Understanding Drug Abuse and Addiction (and How to Go Clean)

Drug abuse disorder is a serious condition that negatively affects patients’ lives. Drug abuse disorder patients can potentially harm themselves or those around them because of the effects of a substance. This potential harm is not only violence-related. It also includes damage to their career, relationships, and other similar aspects. While treatments exist for drug abuse disorder, the variety of addictive substances can require specific methods for treating patients. This makes drug abuse disorder a complex issue, varying from one patient to another. This sample essay will discuss how drug abuse disorder manifests, affects patients, and how these patients can go clean.

Defining Drug Abuse Disorder

Drug abuse disorder or DAD is excessive drug use that turns the patient into a substance-dependent individual. The Johns Hopkins Medicine website (n.d.) defined the disorder as a behavioral pattern where substance use causes problems in a patient’s life. Drug abuse disorder can lead patients to become a burden to their family and social groups, as well as increase the risk of other problems (Grant et al., 2016). For instance, excessive drug use may be preventing an individual from going out and attending to their professional responsibilities. The substances of abuse can either be legal drugs, such as nicotine and prescription medicines, or illegal substances, such as marijuana and methamphetamine. As long as a substance has an addictive characteristic, it can become a substance of abuse and cause a user to develop a drug abuse disorder.

Since different substances have varying addictive qualities, patients can develop drug abuse disorders differently. Alcohol users may take longer to develop disruptive behavioral patterns while methamphetamine users can become addicted quickly because of the high-addiction risk of the substance. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (2013) categorized substance use disorder as a spectrum disorder (cited in Koob, 2021). They identified four levels; beneficial use, casual/low-risk use, high-risk/harmful use, and chronic dependence/substance use disorder (Spectrum of Substance Use, 2019). The leftmost side of the spectrum is "beneficial use" which pertains to healthy substance use, such as medication for mental illnesses. On the opposite side of the spectrum is "chronic dependence/substance use disorder" which refers to compulsive drug use, leading to negative effects. Patients can enter the spectrum at different levels, depending on the substance of abuse and other external factors, such as existing mental illnesses.

Causes of DAD

Similar to other behavioral problems, drug abuse disorder has various causes . According to Jahan & Burgess (2020), the causes include psychological, biological, sociocultural, and environmental factors. Psychological factors include existing psychiatric disorders that may stem from other factors, such as biological and social. For instance, ADHD patients have an increased risk of drug abuse disorder because of their condition (Jahan & Burgess, 2020). The behavioral pattern from their condition may instigate the abusive use of substances. This makes them susceptible to the dangers of DAD, especially when family members or friends fail to notice the behavior.

Aside from genetic factors, psychological factors include traumatic events that can cause DAD. Traumatic events include violent experiences, such as assaults, and societal crises, such as the COVID-19 pandemic. Studies have shown that the recent pandemic has led DAD patients to increase their drug use, shift to another substance, and experience relapse. For non-DAD patients, the feeling of fear, uncertainty, and anxiety due to the pandemic has led to the development of mental illnesses, such as DAD (cited in Chiappini et al., 2020). This also showed that multifactorial causes of DAD as one factor can become a cause for another, leading to the increased risk of the disorder.

Studies have also shown that drug abuse disorder can manifest more in certain groups. Grant et al. (2016) found that Caucasians, Native Americans, men, single young individuals, divorced adults, lower-educated individuals, lower-income individuals, western-U.S. citizens, and disabled individuals had higher risks of drug abuse disorder. This trend can be due to various factors, such as mental conditions and the successful  legalization of marijuana in Western U.S. states. For the case of disabled individuals, the co-morbidity factor explains the trend as they have a significant risk of DAD compared to the general population. The study showed that DAD affects a specific demographic, providing insight into the psychological and environmental conditions of these groups and how they may result in the development of disruptive behavioral patterns.

Diagnosing DAD

As mentioned earlier, DAD involves substance abuse along with disruptions in a patient’s life. However, recognizing this pattern is only one step in the diagnostic process. Jahan & Burgess (2020) stated that patients must undergo historical and physical assessments, laboratory tests, and the DSM-5 test. The historical and physical assessments are standard procedures to get an understanding of the patient’s overall condition. Laboratory tests, which include blood alcohol level and urine drug screen, complete blood count, liver function test, hepatitis panel, and pancreatic enzyme serum level test, help determine if a patient’s body contains an unhealthy amount of addictive chemicals. These tests are necessary to ensure that a patient’s behavior is related to drug abuse and not other illnesses.

Finally, the DSM-5 test aims to determine the substance of abuse for a DAD patient. The test involves 11 criteria pertaining to behaviors that a patient may have developed over 12 months (Jahan & Burgess, 2020). Most of the criteria involve behavioral descriptions regarding a patient’s intent, substance amount taken, and response relating to the use of a substance or lack of access to it. When a patient meets at least two criteria, physicians can identify the substance of abuse. For instance, a patient may meet the criteria for continued use of heroin despite social and occupational impairment and withdrawal symptoms after discontinued use of the substance. These two criteria, out of the 11, are enough for physicians to determine that the patient is addicted to heroin.

How Patients Can Go Clean

Once physicians diagnosed a patient, they can proceed with treatments for drug abuse disorder. However, treating DAD is a complex process since each type of addiction responds to different treatments. The National Institute on Drug Abuse (2019) even stated that there is no single treatment for drug abuse disorder patients. As such, the American Society of Addiction Medicine created a set of criteria to help physicians provide the correct treatment for each patient. The criteria involve current mental health, medical history, willingness to change, intoxication/withdrawal potential, relapse potential, and living situation (Williams et al., 2016, cited in Jahan & Burgess, 2020). Attending physicians will have to assess a patient and place them into programs based on their criteria placement.

Despite the complex process, most treatments for DAD include behavioral counseling, medication, medical applications use, and treatment of co-occurring mental health problems (Treatment Approaches, 2019). Behavioral counseling involves the modification of patient behaviors either through outpatient or inpatient behavioral treatment. In outpatient behavioral treatment, patients will undergo multiple therapy sessions which decrease in quantity as their recovery improves. In inpatient behavioral treatment, patients remain in medical facilities. This type of behavioral counseling is mostly for severe cases where patients have become a threat to themselves and those around them (Miller, 2022). They may be exhibiting violent behaviors due to withdrawal or in a state where they cannot function properly without medical supervision. Still, this type of counseling aims to provide therapy, mostly in the form of community-based therapies, to help patients overcome their addictions.

Other than therapies, medications are effective for treating drug abuse disorders. The type of medication that a patient will take will depend on the substance of abuse and their current medical condition. Methadone, naltrexone, and buprenorphine are effective medications for opioid addiction while acamprosate and disulfiram are effective for alcohol addiction (Treatment Approach, 2019). Other medications can help suppress withdrawal symptoms and detoxify a patient’s body. There are also innovative medication methods, such as the FDA-approved reSET®, a mobile application that aids in behavioral therapy. Patients can use them in conjunction with medications, such as buprenorphine. Finally, there is Koob’s (2021) research regarding the use of medications and therapies to reset a DAD patient’s brain. Koob (2021) focused on the concept of hyperkatifeia, or the negative emotional response to withdrawal, and how medications can reverse the response. However, the framework is still in the development stage and there is a need for more research.

Conclusion

Drug abuse disorder is a life-changing condition that comes from multifactorial causes. The availability of addictive substances, both legal and illegal, makes the disorder a concerning issue. This is especially true for specific demographics that are at a higher risk of developing DAD. Still, recognizing that the disorder affects a certain demographic can be beneficial in addressing the issue and understanding how to approach patients. Experts are continuously developing new methods to help treat DAD patients and as more studies bring to light information about the disorder, the more effective treatments can become.

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References

Chiappini, S., Guirguis, A., John, A., Corkery, J., & Schifano, F. (2020). COVID-19: The Hidden Impact on Mental Health and Drug Addiction. Frontiers in Psychiatry. Available at https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00767/full. Accessed: October 6, 2022.

Grant, B., Saha, T., Ruan, J., Goldstein, R., Chou, P., Jung, J., Zhang, H.,...Hasin, D. (2016). Epidemiology of DSM-5 Drug Use Disorder, Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry. Available at https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2470680. Accessed: October 6, 2022.

Jahan, A. & Burgess, D. (2022). Substance Use Disorder. StatPearls Publishing. Available at https://www.ncbi.nlm.nih.gov/books/NBK570642/. Accessed: October 6, 2022.

Koob, G. (2021). Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development. Pharmacological Reviews. Available at https://pharmrev.aspetjournals.org/content/pharmrev/73/1/163.full.pdf. Accessed: October 6, 2022.

Marijuana Legality by State. (n.d.). DISA. Available at https://disa.com/maps/marijuana-legality-by-state . Accessed: October 9, 2022.

Miller, L. (2022). Substance Abuse Treatment Types & Therapy Programs Near Me. American Addiction Centers. Available at https://americanaddictioncenters.org/therapy-treatment. Accessed: October 6, 2022.

Spectrum of Substance Use. (2019). Alberta Health Services. Available at https://www.albertahealthservices.ca/assets/info/hrs/if-hrs-spectrum-of-substance-use.pdf. Accessed: October 6, 2022.

Substance Abuse/Chemical Dependency. (n.d.). Johns Hopkins Medicine. Available at https://www.hopkinsmedicine.org/health/conditions-and-diseases/substance-abuse-chemical-dependency. Accessed: October 6, 2022.

Treatment Approaches for Drug Addiction. (2019). National Institute on Drug Abuse. Available at https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction. Accessed: October 6, 2022.