People also believe that they are addicted to some substance because they experience withdrawal symptoms if that substance intake is stopped. For example, I have headaches with tea or coffee; I must be addicted to tea or coffee. However, experiencing enjoyment or going through withdrawal does not mean that a person has an addiction.
The definition used here refers to the problematic use of a substance such as alcohol.
One simple way of describing addiction is the presence of the 4 Cs:
· loss of Control of amount or frequency of use
· Compulsion to use
· use despite Consequences.
Signs & Symptoms
The harms of substance use can range from mild (e.g., feeling hungover, being late for work) to severe (e.g., homelessness, disease). While each time a person uses a substance may seem to have little impact, the harmful consequences can build up over time. A person who keeps using substances despite the harmful consequences may develop a substance use problem.
The harms of substance use can affect every aspect of a person’s life. They include:
· injuries while under the influence
· feelings of anxiety, irritability, or depression
· trouble thinking clearly
· problems with relationships
· spending money on substances rather than on food, rent, or other essentials
· legal problems related to substance use
· loss of hope, feelings of emptiness.
Some people may be aware that their substance use causes problems but continue to use, even when they want to stop. They may use more than they intended or in situations where they didn’t want to use.
Some people may not see that their substance use is out of control and is causing problems (denial). However, this so-called denial may be a lack of awareness or insight into the
situation. Whether people realize it or not, lack of control is another sign that substance use is a problem.
Causes & Risk Factors
People become addicted because of a combination of factors.
· Genetic factors: Some people may inherit a vulnerability to the addictive properties of drugs.
· How drugs interact with the brain: People use alcohol and other drugs because they stimulate the brain to “feel good.” This immediate rewarding experience makes people want to repeat it. All substances with addictive potential stimulate the release of dopamine, a chemical in the brain that is associated with reward and pleasure.
· Environment: Peoples’ home and community and the attitude of their peers, family, and culture toward substance use can influence whether or not they develop substance use problems. People who experience prejudice or marginalization may use substances to cope with feelings of trauma or social isolation.
· Mental health issues: More than 50 percent of people with substance use disorders have also had mental health problems during their lifetime. When people have mental health problems, even limited substance use can worsen their condition.
· Coping with thoughts and feelings: People may turn to substances to cope with difficult emotions or situations. They start to rely on substances to regulate their emotions
Researchers have tried various ways to sort out the complex causes of substance use problems. One way is to ask which factors put people at risk and protect them from substance use problems. Since substance use often begins in youth, research has focused on this age group.
Risk factors for substance use problems in youth include:
· alcohol or other drug problems among family members
· poor school performance
· poverty, family conflicts, chaos or stress
· having friends who drink or use drugs
· not fitting in socially or being excluded because of factors such as race, ethnicity, gender, or sexual orientation
· emotional, physical, or sexual abuse
· experiencing discrimination or oppression.
The protective factors for substance use problems include:
· having a positive adult role model
· good parental or other caregiver supervision
· having a strong attachment to family, school, and community
· having goals and dreams
· being involved in meaningful, well-supervised activities (e.g., sports, volunteer work).
Diagnosis & Treatment
Screening questionnaires (e.g., the CAGE) can help quickly identify a substance use problem or determine the level of dependence.
1. Have you ever tried to Cut down on your drinking or other drug use?
2. Have you ever felt Angry at or annoyed by someone else’s comments about your drinking or other drug use?
3. Have you ever felt Guilty about your drinking or other drug use?
4. Have you ever used alcohol or other drugs as an Eye-opener—that is, have you used first thing in the morning?
Once a substance use problem is identified or suspected, health care providers will ask about:
· the degree of use
· the consequences of use
· the patient’s readiness to engage in treatment.
There is no “one-size-fits-all” approach to addiction treatment.
Choosing the appropriate treatment depends on the severity and type of addiction; the support available from family, friends, and others; and the person’s motivation to change.
· Self-help: Some people with substance use problems can make changes on their own using self-help materials (e.g., self-help books and websites).
· Self-help groups: Self-help groups—also called mutual aid groups—support people working to change their substance use. Many people participate in a self-help group at the same time that they are informal treatment. The oldest and largest self-help organization is Alcoholics Anonymous (AA). Today, many self-help groups have various philosophies and approaches for people with substance use problems.
Some treatment programs have adopted a harm reduction approach to reach out to people who may not be ready, willing, or able to give up substances.
Examples of harm reduction strategies include:
· helping people learn safer ways to use the substance
· helping people learn how to recognize the signs of an overdose
· providing clean needles and other injection equipment (“works”) for injection drug use (to reduce transmission of infections such as HIV/AIDS and hepatitis C through needle sharing)
· helping to ensure that people’s basic needs, such as food, shelter, and medical care, are met
· substituting a safer drug for the one a person is using (e.g., substituting methadone for heroin)
Counselling Counselling comes in various forms, including individual, group, couples, and family therapy. Counselling generally aims to:
· increase people’s awareness of how substance use affects their lives, what puts them at risk of substance use and how to reduce substance use.
· help people examine their thoughts and emotions and learn how these inner experiences affect how they behave, how they interact with others, and how others see them.
· help promote physical, emotional, and spiritual wellness
· help people manage cravings and temptations to use substances
· help people with substance use problems meet their needs through assertive communication
· help people find ways to meet people and form relationships that aren’t focused on substance use.
Alcohol and other drug education
Alcohol and other drug education can help people learn about the effects of alcohol and other drugs and support people in making informed choices. Some treatment programs also offer alcohol and other drug education to family members.
Treatment using medications should always be paired with at least brief counselling or, if available, a structured treatment program. Medications that can be used to treat problematic substance use and addictions include:
· a nicotine patch, gum or an inhaler, or taking bupropion (Zyban) for smoking cessation · methadone or buprenorphine for people who are dependent on heroin or other opioids.
Medications to treat other types of addiction are limited.
· Naltrexone (Revia) can reduce cravings to drink in people who are alcohol dependent. Naltrexone can also be used to block the effects of opioids.
· Disulfiram (Antabuse) which causes people to feel sick and nauseous if they drink alcohol, can be used to treat alcohol dependence.
People sometimes need short-term help dealing with substance use withdrawal. Withdrawal management helps them manage symptoms when they stop using the substance. It helps prepare clients for long-term treatment. Clients also learn about substance use and treatment options.
Other supports and services
Many treatment programs offer a variety of other supports and services, including information and counselling about:
· stress or anger management
· grief and trauma
· finding a job or going back to school
· healthy eating
· accessing safe, affordable housing
· getting social assistance or disability benefits
· managing money and budgeting
· developing parenting skills.
(Adapted from Addiction: An Information Guide © 2010 Centre for Addiction and Mental Health.)
Frequently Asked Questions
Why do people keep using substances?
One thing that makes the transition difficult is that the immediate effects of problematic substance use tend to be positive. The person may feel good, have more confidence, and forget about their problems, but it is all temporary, and long-term adverse effects might not be evident for some time.
When the person uses substances to escape or change their feelings, using can become a habit, which can be hard to break. Continued substance use, especially heavy use, can cause changes in the body and brain. A person who develops physical dependence and then stops using may experience distressing withdrawal symptoms. These changes may explain why people continue to crave the substance long after they have stopped using and why they may slip back into problematic use patterns.
How do I know if I need treatment?
If you feel that substance use is causing problems in your life and that you are unable to control your use, see a trained counsellor for an assessment. This assessment gathers information about your use and related problems and other factors in your life, such as your personal strengths and supports. This information will help you and your counsellor decide whether you might benefit from treatment or other support.
(Adopted from CAMH- Centre for Addiction and Mental Health)
Where can I find help, treatment, and support?
· Treatment at Savera Medical Centre: Access SAVERA