, fear, or anxiety. • Loss
of control occurs, getting drunk when not expecting to, using more than planned, breaking self-imposed rules, inability to
predict the outcome of using. • Lifestyle
changes begin to occur, Individual rearranges life so he/she can continue to use, begins to associate with others who are
also abusing substances, begins to spend greater amounts of time in locations where the substances are used, the individuals
quality of life begins to deteriorate.• Blackouts occur more frequently.• The
individual may be irritable, or may become angry easily.• Rationalization and projection occur more
frequently. ("Rationalization" is a person's attempt to explain his/her behavior in order to avoid responsibility.
"Projection" is attributing one's problems to another person.) • The individual violates his/her value system, which contributes to emotional
distress. • The individual experiences
many consequences, such as deterioration of relationships, financial difficulties, etc. • Denial continues to grow.• The individual gives up
important activities. • Self-esteem
decreases. • The individual's
health begins to deteriorate.
Stage 4: Chronic Chemical Dependency - Substances Used to Feel Normal • Individual uses substance to feel “normal”
and avoid pain, physical withdrawal and emotional pain of recognizing the reality of his / her situation, rather than for
achieving euphoria. • Blackouts
are longer and more frequent. • The
desire to use the substance becomes central in ones life. • The
individual experiences complete loss of control; e.g., arrests, theft, prostitution, etc. • The individual experiences physical problems. • The individual experiences paranoid thinking and fear of
insanity. • The individual feels
isolated, and, due to his / her behaviors may no longer be welcomed to spend time with family and friends while using. • The individual feels a loss of
desire to live and may begin to present with suicidal thoughts and attempts.
Treatment options.Developing
a treatment strategy for substance abuse requires a thorough assessment. Treatment options may include a variety of psychotherapies
including individual family and couples work, referral to a 12 step program such Alcoholic Anonymous or a similar self help
group to compliment the work you are doing in psychotherapy. In some situations, a referral to a psychiatrist for a medication
consult may also be beneficial. If one is truly chemically dependent, one may need to be admitted to an inpatient facility
for medical detoxification, especially in the case of alcohol and some prescription medications that, if discontinued abruptly,
can result in serious medical complications and death.
If you have any questions
about this information please feel free to contact me at 617-461-8479, or you may e-mail me at; josephwinnlicsw@josephwinnlicsw.com.
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