Substance Dependence
What is Substance Dependence?
Substance dependence is also known as drug dependence. It is a situation that normally arises when you use a particular substance repeatedly, over a significant period of time, leading to you being unable to stop, even when the substance has started affecting you adversely. With some highly addictive substances it may only take one or a few uses to become dependent. Substance dependence, as a term, is often used interchangeably with drug addiction.
At one time they were regarded as two distinct terms. However, after the Diagnostic and Statistical Manual of Mental Disorder redefined the meaning of substance dependence, it became obvious that drug addiction and substance dependence are more or less the same thing.
How Do You Become Dependent on a Substance?
In simple terms, it starts with you taking a substance because of the good you think it will do for you. As you continue to use this substance, over time it begins to affect you in a negative way. However, you find it difficult to see what exactly is happening, despite the negative effects, because your body has become used to the substance. This means that you are now dependent on it.
Substance dependence is categorised as two forms: psychological dependence and physical dependence.
What Exactly is Substance Withdrawal and How Does it Happen?
As soon as the substance you are taking begins to cause harmful effects such as hallucination, mood swings, anxiety, restlessness, amongst other symptoms (depending on the substance), you may begin to sense trouble and attempt to stop (withdraw). You are, however, not in the clear yet, as the withdrawal period will begin to produce its own symptoms, known as withdrawal symptoms.
Withdrawal symptoms come in two classes: There are physical symptoms, such as restlessness, change in appetite, muscle ache, nausea, diarrhoea, sweating, and dehydration, amongst others. On the other hand, there are psychological symptoms such as anxiety, mood swings, depression, and cravings for more of the substance, along with other symptoms. The goal of these symptoms is to force you into a relapse.
Addiction, or substance dependence, can also occur in pregnant women. When it does, the withdrawal symptoms won’t only be experienced by the mother, but also by the baby. This situation is known as Neonatal Abstinence Syndrome (NAS), a condition that can be very dangerous.
What Substances Can Someone Become Dependent on?
There are a many substances that have the potential for dependence. Some of them include heroin, cocaine, tobacco, barbiturates, alcohol, benzodiazepines, amphetamine, cannabis, ecstasy, and more. The potential of which any of these drugs to cause dependence is not a hard-and-fast rule. It differs according to the kind of substance taken, the individual, the quantity taken, the frequency of intake, the means of intake, and the duration of intake.
Signs that Show that You Have Become Dependent on a Substance
Substance dependence can be diagnosed with psychological dependence and without psychological dependence. In psychological independence, factors such as evidence of tolerance and withdrawal can be viable means of diagnosing substance dependence.
Apart from those symptoms of psychological dependence, you will know that you are experiencing substance dependence when you begin to notice any of these signs:
- You use the substance in larger quantities or longer periods than you intend to.
- You have a continuous desire to use or have failed in attempts to cut down.
- You spend a good amount of time seeking out the substance or recovering from its effects.
- Your social, work-related, and recreational activities give way to its use.
- You continue to use it even after realising that its use is already doing damage to your body.
- You begin to experience medical complications, such as hospitalisation and abscesses arising from use.
- You continue craving the substance more and more.
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Treatment of Substance Dependence/Drug Abuse
Though substance dependence or addiction is a complex situation, it can still be treated. The main reasons for treatment include enabling the you to manage your substance misuse, withdraw successfully without too many complications, and to handle abnormal health conditions arising from the abuse/dependence.
Treatment for dependence differs in relation to the type of drug used, the dose consumed, how long it has been consumed for, and the medical and social effects of the dependence. Also, the choice of treatment method, which best suits each individual, depends on a number of factors. Some of the factors include the personality of the individual, the type of drug consumed, the individual’s physical and mental fitness, and the treatment programmes available within the person’s location.
Furthermore, the goal of treatment differs in regards to country. In the US, and some developing countries, the aim of dependence treatment is complete abstinence from any kind of drug. In Europe, on the other hand, treatment is more wide ranging. The goals may be to treat the dependence to the extent that it no longer interferes with the your social and occupational activities, a reduction in criminal behaviour, changing the means of intake to a less dangerous one, and more.
It is important to note that dependence treatment in the Europe been more favourable than in the US.
Residential Treatment
There are two divisions of residential treatment for substance dependence – 12-step programmes and therapeutic communities. Twelve-step programmes use faith-based methods to treat addiction. Their approach considers the relationship between thought, feelings, and behaviour. They see addiction as a behaviour, not a disease. Some of the recovery programmes under the 12-step treatment umbrella include Alcoholics Anonymous, Narcotics Anonymous, Drug Addicts Anonymous, and Pills Anonymous.
There is also the presence of substance-abuse rehabilitation centres to treat more complex cases of addiction/dependence. The treatment offered by these centres are more effective, since, first of all, they isolate the patient from dealers and other users. Also, within the rehab centers, drugs are prescribed by physicians, from time to time, to help in reducing the effects of the addiction, as well as the withdrawal symptoms, both physical and psychological.
Behavioural Programming
Behavioural programming can contribute immensely in helping you abstain from addiction. Some of the programmes that have been initiated under behavioural programming include behavioural marital therapy, community reinforcement approach, cue exposure therapy, and contingency management strategies.
Behavioural treatments like CRAFT (Community Reinforcement and Family Training) have equally encouraged families to enter their loved ones into treatment.
There have also been some alternative therapies used like acupuncture, laser therapy, and electrostimulation. The potency of those alternative methods are, however, in doubt as there is no proof of their effectiveness.
Challenges to Substance Dependence Treatment
A number of techniques have been developed by psychologists to treat substance dependence. Each of these approaches, however, have some shortcomings. The psychodynamic approach is one of these techniques. In this approach, psychologists seek to understand the conflicts and needs of the addicted person, to locate their emotional weaknesses and what they use as a defence mechanism. Using this approach alone, however, is unlikely to solve addiction problems. The approach works better when combined with other approaches like cognitive and behavioural approaches.
Another technique is a biological technique which involves many approaches combined, such as gradual dosage reduction, the use of drugs containing chemicals that will counter the activities of the substances in the brain, and replacement of the substance with another addictive drug. The problem with the biological technique is that it may provoke some unwarranted complications, such as withdrawal symptoms, which are no good to an addicted person.
Some self-help therapies also exist. Their approach usually involves teamwork and sharing concerns among addicted persons. The problem with self-help therapies, however, is that they can only work well for mild cases of dependency and cases involving younger people.
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Legislation
Legislation against addictive drugs varies from country to country. They may be legal, legal as part of government use (to carry out research), illegal to be used for any purpose, and sometimes even illegal to be possessed.
Substances usually covered by legislation include cocaine, cannabis, amphetamine, barbiturate, benzodiazepines, anesthetic, hallucinogens, and other synthetic drugs. Nicotine and alcohol, on the other hand, are usually not covered by legislation.
Legislation, though good for health and moral reasons, may worsen the situation for addicts. Legislation means they have to face not only health challenges, but criminal ones as well.
A Brief History of Substance Dependence
The history of drug addiction can be traced back to ancient times when opium was more commonly consumed. Opium was consumed as a means of curing some health or psychological challenges. This consumption continued until the nineteenth century when its use had become widespread in the US.
Such a widespread increase also meant widespread addiction, particularly among soldiers fighting in the civil war. As the addiction to opium became rampant, morphine was used to treat it. Unfortunately, morphine itself also has considerable addictive potentiality. However, many people didn’t become addicted to it. Opiates were also prescribed for women since it was believed to reduce, what was then referred to as, ‘female troubles’.
Soldiers eventually moved from opium to heroin, particularly during the Vietnam War. Today, advancements in biochemistry, easier access to drugs, the increase in health and psychological problems, and many other reasons have made drug addiction a global phenomenon.
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