Ever wondered why it is so hard for people with addiction to just stop?!
A biological model of addiction identifies drug abuse as: compulsive drug seeking and use despite harmful consequences, due to a dependence on the substance in an effort to avoid physiological withdrawal symptoms.
A psychological model of addiction purports that: drug use is maintained by avoidance of negative psychological states, such as memories of trauma, or a mental health disorder.
Why do we use Drugs?
There are many reasons why an individual might experiment with drug use:
- Pleasure: Many drugs produce feelings of intense pleasure initially. Stimulants such as amphetamines produce an initial “high” with feelings of energy, confidence and even a sense of power. Opiates will produce feelings of relaxation and satisfaction. This high is initially sought with experimental drug use, though drug abusers will notice the pleasure decreases over time, requiring more of the drug to achieve the same effect. At this stage, drug use becomes about feeling “normal” and avoiding the withdrawals.
- Avoidance: Another motivator for drug use is to avoid certain emotional states like anxiety and depression. A commonly observed effect from alcohol is the lowering of social inhibitions which allow us to feel more confident and talk more easily with others. In this manner drinking alcohol can become a safety mechanism for anxiety, leaving us feeling like we are socially inept without a drink, leading to abuse over time. Reliance on drugs to avoid internal experiences also leaves the recovering addict vulnerable to relapse when experiencing these avoided states, meaning that they become a “trigger.”
- Performance: Some people use and abuse drugs to gain a perceived chemical enhancement, perhaps improving cognitive ability through Ritalin abuse, or athletic performance through steroids. These become addictive when the user feels inadequate without the enhancer.
- Curiosity: Experimenting with drugs because your peer group is doing it is a strong risk factor for teens. Trying to impress friends or express independence from parental control and society can increase the risk for drug experimentation and addiction.
Risk Factors for Addiction
Risk factors for addiction include:
- Early use;
- Administration via smoking or injecting;
- Drug using peer group;
- Experimentation with drugs and alcohol;
- Availability of drugs at school;
- Lack of parental supervision;
- Community poverty;
- Aggressive behaviour in childhood.
So when does use become addiction?
Drug addiction is defined as a disorder by the DSM-V when at least two of the following criteria are met in one year:
- When using more or over a longer period of time than intended;
- Has persistent desires and attempts to cut down;
- Spends excessive amounts of time obtaining the drug;
- Has strong cravings for it;
- Cannot fulfill obligations at home or work;
- Continued use despite social or interpersonal issues resulting from use;
- Social, occupational or recreational activities are given up because of use;
- Using in situations where the user is in danger;
- Using continues despite physiological or psychological problems resulting from it;
- Symptoms of tolerance, whereby the user needs more of the substance to achieve intoxication;
- Symptoms of withdrawal, whereby the user experiences negative physiological and/or psychological symptoms as a result of ceasing using.
Consequences of Addiction
Prolonged drug and alcohol abuse can result in a range of physiological, psychological and social issues.
- Organ damage;
- Hormone imbalance;
- Fertility issues or foetal damage;
- Gastrointestinal disease;
- Risk of HIV/AIDS.
- Emotional dysregulation and mood swings;
- Development or maintenance of anxiety and/or depression;
- Poor judgement and problem solving skills;
- Poor attention and concentration;
- Memory difficulties;
- Loss of friendships;
- Job loss;
- Criminal charges;
Working with Addiction
If you know someone struggling with addiction, or are in addiction yourself, one of the hardest steps is the first in seeking help. The reasons outlined above for commencing drug use help maintain it over time, and provide reasons for not quitting.
It is very important for the recovering addict to find support in people they can trust and relate to. It can be a barrier to treatment if the individual does not feel understood by their therapist, and disengagement can be high.
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) can be great social support networks, though once again, it is important to find a group you connect with. For the vast majority in addiction, self-criticism and self-loathing are present, meaning that discussing their lives in addiction can be extremely difficult and shaming. Therefore, finding non-judgmental social support is crucial to recovery. When feeling shamed and judged the likelihood of relapse increases due to seeing the self as a failure and “giving up.”
Treatment for Addiction
Overcoming addiction requires thorough assessment of the contributing and maintaining factors of drug use for each unique individual.
Treatment for addiction needs to focus on a biopsychosocial model:
- Treating physical dependence will require detox and collaboration with a medical team.
- Working with psychological factors which maintain addiction, such as co-morbid anxiety or depression may require psychological input. Trauma and PTSD is also prevalent in addiction and avoidance of the associated symptoms maintain addiction. Behavioural strategies such as relaxation tools and management plans for trigger situations are also utilised in treatment.
- Social treatment requires increasing a social support network, use of assertiveness, as well as increasing life skills through responsibilities and gaining/maintaining suitable employment.
Coping strategies for managing the biopsychosocial symptoms and triggers is essential for functioning in daily life without using.
Treatment is often initiated with Motivational Interviewing, to help the user decide for themselves whether they are ready to engage with recovery. Harm minimisation is usually a key goal for initial treatment of addiction. Addiction can result in severe physiological, psychological, and social consequences, and as such, decreasing the risk of harm (such as through needle exchange services) is a priority. A method of abstinence completely from drug use (often including alcohol), or a reduction of use, will depend on the individual and what they feel they can manage and cope with. Generally the abstinence method is preferred, though coming from a harm minimisation perspective, reduction is a forward step.
If you are, or know someone, struggling with substance addiction, please make an appointment to come and see me.
Author: Dr Rose Gillett, B Psych (Hons), D Psych (Clinical), MAPS.
Dr Rose Gillett is a Clinical Psychologist working with children, adolescents, adults and couples. With considerable experience working with recovering addicts in private settings, and within residential rehabilitation programs, Rose is passionate about helping her clients achieve their goals, and has a particular interest in alcohol and drug addiction, PTSD, and attachment concerns in adults and young people.
To make an appointment with Clinical Psychologist Dr Rose Gillett, try Online Booking – Loganholme or call M1 Psychology (Loganholme) on (07) 3067 9129.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). London: American Psychiatric Publishing.
- Hamilton, M., King, T., & Ritter, A. (2004). Drug use in Australia: Preventing harm (2nd ed). VIC: Oxford University Press.
- National Institute on Drug Abuse. (2014). Drugs, brains, and behavior: The science of addiction. NIH.