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Substance Abuse Disorders
“First you take a drink, then the drink takes a drink,
then the drink takes you.” - F. Scott Fitzgerald
Definition
Substance-related disorders are disorders associated with the use of alcohol, nicotine, drugs, medications, or toxins. Substances that can be abused include amphetamines, alcohol, caffeine, cocaine, hallucinogens, inhalants, marijuana, nicotine, opiods, phencyclidine (PHP), sedatives, hypnotics, anabolic steroids, club drugs or anxiolytics. Prescribed and over the counter medications can also cause a substance related disorder.
If you have used alcohol or drugs in a hazardous situation (like while driving or at work), suffered legal consequences from your use (like received a DUI), your attendance at work or school has been affected by the drug, or alcohol or drugs have impacted your relationships with loved ones, then you’ve abused a substance.
Prevalence
According to The National Institute of Health, substance abuse has reached epidemic levels in the United States. In a survey taken in 1995, two-thirds of all 12th grade students interviewed said that they felt they had to choose whether or not to use drugs before they graduated from high school. In studies done in 1998 and 1999, 56 percent of 12 to 17 year olds reported that marijuana was easy to get and 72 percent of this group reported that alcohol was very easy to obtain. By the time they are 17 years old, 56 percent of adolescents state that they know a drug dealer.
Principles of Addiction Treatment
The National Institute of Health has defined thirteen principles of treatment that have been verified by extensive clinical studies. Nine are pertinent to outpatient treatment. The Mindful Health Foundation has based its outpatient substance abuse program on these criteria. Read more about choosing the right program below.
The following is from The National Institute of Health and The National Institute on Drug Abuse’s “Principles of Drug Addiction Treatment”:
1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
2. Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial. Potential treatment applicants can be lost if treatment is not immediately available or is not readily accessible.
3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, psychological, social, vocational, and legal problems.
4. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient at times may require medication, other medical services, family therapy, parenting instruction, vocational rehabilitation, and social and legal services. It is critical that the treatment approach be appropriate to the individual's age, gender, ethnicity, and culture.
5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on his or her problems and needs. Research indicates that for most patients, the threshold of significant improvement is reached at about 3 months in treatment. After this threshold is reached, additional treatment can produce further progress toward recovery. Because people often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address issues of motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding non drug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships and the individual's ability to function in the family and community.
7. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because addictive disorders and mental disorders often occur in the same individual, patients presenting for either condition should be assessed and treated for the co-occurrence of the other type of disorder.
8. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.
9. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Addicted individuals may require prolonged treatment and multiple episodes of treatment to achieve long-term abstinence and fully restored functioning.
Participation in self-help support programs during and following treatment often is helpful in maintaining abstinence.
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