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Addiction and Substance Abuse

Introduction

An "invisible line" can be drawn between substance abuse and addiction, also called substance dependence. Substance abuse is a behavior, something people do. And lots of people do it. In some age and race groups, more people abuse substances (such as alcohol or other mood-altering drugs) than do not. Our society approves of substance abuse, and sometimes even encourages it. Advertisements, movies, and other media would have us believe that abusing substances - getting drunk or high - can be funny, cool, or even sexy. Most people who abuse substances do so when they are young, and most grow out of that stage in their lives.

Some of the people who abuse substances, though, will cross the "invisible line" to become addicted or dependent. Some estimates say that 8-14% of the population will be addicted to drugs or alcohol at some point in their lives. Substance dependence or addiction is a brain disease. It is not caused by another condition, like depression, or by a certain type of personality. Unfortunately, there are still many people in this country, including some physicians, who do not understand that addiction is a disease. Physicians, fortunately, are becoming more educated. Because addiction is a disease of the brain, it requires appropriate medical treatment.

The importance of treating addiction is apparent when statistics about the effect addiction has on our society are studied. Addiction, including nicotine dependence, contributes to more deaths than any other health condition. Patients with addiction have 7 times the death rate (7 times more deaths) compared with people without the disease. Studies have shown that addiction causes serious problems in families. Some studies have shown that more than half of divorces, domestic violence cases, and childhood sexual abuse are related to substance abuse or addiction. Fetal alcohol syndrome (caused by mothers drinking while pregnant) is the number one cause of mental retardation in this country. Addiction is the number one preventable cause of impaired job performance and loss of employment in people ages 20-50. Because of its impact on so many areas of a person's life, substance disorders are the number one health problem in this country.

People with the disease of addiction will lose control again and again, due to their use of alcohol and/or other drugs. This loss of control will make things in their lives go badly or become difficult. As a person's dependence on a substance gets worse, or goes on longer, he may have problems feeling good about himself, having relationships, keeping a job, staying out of financial and legal trouble, and staying healthy. Addiction is a disease that runs in families. One of the biggest factors that determine whether people will cross over the "invisible line" between substance abuse and substance dependence, is genetics.

Substance dependence can lead to many long-lasting or emergency health problems, like:

Addiction can occur along with other mental health disorders. Some people might have depression and addiction at the same time. People with both addiction and depression will not get well without appropriate and aggressive treatment for both problems. About 50% of people with substance abuse/ addiction have a psychiatric diagnosis as well, and about half of those patients with psychiatric illnesses also have serious disorders of either substance abuse or substance dependence. It is also possible for people with addiction to display anxiety or depression, which can be solely related to the substance use/abuse or withdrawal from it.

Treatment

The right treatment for substance abuse is dependent on the right diagnosis, as with any other chronic illness. There are many tools that help doctors and counselors diagnose people with this disease, and can help people understand whether they are dependent on alcohol or other drugs. One tool that can easily be applied by most people to see if they have dependency on alcohol or other drugs is called the CAGE Questions.

Answering yes to even one of the CAGE questions indicates a possible problem with substance abuse or dependency and should lead a person to seek further evaluation and help.

For adolescents, a brief screening test known as the CRAFFT Questions may be more appropriate and easier to use. Answering yes to 2 or more questions suggests a significant problem.

Another factor to look at is tolerance, which is a physical reaction in the brain. Tolerance occurs when brain cells in certain areas of the brain need more and more of the substance to feel the same high. It can also occur when people use the same amount of the substance but do not experience the same effects as they used to.

The disease of substance dependence can be treated. There are many ways to get help; from formal treatment centers to attending self-help groups. People with this disease should be able to work with their primary care physicians to get the appropriate help. Doctors and other health professionals can help people treat their addictions the way they can help them treat other diseases, like diabetes or arthritis. Treatment has two major parts:

  1. Detoxification (called "detox"), which helps people get all of the drugs out of their body systems.
  2. Rehabilitation, which helps people rebuild all of the aspects of their lives that suffered through the loss of control caused by substance dependence.

Self-help groups like Alcoholics Anonymous (AA), which help people cope with their lives without alcohol or other drugs, are a part of rehabilitation. Recovery from addiction is ongoing, and self-help groups are important in keeping the disease from relapsing, or becoming worse again.

There is also help available to those who care about those with addiction problems. Some people consider addiction to be a family disease - at times, family members can be just as in need of help as the person who is addicted. This type of help can range from treatment center programs to attending self-help groups such as Al-Anon.

Prevention

Most importantly, substance abuse and therefore addiction can be prevented. There are things that we can do as individuals to prevent addiction, and things that we must come together in communities to do. People who never use drugs or drink alcohol never become dependent on them. This is especially important for those with a family history of addiction. People who start using alcohol or other drugs at young ages are more likely to cross the line into addiction, and so delaying the start of substance use and abuse is another way that we can prevent substance dependence. Our communities can help by teaching people that binge drinking and drugging are dangerous, and by changing our social attitudes so that substance abuse is no longer celebrated or seen as glamorous.

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Last Reviewed: Jul 20, 2010

Christina M Delos Reyes, MD Christina M Delos Reyes, MD
Assistant Professor of Psychiatry
School of Medicine
Case Western Reserve University

Edna M Jones, MD, MRO Edna M Jones, MD, MRO
Former Clinical Assistant Professor of Family Medicine
College of Medicine
The Ohio State University

Ted   Parran, MD Ted Parran, MD
Associate Professor of General Medical Sciences
School of Medicine
Case Western Reserve University