Thursday, February 24, 2011

therapy thursday: addicted


Americans love drugs. And I'm not just talking about the illegal ones. Have a headache? Take a pill. Bad day at work? Drink yourself silly. We love taking substances that make us feel better, alter our mood, or control our behavior. In fact, throughout history and in cultures all over the world, experimenting with drugs to alter mood has been popular. And though some people may benefit from the effects of substances, there are those who can't stop.

While they may sound the same, there is a difference between substance abuse and substance dependence. Substance abuse is when the substance takes over one's life and hurts one's functioning. It is a pattern of recurrent use that causes a person to not fulfill their role at work, home or school; to use in physically dangerous situations; to continue using though they have been busted legally; and continued use despite persistent social and interpersonal problems.

Substance dependence is when the drug takes over the person's life. Ever see Intervention on A&E? The person spends all of their time, energy, and resources obtaining and using the substance. A person isn't using to get high anymore, they are surviving on the drug. To stop use causes pains, so they continue to use to avoid pain. Substance dependence is marked by signs of tolerance, withdrawal symptoms, withdrawing from social activities due to use, desire to cut down use without success, and continued use despite evidence of harmful physiological and psychological effects.


There are several theoretical approaches to drug dependence:
  1. Biological - prolonged use changes the brain processes and structures. Genes may also predispose a person to developing addiction. Do you know that guy (it's usually a guy) in your social group that can drink everyone under the table? He may be able to consume large amounts of alcohol without effect, but he is flooding his brain with alcohol which is changing his brain chemistry. He's more likely to become an alcoholic, because depending on how much and how often he is drinking, his brain and body may begin to rely on the alcohol to function as the alcohol replaces naturally produced neurotransmitters in the brain.
  2. Learning - Substance use is a chain of positive and negative reinforcement: Drugs reward the pleasure centers in the brain (plus), and they may help you deal with a stressful situation (minus). People learn to use drugs by association, such as they use when hanging out with certain people or in a certain environment. Drug addiction is an automatic process, i.e. it is hard to break the habit and people use without thinking about it. When the cues a person associates with use are there, the addiction kicks in.
  3. Cognitive - A person's attitudes, beliefs and expectations play a role in addiction. If you think Advil will help your headache, you'll take it. If you think drinking will ease your stress, you'll drink. According to my professor, research has shown that the expectations one has about the alcohol content predicts the amount they will consume better than the actual alcohol content of a beverage. Have you ever seen that girl at a party? You know who I'm talking about. The one who's had two drinks and is acting a fool. Yeah, her. She believes that the alcohol content in electric lemonade is going to get her hammered, so after two drinks, she thinks she's drunk, even though the electric lemonade was made with Kamchatka vodka. I was probably her college...a long time ago.
  4. Sociocultural - Society is the ocean we swim in, but fish don't know they're in water. Your social surroundings control you when it comes to substance abuse. You do what your friends do, and if you don't,  you get new friends. The best predictor of adolescent drug use is association with drug using peers. Many heavy drinkers in college stop drinking heavily once they're out of college. Think about yourself. Did you drink more in college? Then real life happened, right? Yeah, me too.
Not just one of these theories can predict if someone will become an addict. Substance use and addiction are shaped through an interaction between biological, psychological, and sociocultural factors. That's why to treat an addict, you must treat each of these areas of an addict's life.


Of the many types of drugs, alcohol is the most devastating. According to my professor, approximately 18 million people in the US have a drinking problem. 11 million suffer from alcoholism. It is the leading drug of choice among young people. Take the short psychological screening for alcohol dependence:

The CAGE Questionnaire
  • Have you ever felt you should CUT down your drinking?
  • Have people ANNOYED you by criticizing your drinking?
  • Have you ever felt GUILTY about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (EYE-opener)?
If you answered "yes" to 2 of the 4, you are at risk of a having a drinking problem or being an alcoholic.


Drugs are easy to get, easy to use, and it's easy to become addicted. Quitting is difficult because withdrawal is painful and dangerous. If you know someone who needs help, please talk to them. Get them help. Find an addiction therapist who approaches treatment by treating the biological, psychological, and sociocultural factors. Success is rare, but possible. If you live in the Columbus, OH area and need a referral, email me at

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