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Understanding Substance Abuse

The substance-related disorder is characterized by taking an increased amount of drugs to overcome a growing tolerance and withdrawal symptoms the individual endures without a constant supply of drugs. In DSM-5, substance-related disorders include problems with the use of depressants (like alcohol, barbiturates and benzodiazepines), stimulants (like amphetamines, cocaine, nicotine and caffeine), opiates (like heroin, codeine and morphine) and hallucinogens (like cannabis and LSD).

Once a drug is taken, an individual needs an increased amount of drug to overcome their tolerance and intense cravings (withdrawal symptoms). It is difficult for them to part with the use of the drug even though it causes harm to them. The cravings overpower the desire to stop.

 

DSM 5 CRITERIA

Each drug has its own DSM criteria for diagnosis for particular drug abuse but substance use disorders span a wide variety of problems arising from substance use and cover 11 different criteria:

1. Taking the substance in larger amounts or for longer than you meant to

2. Wanting to cut down or stop using the substance but not managing to

3. Spending a lot of time getting, using, or recovering from use of the substance

4. Cravings and urges to use the substance

5. Not managing to do what you should at work, home or school, because of substance use

6. Continuing to use, even when it causes problems in relationships

7. Giving up important social, occupational or recreational activities because of substance use

8. Using substances again and again, even when it puts you in danger

9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance

10. Needing more of the substance to get the effect you want (tolerance)

11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.


The DSM-V allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified:

  • MILD: Two or three symptoms indicate a mild substance use disorder.

  • MODERATE: Four or five symptoms indicate a moderate substance use disorder.

  • SEVERE: Six or more symptoms indicate a severe substance use disorder.

 

CAUSES

1. Biological Influence:

Genetic factors may influence how people experience drugs. Many types of research have indicated that certain individuals have genetic vulnerability for drug abuse and also having a history of drug abuse in the family can contribute to the development of addiction. Neurotransmitters like dopamine, serotonin and norepinephrine which are involved in the brain’s reward system play are major role here.


2. Psychological influences

Personality factors like impulsivity and sensation seeking have been linked to substance use and gambling disorders. Early exposure to the significant adverse experience of trauma can contribute to the development of substance use disorder by influencing the coping ability of an individual. Other mental health conditions such as depression, anxiety, attention deficit disorder, and post-traumatic stress disorder can increase the risk of substance use.


3. Socio-cultural influences

Dysfunctional family settings especially parental alcohol and drug problems and parental abuse or neglect of children can contribute to the development of drug abuse problem. Social pressure to engage in risk-taking behaviours including substance use to be included in a group especially in teenagers and having stressful jobs can a lead to individuals turning towards the use of a substance to cope with the pressure. Also norms and religious beliefs that govern the use of alcohol and drugs and ethnic variations the body’s rate and efficiency of metabolizing drugs and alcohol play a role in the development of the disorder

 

STEPS IN SUBSTANCE ABUSE

1. Experimentation

Exposure to potentially addictive drugs and curiosity to explore them

2. Regular use

Regular use of drugs and starts affecting life activities

3. Risky use

 impairs the functioning of the individual in and people may acknowledge that drugs or alcohol are beginning to affect their lives, they may hesitate to decrease their substance consumption or to get them help.

4. Dependence

Serious impairment of the functioning of the individual. people will continue to drink and use drugs regardless of the impact on their health, job, friends or anything else.

5. Addiction

A change in the chemical makeup of the individual’s brain and will have intense cravings for drugs or alcohol and they will act on these cravings until they go away.

 

TREATMENT

No single treatment is appropriate for all individual. The treatment plan should be continuously assessed and evaluated to meet the changing needs of the individual.

1. Medications prescribed by the psychiatrist should be taken.

2. Anonymous programme: Attending the 12 step programme for quitting alcohol or nicotine which provides a safe space for the patients to heal.

3. Psychological counselling is done with therapies like Cognitive Behavior Therapy and Motivational Enhancement Therapy to motivate the clients to meet their goals. Aversive therapies are also used to induce negative feelings towards the drug.

4. In-patient facilities in rehabilitation centres and hospitals cater to the needs of the individual

5. Having social support is crucial for the recovery of the individual. They also act as a protective factor for relapse.

6. Engaging in relaxation techniques and positive self-talk helps in the process of recovery.

 

PREVENTION

Education and community-based approaches can be used effectively to target the population about the effects of drugs. These programs can be conducted as school workshops or can be done at the community level as campaigns.
Relapse can be prevented by sticking to the treatment plan designed by the professional and avoiding high-risk situations. Reach out to your doctor in case repeat of drug use.

 

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Delhi, India

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