Impact of Addictions
Robbyn R. Wallace
Foundations of Addiction & Addictive Behaviors
October 30, 20016
Impact of Alcohol
Identifying a drinker may appear simple when signs—such as slurred speech, uncoordinated movements, lowered inhibitions, even alcohol breath—are recognizable, but identifying a deeper addiction may not be as simple. It is not uncommon for alcoholics to hide obvious symptoms of the addiction for long periods of time, and equally common for the addict and surrounding people to ignore the addiction—state of denial. Of course, alcoholism is the most severe form of problematic drinking, involving not only all symptoms of alcohol use disorder (AUD) but also involving physical dependence. Reliance on alcohol to function or experiencing physical compulsion to drink strongly suggest alcoholism/alcohol addiction.
Addiction involves more than simply stereotyping disease conceptions of alcoholism or the inherent addictive quality of narcotics cast upon anyone who might use alcohol/substance. This is highly contingent upon prevailing societal views—i.e. The evolution of marijuana from a spiritual tool to a recreational substance to a substance with tremendous medicinal potential; as studies continue to confirm the medicinal value and low risk to well being, society will continuously become more accepting of its use—even as a recreational activity. The removal of the legal problems in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; APA, 2013) appears to indicate a cultural shift away from criminalizing substance users, revealing a progressive susceptibility to social and political influences (Robinson & Adinoff, 2016). Substance/alcohol use has become less of a taboo subject. Biological, cognitive, behavioral, psychological and sociocultural factors are all thought to play a role in the development of alcohol dependence (Lewis, 2014). Similar styles of alcohol usage and/or dependence is commonly found to exist within the same nuclear family—many times generational—however, it should be noted that other behaviors or traits run in families that may have little or no biological basis. The contribution of genetic and other biological factors to susceptibility in the development of AUD appears significant.
According to Garland and Pettus-Davis (2012), adolescents with extensive trauma histories tend to engage in more extreme patterns of substance misuse than do adolescents with minimal or no exposure to trauma, which may also account for more severe psychiatric symptoms (Garland & Pettus-Davis, 2012). Many times individuals with trauma history's attempt to self-medicate their consequential psychological distress. Out of a reportedly 176.6 million alcohol users in 2014, only an estimated 17 million have AUD (SAMHSA, 2016). It is not uncommon for drinking to begin at an early age as evidenced in self-report data. There are differing levels of drinking such as; (a) moderate drinking—up to one drink each day for women and two for men, (b) binge drinking—five or more drinks per occasion, blood alcohol concentrations (BAC) greater than 0.08 g/dL, at least one day per last 30 days, (c) heavy drinking—five or more drinks on same occasion five or more days within last 30 days (SAMHSA, 2016). Heavy or excessive drinking leads to greater risk of development of AUD as well as other health and safety concerns.
Impact of History upon Addiction Theory and Treatment
All throughout history ways to alter consciousness, to include perceptions of one’s sensate body, has been sought by humans through taking herbs, drugs or psychoactive substances—including alcohol. These practices have led to many impressive, important contributions to culture and in the field of science. Not only do these practices have historical relevance but some continue to have present value, some herbs/substances are used as a spiritual tool. Addiction theories integrate to provide complimentary theoretical synthesis for a more holistic perspective and cover the following domains; (a) genetic theories—inherited mechanisms causing or predisposing individuals to addiction, (b) metabolic theories—biological, neuroscience and cellular adaptation to chronic exposure of substance/alcohol, (c) conditioning theories—cumulative reinforcement of drug/alcohol or other associated activities, (d) adaptation theories—exploration of psychological and social functions enacted by drug effects. Theories create a frame in which to understand addiction, construct proper assessment and conduct appropriate treatment.
The ever-changing historical and cultural milieu influence the prevailing legal, moral, and medical and mental health conceptualizations of substance use. The history of a disorder, if understood, provides critical information needed to assess and treat—including preventive strategies—alcohol use disorder (AUD). AUD ranges, on broad continuum, from occasional problematic overuse to chronic, progressive alcohol dependence. Clinically, AUD is qualified based on standardized criteria—abuse vs. dependence—and range in frequency, severity, and symptoms. Having an awareness of the history of AUD is helpful in risk assessment and building an evidence-based treatment plan with effective strategies personalized to individual and social contextual considerations.
When comorbidity between alcohol use disorder and other mental disorders occurs, it does not equate a causal relationship irregardless of one appearing first. Alcohol abuse may lead to experiences of one or more symptoms from another mental disorder—for example, there is an increased risk for psychosis in marijuana abusers. There is a reciprocal vulnerability that having a mental disorder could lead to substance/drug abuse, such as the use of tobacco as means to lessen mental distress and improve cognition in a client with schizophrenia. When factors—such as genetic vulnerabilities, underlying neurological deficits, and/or early exposure to stress or trauma—overlap, it can cause substance use disorders and other mental disorders (NIH, 2016). The underlying role of psychopathology in the onset and maintenance of addiction is the therapeutic focus, from a psychological theoretical perspective.
There is a high prevalence of substance abuse/dependency among individuals with mood and anxiety disorders, also there is an even higher prevalence of mental disorders among patients with drug use disorders (NIH, 2016). Environment influences complex gene interaction involving multiple genes, such as protein influence response to substance—experience is pleasing or not—as well as determining duration substance remains in the body. Genes indirectly alter the stress response system, also responsible for increasing the presence of risk-taking/novelty-seeking behaviors, and can influence development of AUD and other mental disorders. The way stress increases vulnerability to addiction is explained by dopamine pathways, which indicates use of medications that directly target dopamine regulation. Stress is thought to increase susceptibility to addiction as well as other mental disorders, likely sharing a common neurobiological link between addiction and other mental disorders.
Changes in the brain are involved in both substance use disorders and other mental disorders and because of the overlap of brain areas involved one (substance or mental) disorder is thought to affect other disorder(s) (mental or substance). In other words, substance abuse that precedes initial symptoms of mental illness are thought to produce changes in brain structure and subsequently function that modify gene expression. However, vice-versa associated brain activity changes are thought to increase the vulnerability to substance abuse—due to enhancement of positive effects, reduction in awareness of negative effects, or the alleviation of unpleasant effects (NIH, 2016).
DSM-5 Criteria and Severity
Although humans have a lengthy and complex relationship with substances throughout history, the mental health involvement, with addiction to help regulate the extremes associated with excessive use of substances, is a more recent part of human history. The DSM, considered the official nosology of the American mental health system, evolved from psychoanalytic roots in effort to develop a unified nosology. The DSM-III achieved significant advancements, guided by atheoretical, consensus-based diagnostic entities, in diagnostic reliability and validity—supportive to the scientific development of the mental health field (Robinson & Adinoff, 2016, p. 18). However, currently it is assumed that clinicians are able to conceptualize in much more diverse ways such as an integration of of theories in effort of a more three dimensional vantage, in ways that provide opportunity to conceptualize data from theoretical frameworks—such as biopsychosocial, providing opportunities to incorporate more personalized evidence-based strategies into treatment plans. Clinicians retain perspectives from accumulated personal experience and education, creating unique conceptualizations of causal etiology of AUD.
The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met within a 12-month period (APA, 2013). AUD diagnostic criteria include loss of control over consumption, continued alcohol use despite harmful consequences, tolerance buildup, drinking leading to risky situations, or withdrawal symptoms developing. When excessive recurrent alcohol use begins to cause clinically and functionally significant impairment—e.g., medical issues, disability, and failure to accomplish important responsibilities at home, work or school—substance use disorder is indicated and is evidenced by risky use, social impairment, impaired control, and pharmacological criteria (APA, 2013). AUD is one of the most common of the substance use disorders; excessive use increases the risk of the development of serious health issues including the issues associated with intoxication behaviors and withdrawal.
Addiction should not be automatically assumed without appropriate assessment; instead, it should cue therapist to conduct an alcohol risk assessment—such as the Alcohol Use Disorders Identification Test (AUDIT; AUDIT, 2010)—aimed at recognizing or confirming diagnosis. The AUDIT (2010) is a 10-item screening tool, developed by the World Health Organization (WHO), and is used to assess alcohol consumption, drinking behaviors, and alcohol-related problems. Scores of 8 or more indicates hazardous or harmful alcohol use. The AUDIT demonstrates standards across genders and wide spectrum of racial/ethnical groups, making it clinically relevant for diverse populations.
Social and Cultural Issues
The struggle to restrict usage within acceptable social limits leads to the aberration of addiction. This usually takes place overtime, leading to desensitization—tolerance is built. Initially, use may be enjoyed in a recreational type way, like when an individual gets into the habit of having a drink daily to relieve work-day stress or when an individual uses cocaine as a way of staying up late to study for exams. Although some may be able to continue occasional usage, other do not possess such capacity for casual use. Addiction can be gradual for some and abruptly for others, as the use increases, more time, energy and attention is devoted to thinking about getting intoxicated/high, purchasing substance/drug, preparation and active use increases until it is primary focus in the individuals life. At this point other responsibilities, such as employment, familial and peer relationships, and community obligations, began to deteriorate.
Legal and Social Consequences
The misuse of alcohol can be not only harmful to the user, it affects others and can have a negative impact on relationships as well as society—such as decreased productivity at work, increase in accidental injuries, aggressive behavior toward others, or child and/or spousal abuse. Alcohol cost the United States of America approximately 224 billion dollars annually, including health care costs, crime, and lost work productivity (NIH, 2016). The legal consequences, such as with a driving under the influence (DUI) conviction, can become costly and time consuming as well as interfere with normal routines. It become even more complicated for someone struggling with AUD when they get their second, third, perhaps even fourth DUI and face a felony conviction. Or perhaps, any number of crimes that can be easily committed when some people are intoxicated depending on the level of intoxication.
A biopsychosocial perspective (Buckner, Heimberg, Ecker & Vinci, 2013) on alcohol use disorders with consideration to a lifespan, person-in-environment perspective, the reciprocal nature of the individual and the social context influence the creation and maintenance of the alcohol use disorders. With marijuana, the medicinal value is worthy of reconsideration as social perception changes given evidence of medicinal value. Steve Jobs—e.g., Apple—once stated, in an interview (Fink & Segall, 2015), that doing LSD/acid/hallucinogen—when he was younger and before his success—was one of the best decisions he had ever made, and furthermore, he contributes much of his success to such experiences. In order to understand and effectively treat someone with AUD, the impact of the family should be considered (AAMFT, 2016; Lander, Howsare & Byrne, 2013). There is a reciprocal relationship between the addiction process and environment, just as people influencing their social environment and in turn are influenced by the social environment.
References
Alcohol Use Disorder Identification Tool (AUDIT). (2010). Retrieved from: https://www.drugabuse.gov/sites/default/files/files/AUDIT.pdf
American Association of Marriage and Family Therapy (AAMFT): Substance Abuse and Intimate Relationships. (2016). Retrieved from: https://www.aamft.org/imis15/AAMFT/Content/Consumer_Updates/Substance_Abuse_and_Intimate_Relationships.aspx
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Buckner, J. D., Heimberg, R. G., Ecker, A. H., & Vinci, C. (2013). A biopsychosocial model of social anxiety and substance use. Depression & Anxiety (1091-4269), 30(3), 276-284. doi:10.1002/da.22032
Fink, E. & Segall, L. (2015). CNN Money: I did LSD with Steve Jobs. Retrieved from: http://money.cnn.com/2015/01/25/technology/kottke-lsd-steve-jobs/
Garland, E. L. & Pettus-Davis, C. (2012). Self-medication among traumatized youth: Structural equation modeling of pathways between trauma history, substance misuse, and psychological distress. Journal of Behavioral Medicine, 36, 175–185. DOI 10.1007/s10865-012-9413-5.
Lander, L., Howsare, J. & Byrne, M. (2013). The Impact of Substance Use Disorders on Families and Children: From Theory to Practice. Social Work Public Health, 28(0), 194–205. doi:10.1080/19371918.2013.759005
Lewis, T. F. (2014). Substance abuse and addiction treatment: Practical application of counseling theory. Upper Saddle River, NJ: Pearson
National Institute on Drug Abuse: Advancing Addiction Science (NIH). (2016). Retrieved from: https://www.drugabuse.gov/ebook/azw/1155
Robinson, S. M., & Adinoff, B. (2016). The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations. Behavioral Sciences (2076-328X), 6(3), 1-23. doi:10.3390/bs6030018
Substance Abuse and Mental Health Services Administration (SAMHSA): Substance Use Disorders. (2016). Retrieved from: http://www.samhsa.gov/disorders/substance-use
