How Do Substance Use Disorders Begin?
This is a very difficult question to adequately address, as there is no one particular pathway to developing a substance use disorder. In some cases, individuals develop a substance use disorder at a relatively young age; in other cases, individuals may develop the issue later on in adulthood. Typically, many people start using certain drugs, such as tobacco or alcohol, at some point in their adolescence.
There are a number of different sources that have investigated the notion of “gateway drugs,” such as marijuana, in the development of substance use disorders in children and adolescents; however, perhaps the true gateway drugs are substances that are much more readily available, such as tobacco and alcohol. Even if young people do not have direct access to these substances, it is not hard for them to procure them. In addition, young people are exposed to them through the media and within their own environments (e.g., parental use, peer use, etc.).
There are a number of identified risk factors that are associated with a greater probability for the development of a substance use disorder. The more risk factors an individual has, the greater the probability that a substance use disorder may develop. According to Substance Abuse and Dependence in Adolescence, these risk factors include:
- Having a first-degree relative with a history of a substance use disorder increases the risk that an individual will develop a substance use disorder. The risk is also slightly increased by having any relative with a history of a substance use disorder; however, there is a marked increase in the potential to develop a substance use disorder when one has a parent or sibling with a substance use disorder. This is believed to reflect a genetic risk factor, but in cases where individuals live with first-degree relatives who consistently use and abuse drugs, it also may reflect aspects of a learned behavior.
- Being diagnosed with or having a psychological disorder also increases the risk of developing a substance use disorder.
- Gender affects the likelihood of developing a substance use disorder. Men develop substance use disorders more often than females.
- Family strife or lack of support is also associated with an increased risk of developing a substance use disorder. This can include things like a lack of parental supervision, divorce, abuse issues in the family, uninvolved parents, and so forth.
- Peer pressure is associated with a higher risk of developing a substance use disorder; this is particularly true in children and adolescents.
- Chronically feeling isolated, anxious, or depressed even in the absence of a having a formal psychological disorder is associated with a higher risk for the development of a substance use disorder.
- Taking medications or drugs that have a high potential for abuse or addiction is associated with the development of a substance use disorder. Someone who begins drinking alcohol at a young age or illegally using prescription medications is at a higher risk for abuse issues. Typically, individuals who take medications with a prescription and within their prescribed parameters do not experience a significantly greater risk of developing a substance use disorder.
A number of causal explanations are proposed; however, no single causal explanation can describe the overall problem of substance use disorders. The risk factors above are not the direct causes leading to the development of a substance use disorder but instead indicate behaviors or situations that increase the risk that a person will develop a substance use disorder. Substance use disorders will typically begin to develop when individuals start using drugs or illicit substances in order to experience their psychoactive effects (e.g., to experience the “high” or euphoria associated with use, to avoid stress, to avoid responsibilities, to avoid feeling certain emotions, to fit in with the crowd, etc.).
Signs and Symptoms of a Substance Use Disorder
Even though there is quite a bit of variability in the behaviors that individuals with substance use disorders display, there are some general signs and symptoms that may indicate that someone has such a disorder. A person does not have to exhibit all of these signs; in fact, someone who exhibits three or four of these together may be displaying symptoms of a substance use disorder. However, substance use disorders can only be formally diagnosed by professionally trained and licensed mental health professionals.
The information that follows is designed to be used in an educational format. Anyone suspecting a substance use disorder should seek out a consultation with a licensed mental health professional who is trained and qualified in the assessment, diagnosis, and treatment of these disorders.
Some of the signs that an individual has a substance use disorder include the following:
- The person hides communications with others, such as hiding text messages or only taking phone calls in private, likely because they relate to substance use.
- The person displays a change in overall behavior or personality. For example, the person suddenly seems to be overly sensitive, resentful, irritable, and impatient.
- The person begins spending time with new friends and is secretive about these friendships.
- The person begins breaking rules. Children and teens may begin breaking rules regarding curfews or restrictions on places they can visit. Adults may begin neglecting personal responsibilities.
- The person has an unexplained need for money or is unable to account for money that is spent.
- The person suddenly has an excessive need to be alone or is frequently unreachable.
According to the American Psychiatric Association, the formal symptoms of a substance use disorder include:
- The person begins taking the substance in larger amounts than intended or over a longer time period than originally intended.
- The person begins to spend a great deal of time trying to obtain the drug of choice, using it, or recovering from its use.
- The person engages in a number of unsuccessful efforts to cut down or control drug use.
- The person has cravings to use the drug of choice.
- The person’s drug use leads to recurrent interpersonal or social problems.
- The person begins to fail to meet required obligations at school, at work, within the family, and with friends as a result of the drug use.
- The person begins to use drugs in instances where it is physically dangerous to do so, such as at work or prior to driving.
- The person continues to use drugs despite knowing that the drug use is causing problems.
- The person displays signs of physical dependence, such as tolerance and/or withdrawal symptoms when going without the drug.
Finding a Treatment Center
It is extremely important to choose the appropriate treatment program for the individual. Per the National Institute on Drug Abuse, treatment should be tailored to the individual. While there may be overall treatment protocols to follow, the specific plan must be individualized. Any treatment facility that offers a one-size-fits-all approach to treatment should be avoided.
Appropriate treatment for a substance use disorder consists of a program that delivers empirically validated treatment protocols (treatment approaches that have been supported in research literature), offers a variety of treatment services to address the whole individual, and utilizes licensed mental health professionals who have specific training in treating substance use disorders. The best approach to treating a substance use disorder is an approach that can address the issue from a number of different angles and offer various related interventions to assist the individual in recovery.
There are number of different treatment options that a comprehensive treatment program should offer. Treatment options may include the following:
- Medical detox services: When abused chronically, certain types of drugs will lead to the development of a physical dependence. Individuals who have developed a physical dependence on a drug as a result of a substance use disorder will need to initially engage in a physician-supervised medically assisted detox program. This type of program allows the individual with the substance use disorder to negotiate the withdrawal process while experiencing the minimum level of discomfort possible. If withdrawal symptoms are not controlled, the potential for relapse during the early stages of recovery increases greatly.Depending on the individual situation, this may require the use of certain medications during detox or that the individual be placed on a tapering program where doses of the drug are successively lowered at specific intervals over time. Medical detox can be administered in either an inpatient or outpatient setting, depending on the needs of the individual. The necessity of medical detox is assessed on an individual basis; however, it is always required for alcohol, opiate, and benzodiazepine withdrawal.
- Residential treatment, outpatient treatment, or a combination of both: Some individuals may require initial residential or inpatient treatment in order to go through medical detox, be removed from tough home environments that may sabotage their efforts to remain abstinent, or for other reasons. Other individuals may not require inpatient treatment and may be suited to engage in outpatient treatment from the very beginning of their recovery programs. Individuals who initially require residential treatment will eventually transition to outpatient treatment. These decisions are made on a case-by-case basis.
- Individual therapy, group therapy, or a combination of both: Clients may participate in individual therapy where they are treated on a one-on-one basis with a professional therapist or group therapy where they are treated in a group of their peers by one or more therapists. Oftentimes, clients engage in both forms of therapy as part of their treatment regime.Therapy is designed to identify and address the specific factors that contributed to the person’s substance use disorder, to identify any other formal psychological disorders or emotional issues, to teach coping skills, and to develop a program of relapse prevention aimed at long-term success in recovery.
- Medically assisted treatment programs: Some individuals in recovery, even individuals who do not need to go through medical detox, need the assistance of a psychiatrist or addiction medicine physician during recovery. These mental health professionals can provide support and medical treatment for psychological issues, physical issues, and other complicating factors that require medical treatment.
- Family therapy: In a number of cases, certain family dynamics can contribute or interact with the individual’s substance use disorder. These issues can be addressed in a special form of group therapy known as family therapy. Family therapy has been empirically demonstrated to assist in the treatment of substance use disorders in adults and adolescents.
- Social support groups: A number of different types of social support groups are available that can be useful for individuals in recovery. Alcoholics Anonymous, Narcotics Anonymous, and other variations are popular. These 12-Step groups have a long history of providing support and structure for individuals with substance use disorders. They also inexpensive or free to attend since they are funded by donations. In addition, they are available daily at various times. People can develop a whole new support system of individuals in recovery via the people they meet at these groups.
- Various interventions and complementary therapies: These might be utilized based on the specific needs of the client. Examples include vocational rehab, physical or occupational therapy, academic tutoring services, job placement services, and so forth. In addition, people in recovery may benefit from yoga, meditation, art therapy, music therapy, fitness regimes, or a bevy of other options.
- Long-term aftercare: Recovery from drug abuse is not a time-limited activity. Since addiction is a chronic disorder, there is no cure; it’s a condition that must be managed on a long-term basis. As a result, most individuals need a long-term aftercare plan to guide them for years following their initial involvement in recovery. Many people in recovery continue with aspects of these long-term aftercare programs throughout their lives.Aftercare keeps individuals engaged and focused on recovery once the early stages of treatment are complete, and it comes in many forms. From ongoing individual therapy sessions and regular attendance at support group meetings to daily meditation or yoga sessions, aftercare is about staying connected to recovery support and participating in good self-care.The development of a long-term aftercare program should begin relatively early in the therapy process and continue throughout treatment. The aftercare plan may morph during the recovery process to fit the current needs of the individual.