Substance Abuse

Defined

The terminology used to support those with an addiction can be complex, and words or phrases are often used interchangeably in the general community which have separate meanings within the mental health care field. Some terms may also have unique definitions when related to addiction that do not apply outside the subject (Potter, 2020).

In the context of addiction, a substance is broadly defined as a chemical compound that is known to act on the brain’s reward functions. These reward functions involve naturally made chemicals including dopamine, serotonin, oxytocin and endorphins (Potter, 2020). Stimulating the brain’s reward functions through drug use creates an initial euphoric effect which can disrupt neural transmission or permanently alter neural pathways (NIDA, 2014).

Substance abuse is defined as the use of any substance, regardless of the harm caused, for the purpose of altering mental status or elevating mood (Potter, 2020). Examples of substances include alcohol, marijuana, opioids, caffeine, nicotine and prescription drugs (Myers, 2014).

A drug is a chemical compound that creates a physiological effect when introduced into the body. Drugs come in the form of over-the-counter medications, prescription medicines or illegal substances like heroin (Myers, 2014). Drug abuse occurs when a drug is taken through methods that are not recommended, for a purpose it was not intended for, or is taken in excess quantities (Potter, 2020). 

A substance use disorder (SUD) is a form of self harm (Myers, 2014) that develops over time when someone continues using a substance without regard for the physical and psychological harm that the substance causes for themselves and for others. Those who are experiencing a SUD will demonstrate symptoms of use (physical, cognitive, and behavioral), persistent cravings, a desire to reduce their use but an inability to do so independently, tolerance for the substance of choice that requires increasing amounts of the substance to maintain a high, and an abandonment of responsibilities or normal activity (Potter, 2020). A SUD can be further separated into two groups, substance use disorders and substance induced disorders. Substance induced disorders include intoxication, withdrawal or any long term mental illness or psychosis with onset due to drug abuse (DSM-5). 

Addiction is considered an active disease state, defined by the chronic nature of substance use, abstinence and relapse, and marked by compulsive substance seeking despite negative consequences (Potter, 2020). Under this definition, problem gambling is considered an addiction while other repetitive behaviors (ie problem exercising) are not formally diagnosable addictions (DSM-5).

Addiction may be physical, where the body is dependent on the presence of the drug to function naturally. Or it may be psychological, where the brain feels overwhelmed by a craving for the effect of the drug on the body (URMC, 2022).

When the body is exposed to a substance repeatedly, the chemistry of the user’s brain will change to accommodate the effect, developing tolerance (Myers, 2014). Tolerance requires users to consume increasing amounts of the substance over time to experience the same effects. As increased amounts are consumed, increased side effects from the substance occur, potentially even compounding (Potter, 2020). For example, nicotine tolerance may lead to increased consumption of cigarettes, which increases the risk of lung cancer.

A substance user may experience withdrawal if they have developed a physical or psychological dependence on the substance and suddenly decrease their consumption (NIDA, 2014). Withdrawal, also called acute abstinence syndrome, is a combination of physical and psychological symptoms that occur when the body is deprived of a substance it has been dependent on. These symptoms make it extremely difficult to quit a substance outright, which may lead to relapse. 

Relapse occurs when someone who has maintained abstinence from the use of substance returns to using (Potter, 2020). The risk of relapse reduces over time, but will always be present (NIDA, 2021). 

Detoxification (detox) is defined as the process of safely supporting an addicted person through their withdrawal process, either at home or in an inpatient setting. Sobriety occurs when a person is able to abstain from drug use habitually (NIDA, 2014).

Recovery in the context of substance use is considered to be the state in which the user is no longer physically under the influence of the drug, has maintained abstinence from the use of the substance, and no longer elects to engage in the behaviors that are associated with drug use (Potter, 2020). 

Signs and Symptoms of Intoxication and Withdrawal

The signs and symptoms of intoxication and withdrawal vary depending on the substance being used. The severity and presentation of these symptoms is dependent on dose, tolerance, nutritional status, energy level, environment and culture (NIDA, 2021). Below is a list of the potential physical manifestations of inebriation and acute abstinence from the use of the most commonly abused substances. 

Alcohol Intoxication - slow reaction time, slurred or incoherent speech, loss of gross and fine muscle control, loss of balance, loss of hand/eye coordination, impaired judgment, impaired cognition (Potter, 2020). 

Alcohol Overdose - alcohol poisoning can occur if large amounts are consumed over a short period of time. To rid itself of excess alcohol, vomiting may occur. The brain will begin to shut down executive functions and the individual will engage in erratic, poorly thought out behavior and speech. Balance will be impaired and the individual is at high risk of self injury particularly from falls. Eventually the individual will lose consciousness, and experience slow, erratic breathing, low body temperature and bluish skin. Alcohol poisoning is a medical emergency, and hospital staff will provide stabilization while the body works to remove the toxin (MFMER, 2018). 

Alcohol Withdrawal - increased blood pressure, increased pulse rate, sweating, bowel pain, increased urination, seizures, difficulty paying attention, memory loss, hallucinations, delirium tremens. Delirium tremens (DTs) can lead to seizures and cardiac arrest, which can be fatal if untreated (Potter, 2020).

Nicotine Intoxication - respiratory depression, altered pulmonary function, burns or nicotine stains on hands or fingers, cigarette or spit tobacco odors present (Potter, 2020). 

Nicotine Withdrawal - may present as urges or cravings for tobacco products, difficulty paying attention, difficulty sleeping, hunger, weight gain, and feelings of irritability, depression, nervousness or restlessness (CDC, 2021).

Caffeine Intoxication - shaking in the extremities, agitation, irritability, increased respirations, elevated heart rate, feelings of panic, paranoia, delirium, and restlessness (Potter, 2020).

Caffeine Withdrawal - variable or elevated heart rate, agitation, irritability, dehydration, and bowel distress (Potter, 2020).

Opioid Intoxication - euphoria, pinpoint pupils, reduced respirations, heart rate and blood pressure, and slower than usual cognition, speech and reflexes. An overdose requiring medical intervention may occur (Potter, 2020).

Opioid Overdose - someone who has overdosed on opioids will show signs of respiratory failure. They will be unresponsive and unrousable with slowed or stopped breathing. Their skin will be cold, pale and potentially blue or purple tinted. This condition is a medical emergency and the administration of a naloxone injection can prevent death in some cases (WDHS, 2021). 

Opioid Withdrawal - agitation, variable or elevated heart rate, erratic behavior, muscle aches and pains, sweating, production of tears, running nose, reduced attention span, difficulty falling and staying asleep (Potter, 2020).

Cannabis Intoxication - relaxation, spontaneous laughter, euphoria, increased sensory intake, psychosis, increased thirst and hunger, dry mouth, memory lapses (Potter, 2020).

Cannabis Withdrawal - may lead to muscle tension, memory lapses, difficulty breathing, variable heart rate, visual hallucinations, anger, and belligerence (Potter, 2020). Depressed mood, nervousness, aggression, trouble sleeping, weight loss and restlessness are also seen during acute abstinence (DSM-5).

Cocaine Intoxication - using small amounts of cocaine can lead to elevated heart rate and blood pressure, lightheadedness, confusion, anxiety, restlessness, tremors in the face and hands, pallor, sweating, fever, and enlarged, nonreactive pupils. Larger amounts of cocaine can cause additional symptoms including seizures, loss of urinary control, fever, profuse sweating, difficulty breathing, and blue tint to skin (Potter, 2020). Frequent nose bleeds or a running nose may also develop and be accompanied by overconfidence or paranoia (AAC, 2021). 

Cocaine Overdose - an overdose of cocaine leads to elevated blood pressure and erratic heart rate. Body temperature will rise, pain in the chest will develop and the body will shake with tremors. Eventually, the individual may experience a heart attack, stroke or seizure which could lead to death without medical intervention (AAC, 2021).

Cocaine Withdrawal - short term use withdrawal symptoms include weight loss, anxiousness, confusion, depression, suicidal thoughts, irritability, restlessness, and difficulty falling or staying asleep (Potter, 2020). Symptoms of withdrawal from long term use can be permanent and severe, and include decreased cognitive ability, chronic anxiety, decreased function of the heart, kidney failure, seizures, paralysis, strokes, and loss of muscle mass to the point of amputation (USNLM, 2021). 

Stimulant Intoxication (ie methamphetamine) - symptoms include elevated temperature, dry mouth, appetite loss, elevated heart rate and blood pressure, tremors, and difficulty sleeping (Potter, 2020). Altered mental status, hallucinations, delusions, and excess energy may be observed, and feelings of chest pain or palpitations may develop. (Vasan, 2020).

Stimulant Overdose - this condition presents as gross psychosis and paranoia which can require chemical or physical restraint to prevent harm to self or others. Excessive tachycardia and dysrhythmia puts pressure on the heart and vessels, which can create a hypertensive emergency or stroke (Vasan, 2020).

Stimulant Withdrawal - abstaining suddenly after chronic use can lead to immediate and life threatening changes to heart rhythm (Potter, 2020).

Anabolic Steroid Intoxication - symptoms of use include impaired judgment, delusional ideas or beliefs, extreme and unreasonable paranoia and aggression, manic behavior (NIDA, 2021). 

Anabolic Steroid Overdose - an overdose of this drug manifests as it builds up in the body over time. Long term use brings with it a risk of kidney damage, liver damage, heart damage, and blood clots (NIDA, 2021). Men risk shrinking testicles, reduced sperm count and quality, baldness, breast tissue development, and a higher risk of prostate cancer. Women risk excessive hair growth, decreased breast tissue, baldness, an enlarged clitoris, deepened voice, and changes to menstrual cycle. Teen users risk stunted growth of bone, which leads to a reduction in height (Middlebrook, 2021). Long term use may also manifest as severe acne, strokes, depression, and suicidal thoughts (Potter, 2020).  

Anabolic Steroid Withdrawal - may cause sweating, vomiting, stomach and muscle cramps, convulsions and tremors (Potter, 2020). Additional symptoms may include fatigue, appetite loss, decreased desire for sex, restlessness and difficulty  sleeping (NIDA, 2021).

Club Drugs Intoxication (MDMA, ecstasy, molly) - symptoms include euphoria, altered sensory intake and reduced attention span, altered mood, elevated body temperature, elevated heart rate and elevated blood pressure (Potter, 2020). Muscle cramps, grinding of the jaw and teeth, blurred vision, sweating and nausea may also develop (NIDA, 2021).

Club Drugs Overdose - an overdose of club drugs may cause high blood pressure and fainting followed by a loss of consciousness. The individual may also experience panic attacks or seizures (NIDA, 2006).

Club Drugs Withdrawal - over the course of the week following moderate use, the body will undergo hormonal changes in an effort to return to baseline chemistry. These changes present as irritability, impulsiveness, anxiety, aggression, depression and difficulty sleeping. A decreased appetite for food, reduced interest in sex, and trouble paying attention are also common during the withdrawal period (NIDA, 2021).

Inhalant Intoxication - symptoms of inhalant intoxication usually only last between a few minutes and a few hours after exposure. An inhalant user may immediately experience a sense of euphoria, dizziness, rapid eye movement, blurred vision, slurred speech, difficulty walking, suppression of reflexes, tremors, muscle weakness and loss of coordination (PsychDB, 2021). 

Inhalant Overdose - even one exposure to an inhalant can cause life threatening respiratory depression, cardiac dysrhythmia or allergic reaction (Potter, 2020). Chronic inhalant use can lead to loss of brain function, nerve damage, swelling of the brain and dementia. The use of a closed container to inhale from may lead to loss of consciousness due to lack of oxygen (PsychDB, 2021). 

Inhalant Withdrawal - symptoms of withdrawal are typically mild for inhalants and uncomfortable symptoms after use are only reported by about 10% of users (PsychDB, 2021).

Hallucinogen Intoxication - hallucinogenic drugs produce altered perception of self, environment and time while also generating visual, auditory, and tactile hallucinations (ADF, 2021). Drugs in this category include cannabis, mescaline, psilocybins, cocaine, amphetamines, PCP (phencyclidine), LSD (lysergic acid diethylamide) and more (Leikin, 1989). Each drug varies in the perceptions and behavior they produce, but typically euphoria, feelings of well-being, clumsiness, dilated pupils, blurred vision, vomiting and elevated heart rate, breathing and temperature are present. Dose, environment, physical condition and current mental state all factor into how the user will experience the drug’s effects. Some individuals will experience frightening or disturbing hallucinations (ADF, 2021). These cognitive and behavioral changes are a result of each drug’s impact on the action of dopamine, adrenaline and serotonin in the brain (Leikin, 1989). The drug’s effects usually last between 3 to 6 hours (Potter, 2020).

Hallucinogen Overdose - there is a dose relationship for some hallucinogens, meaning the larger the amount consumed, the stronger the effect (Leikin, 1989). While it is very rare to die exclusively from the hallucinogen component of the drug, there is risk the drug is incorrectly formulated or has been mixed with other harmful substances. There is danger stemming from the individual’s altered perception and behavior, which may lead to accidents or dangerous situations (DEA, 2020). When someone has a frightening experience, a panic attack may develop that requires medical intervention. Chronic use of hallucinogens, especially when taken in high doses, may lead to irreversible brain chemistry changes and/or drug-induced psychosis (Leikin, 1989).

Hallucinogen Withdrawal - tolerance develops quickly with hallucinogens, and psychological dependency may occur in some people. There is not strong evidence to suggest that physical dependency develops, however the use of these drugs may have a lasting effect. It is common for even occasional users to experience a flashback, which is a seemingly random, sudden onset re-experience of the drug that occurs days, weeks or even years later. Flashbacks are more likely to occur during periods of other drug use or of high stress (ADF, 2021). 

Depressant Intoxication - sedatives, tranquilizers and hypnotic drugs act on the central nervous system to slow brain activity. They are used during anesthesia, to treat acute pain, and to control anxiety, panic or stress episodes. Sedatives can also reduce disordered sleeping and lessen muscle spasms (NIDA, 2021). Types of sedatives include melatonin, antihistamines, barbiturates, opiates, benzodiazepines, anticonvulsants, antidepressants and antipsychotics (Simone, 2021). Early signs of depressant intoxication may appear the same as being drunk (USNLM, 2021). Usage can lead to memory lapses, slurred speech, dizziness, and drowsiness, nausea, vomiting and diarrhea (Potter, 2020). After use, someone may also experience a poor ability to concentrate, confusion, headache, dry mouth or lightheadedness (NIDA, 2021). 

Depressant Overdose - an overdose of a depressant occurs when more than the recommended dose is taken, either by accident or intentionally (USNLM, 2022). Large dosages lower blood pressure and reduce breathing, which creates a low oxygen condition over time. If severe, brain damage can occur and may be permanent (NIDA, 2021). Without interventions, respiratory depression can lead to death (Potter, 2020).

Depressant Withdrawal - tolerance of, and physical dependence on, sedative medication develops quickly, making the medication highly addictive. Immediately stopping these drugs can create a life-threatening condition that requires immediate medical intervention. Chronic use of depressants can cause prolonged, toxic blood levels of the substances consumed, harming the body over time (USNLM, 2022). Acute abstinence symptoms include convulsions, tremors, muscle cramping, vomiting, and sweating (Potter, 2020). 

How Addiction Develops

Drugs work by flooding the body with reward chemicals, providing instant gratification. This rush of reward chemicals leads the brain to adapt to the large volume of stimulating chemicals by reducing the number of receptors for those chemicals. This change in the brain develops quickly, and can lead to tolerance for the drug of choice and an inability to experience pleasure during normal activity, which can then cast a shadow on once enjoyable experiences (NIDA, 2021). 

Whenever the body experiences activation of this reward circuitry, it forms a positive memory, which has an encouraging effect related to drug use (NIDA, 2014). This experience also associates positive feelings with the environment where the drug was consumed, which increases risk of use each time the individual returns to that environment (DSM-5). Given the challenges, addiction is known to be extremely difficult to overcome and can have lifelong implications (NIDA, 2021).

Approximately half the risk for addiction is accounted for by the genes each person is born with. These genes define the body’s sensitivities and dispositions, while environment and development define how we will grow to interact with addictive substances (NIDA, 2021). Social and biological factors including sexual orientation, education level, income level, age, race and culture all influence individual substance use habit formation. Equally important are interpersonal, familial and community dynamics as exposure to drugs through friends is a primary determinant of use (ODPHP, 2020).

The typical first time drug use event occurs between 18 and 24 years of age (DSM-5). Studies show that the earlier drug use begins, the higher the risk of later addiction (NIDA, 2021). In fact, 70% of individuals who engage in illegal drug use prior to age 13 will develop a substance abuse disorder over the course of the following 7 years (NCDAS, 2021).

Individuals who suffer from mental illnesses are at an increased risk of self medicating through the use of substances. This population may be considered to have a dual diagnosis which signifies a more complex recovery pathway (Potter, 2020). Approximately 40.7% of individuals who use drugs in a given year have a co-occuring mental illness. Use of drugs by individuals with mental illness often exacerbates the underlying mental and physical conditions present due to the risky behaviors associated with drug use (ie needle sharing) which are made worse by the presence of poor nutrition and hygiene (CBHSQ, 2015).

Addiction in the United States

Addiction is a recognized public health crisis in the United States, and the federal government has defined reduction of drug use by 2030 as a priority goal (USDHHS, 2020). In fact, life expectancy in the United States has been on the decline since 2015, in part due to an increase in drug related deaths (NCDAS, 2021). Regrettably, less than half of United States residents who struggle with addiction will receive any medical care for their condition in a given year (USDHHS, 2020).

Broadly speaking, 17% of females and 22% of males over 12 years old report having misused prescription drugs or abused illegal drugs within the last 12 months. If we include alcohol and tobacco use, the number of annual users, aged 12 and above, increases to 60.2% of the United States population. Drug use peaks between age 18 to 25 years at 39%, and remains high at 34% until age 29, and is more common in metropolitan areas than it is in rural communities (NCDAS, 2021). 

Alcohol use is extremely common in the United States. 26.4% of adults over 18 years of age have engaged in binge drinking in the last 30 days and nearly 70% of individuals in their early 20’s report having been drunk at least once in the last year (ODPHP, 2020). 12.4% of adult men, 4.9% of adult women, and 4.6% of 12 to 17 year olds will experience alcohol use disorder in a given year (DSM-5). Alcohol abuse is linked to the death of over 95,000 United States residents each year (NCDAS, 2021).

Cannabis use is rising in part due to the drug’s legalization for medical or recreational use in some states. In fact, there was a 15.9% increase in users between 2018 and 2019. At present, approximately 14.5% of adults in the United States have used cannabis within the 12 months (NCDAS, 2021). 

In 2012, the opioid epidemic saw a peak in prescriptions written, with an average of 81.3 prescriptions written per 100 individuals. By 2018, there were only 51.4 prescriptions written per 100 residents. Approximately 70,000 people die from drug overdoses each year, with 67.8% of those deaths due to opioid abuse (NCDAS, 2021). 

At present, the stimulants methamphetamine and fentanyl are considered by 70% of the law enforcement agencies surveyed to be a serious threat to public health. In a given year, 2% of United States adults will use cocaine, while 0.7% will use methamphetamines (NCDAS, 2021). 

Over 2.5% of United States adults reported misusing prescribed tranquilizers or sedatives over the last year (NCDAS, 2021). Inhalants were reported as having been used by approximately 0.4% of the United States population in a given year (DSM-5). 

In the United States, 21% of adults are current smokers, 22% are former smokers and 57% have never smoked a cigarette. Cigarettes make up 90% of all tobacco products used (DSM-5).

Impact of Addiction on the Self 

Substance abuse has a profoundly negative effect on how the brain receives and processes information. Drug users experience decreased inhibitions, impaired judgment and memory, and slowed reaction times. Impaired nutrition commonly occurs, and within the digestive tract, drug use has been associated with ulcers, scarring, diarrhea and constipation (NIDA, 2014). Certain drugs that impact the function of the heart (stimulants, steroids, depressants) can produce abnormal heart rate and function, as well as lead to heart attacks (ODPHP, 2020).

Exposure to infectious diseases, either through environment or active needle sharing, presents a significant risk for active drug users. Exposure to hepatitis, skin infections, endocarditis, tuberculosis and bacterial pneumonia is associated with intravenous drug use (NIDA, 2014), and ¼ of newly reported AIDS infections in the United States result from illegal drug injection (ODPHP, 2020).

Those who use drugs are at an increased risk of physical trauma from falls, motor vehicle accidents, domestic violence, fractures and associated chronic pain. These physical ailments, combined with poor health management over time, deteriorates mental and physical health at a rapid pace (NIDA, 2014). 

An additional concern for drug users is linked closely to relapse behavior after periods of abstinence. People who have previously abused drugs are at a high risk of overdose after treatment or incarceration because they may take their old dose, while the tolerance for that dose has declined drastically (NCDAS, 2021).

Drug users frequently report intense desires or urges for use, which are particularly pronounced in environments where drugs were used before (DSM-5). These desires may feel all consuming, especially when physical dependence has developed (NIDA, 2014). Drug users also experience a high level of social impairment, meaning they have a difficult time maintaining family and work responsibilities and obligations. This can lead to devastating social and financial losses (DSM-5).

Addiction behavior has a deep and lasting impact on the family and friends of drug users, which increases the risk of social isolation (NIDA, 2014). 

Impact of Addiction on the Community

The impact of addiction on the family cannot be overstated. When a family member has a substance use disorder, others in the family are at an increased risk for social isolation, effectively lose their addicted family member as a social support, and may be harmed by the changes that occur to healthy family functioning. Family members may utilize coping mechanisms like denial, guilt or shame to adjust to the addiction (CBHSQ, 2014), or they may develop codependent behaviors where the focus on limiting the impact of the addiction supersedes other familial needs (Potter, 2020). 

Codependent behaviors are often designed to prevent the addict from damaging the image or reputation of the afflicted person, and their family, within the community. Over time, the family unit becomes so invested in hiding or minimizing the impact of the addiction, that nearly all family interaction revolves around the addict and their actions (CBHSQ, 2014). 

Enabling is a form of codependency, where family members work to reduce the impact of the addiction on the family unit, which in turn creates an environment where continued drug use can more easily occur. When codependency develops in children with parents who have addiction, those behaviors grow into personality traits that include emotional neediness, approval seeking, low self-esteem, inability to assert needs and boundaries, poor communication skills, and over offering of self through advice giving, taking unnecessary responsibility for others, and difficulty saying ‘no’ regardless of the situation (CBHSQ, 2014).

Pregnant women who use drugs risk miscarriage, premature birth, low birth weights as well as cognitive and behavioral problems as the child develops (ODPHP, 2020). Birth defects may be present in babies born to drug addicted mothers, and instances of neonatal abstinence syndrome (where the infant is born addicted to a drug) increased four fold between 1999 and 2014 (NCDAS, 2021). 

Beyond the family unit, addiction can impact the community in far reaching ways. Post-arrest drug screens find illegal drugs in over half of all people, including those who have committed homicide, assault and theft (ODPHP, 2020). The United States spends 35 billion dollars on drug abuse prevention each year, and despite that figure, 70,000 United States residents will die from drug overdoses each year (NCDAS, 2021). 

Strategies to Overcome Addiction

It is important to acknowledge that addiction is a chronic illness, and much like other chronic illnesses, the goal of treatment is to reduce symptoms. While there is no cure for addiction, there are proven strategies that will aid in managing the condition by improving overall daily functioning, reducing triggers for use, and starting to heal the family and social units (NIDA, 2021). 

The process of abstinence, detoxification, stabilization and recovery can be benefitted by medical interventions. Prescribed medications may be needed to help maintain homeostasis during detoxification and prevent relapse. Supportive psychological, social and behavioral interventions are available and often delivered effectively through cognitive behavioral therapy (ION, 2015). For more information on cognitive behavioral therapy, click here.

It may be necessary for someone ready to detox to seek a supportive, therapeutic environment of peers, where clinicians work to provide these physical and psychological interventions. Treatment will be tailored to personal drug use patterns and any co-occurring medical, mental, and social problems that may interfere with recovery. The goal of inpatient detoxification is reducing the pain of the immediate symptoms and the acute trauma of withdrawal, while also offering long term symptom relief by building up a tool chest of internal resources (ION, 2015).

The motivation to push through detox and into recovery must come from within. The commitment to long term change results from an evaluation of beliefs, values, and priorities as a way of establishing ideas about preferred outcomes that serve to meet the true need(s) not being met by the addiction. To learn how to identify motivation, click here.

Once detox is complete and motivation is established, the task of maintaining sobriety now stands ahead. The first step forward can be to forgive ourselves for our past and future relapses, and allow ourselves the grace to make mistakes as we work toward a goal that often feels impossible. For more information on forgiveness, click here.

To make the day-to-day easier, consider positive reinforcement (eating a nice meal, devoting an hour to a hobby, pet or friend, making something), contingency contracts (if I get to the end of today, I get something special), and token economies (sticker charts, treat jars, post-it wall) (IOM, 2015). 

Therapists who specialize in addiction counseling may use rational-emotive behavior therapy (REBT) to help us reflect on emotions, thoughts and behaviors. With an objective, third party perspective, they will evaluate our evaluations of certain events or people in an effort to identify any negative perceptions of life events we may be using. Alternatively, we may engage in dialectical behavior therapy (DBT) which is a form of talk therapy that focuses on regulating self destructive emotions while increasing stress tolerance (ION, 2015).

Long term recovered addicts often attest to the relevance and necessity of seeking a higher power than themselves to aid in looking past short term cravings (AAWS, 2001). What we come to identify as our higher power can range from large to small and could be a family unit, neighborhood, career or even a long term goal. Restoring the health and prosperity of that higher power reinforces our positive beliefs and values about ourselves and others. 

It can be worthwhile to seek out a group of peers with similar experiences who have a shared goal of recovery. These support groups can offer a community where it's safe to learn and practice new skills, and there is opportunity to positively reinforce our ongoing success. Many meetings have gone virtual due to covid. Consider entering "addiction support group" AND "my location", into a preferred search engine.

Coping with an Addicted Person

When confronted with an intoxicated person, understand that they are under the influence of chemicals that impair perception, thought formation and execution of physical movement (Potter, 2020). Because of this condition, it is not recommended to try to have important conversations while any one is intoxicated (URMC, 2022).

If we are ready to initiate the conversation about substance use, consider a one on one meeting in a neutral place without loud distractions. Consider researching alcoholics anonymous (AA) or narcotics anonymous (NA) resources prior to meeting in the event that they become receptive. If alcohol or cannabis is the problem substance, avoid places where it is served or used. The goal of the conversation is to share our perspective on how the substance use impacts what matters most to the individual. Be that family, educational opportunities, career progression or any other important aspect of life. Many people will not be moved by appeals to improve their own condition, but can be motivated by improving the well-being of certain others (URMC, 2022).

We must challenge ourselves to be calm and patient while our loved one reacts to our perspective. It is not uncommon for angry emotions to erupt or a depressed, helpless state to take over. We can give ourselves time to process the words they say, think out responses that allow for them to avoid admitting to shame, guilt or embarrassment, and try to focus on their strengths and our belief in their recovery (URMC, 2022).

An intervention can be used to confront the addiction as a family unit supported by friends and community representatives. People suffering from addiction are asked to listen to their loved ones describe the impact of the addiction on the family. The goal of an intervention is to create a space where the individual must acknowledge the negative aspects of their lifestyle and behavior, and accept that a treatment program can help them through detoxification in a way their family cannot (ION, 2015). 

While in a treatment program, a type of family behavior therapy may be utilized to address the impact of addiction on the family unit, within the context of any co-occurring conditions that exist and exert influence. For example, some members of the family may have anxiety or depression, there may be conflict within the family unit, a history of mistreatment of children, or unstable employment. The family works together to identify, address and ideally resolve underlying conflicts that trigger drug use and associated behaviors (ION, 2015).

Verbalized love, support through the logistics of recovery, and encouragement to maintain sobriety are beautiful gifts that we can give those we care about. Yet no matter what actions we do or don't do, there are some times when we must watch those dear to us make their own choices and accept their own consequences. Setting boundaries and limits on how we will interact with the person in question will preserve our emotional reserves. To learn more about boundaries, click here.

Consider seeking out a group of peers who also have a loved one who struggles with addiction. One such organization is Al-Anon, which offers 14,000 weekly group sessions across the United States and Canada for those who are affected by another’s drinking (Al-Anon, 2021). Nar-Anon is also available for those who have been impacted by the narcotic use of a loved one (Nar-Anon, 2021).