Substance-Related and Addictive Disorders

Since the beginning of human history, people have experimented with mind-altering substances. Archaeologists have found the residue of a fermented beverage of fruit, honey, and rice that was being consumed in Northern China over nine thousand years ago. As early as 3400 BC the Sumerians of lower Mesopotamia (modern Iraq) were cultivating the opium poppy, which they referred to as the “joy plant.”

Benjamin Rush, a founding father of the United States and a signer of the Declaration of Independence, is credited with first describing alcoholism as a “disease” in 1784. Prior to his writings on addiction, drunkenness was viewed as a moral defect and solely a matter of choice. Rush, a physician, believed that the alcoholic lost control of his behavior or had what he called “an illness of the will.” He identified the properties of alcohol, rather than the individual’s choice, as the causal agent. He also proposed that alcoholics could be treated by weaning them off of their addiction using less potent substances (similar to the way that methadone is used for heroin addiction today) and that total abstinence was the only effective cure.

 




Characteristic Symptoms

Substance dependence is characterized by a repeated pattern of substance abuse that can result in tolerance, withdrawal, and compulsive drug-taking behaviors. Dependence is what most people are referring to when they use the term addiction.

Tolerance is present when the individual has to use progressively more of the substance over time to achieve a particular high. This tolerance is caused by compensatory responses in the body (e.g., liver enzymes) that oppose the effects of the drug and attempt to return the person to the state he or she was in before using the substance.

Withdrawal is a set of unpleasant physical symptoms that are opposite of the effects of the drug. For example, if using the drug causes a decrease in heart rate, a potential withdrawal symptom might be an increase in heart rate. Withdrawal symptoms, like tolerance, are a result of the body’s compensatory responses and appear when use of the drug is abruptly discontinued. If a person shows evidence of tolerance and withdrawal, he or she is said to have physiological dependence.

Compulsive drug-taking behaviors include uncontrolled use of the drug, craving the drug, excessive amounts of time devoted to obtaining the drug, unsuccessful attempts to cut down or control substance use, and giving up important and pleasurable activities in order to obtain the drug.

 

Types of Substance-Related Disorders

The DSM-5 lists ten classes of substances for which the diagnoses of a substance-related disorder can be given:

Alcohol

Caffine

Cannabis (Marijuana)

Hallucinogens (e.g., LSD)

Inhalants (e.g., paint thinner)

Opioids (e.g., heroin)

Sedatives, Hypnotic and Anxiolytic Substances (e.g., Valium, barbituates, sleeping pills)

Stimulants

Tobacco

Other Substances


Prevalence and Age of Onset

The use of intoxicating substances is extremely common. Based on survey data gathered by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 19.9 million Americans aged twelve and older (approximately 8% of the population of that age group) report being current illicit drug users (meaning they used an illicit drug in the month prior to the survey), while about 126.8 million (approximately 51% of the population aged twelve and older) report being current drinkers of alcohol. It is estimated that among individuals who reported using drugs and/or alcohol in the previous year, approximately 22.3 million (around 9% of the US population aged twelve and older) were addicted. Of these, 69% (15.5 million) abused or were addicted to alcohol, 17% (3.7 million) abused or were addicted to an illicit drug, and 14% (3.2 million) abused or were addicted to both alcohol and illicit drugs.

Addiction occurs more commonly in men, with an average age of onset between eighteen and thirty years old. It has been found that the younger a person starts drinking or using drugs, the more likely he or she is to become addicted as an adult. For example, adolescents who use alcohol before the age of fifteen are four to five times more likely to become addicted than those who wait until their twenty-first birthday to start drinking. Another shocking statistic is that adults who use illicit drugs are more than twice as likely to have a serious mental illness (e.g., depression) than adults who do not use illicit drugs.

 


Treatment & Support

Treating substance-related disorders is a long and difficult process, and relapses are common. It has been found that 40–70% of alcohol-dependent patients relapse within a year following treatment. Ninety percent of treated alcoholics will experience at least one relapse within four years following treatment. While addicts initially chose to use the substance they are now dependent upon, recovery is much more complicated than simply telling them to stop using the drug.

 

Detoxification

Before any treatment can begin, it is necessary for addicted individuals to be detoxified. This means that all the substances they are addicted to are removed from their bodies. Since withdrawal can be severe and even life-threatening, detoxification should always be done under the supervision of a medical doctor. By using a variety of medications a physician can minimize the severity of withdrawal symptoms and gradually move a person through the detoxification process. Medications commonly used during detoxification include benzodiazepines, anticonvulsants, and antidepressants.

Psychotherapy

A wide variety of psychotherapeutic strategies have been developed for treating addiction. Behavioral and cognitive approaches are two common psychotherapeutic techniques that are used. They are based on the assumption that addictions are learned behaviors. In the behavioral approach, the patient is taught how to handle stress and manage situations without alcohol. In cognitive therapy, an attempt is made to alter self-defeating thoughts (e.g., I cannot tolerate anxiety) and irrational beliefs (e.g., I am helpless) that drive a person to use drugs and alcohol. Psychotherapy may be done in either inpatient or outpatient settings.

Relapse Prevention

Once an individual completes detox and inpatient treatment, the focus shifts to helping him or her avoid relapsing into drug and alcohol use. Relapse prevention may include a combination of medication, continued psychotherapy, and twelve-step programs. People recovering from addiction often show significant mood and anxiety problems. These problems may have preceded their addiction or have been caused by it. Left untreated, these problems can play a role in a person returning to substance abuse. For this reason, a variety of medications, such as antidepressants, antianxiety agents, and mood stabilizers, may be prescribed to reduce the symptoms.

Continued psychotherapy is necessary to help the patient identify stressful situations and objects in the environment that can trigger a relapse. Individuals who seek treatment are also referred to some type of twelve-step program. Twelve-step groups are composed entirely of recovering addicts, and involvement in the group is free. The first twelve-step program was Alcoholics Anonymous (AA), upon which all other programs have been based. The basic foundations of all twelve-step programs are the biblical concepts of submission, forgiveness, and accountability. The basic message reinforced by the group is that it is impossible for a person to stop being an addict as long as that person clings to the idea that he or she can ever again take a drink or use drugs. Recovering addicts are taught to significantly change the way they live in order to avoid a relapse.

Pharmacotherapy

Several medications have been developed to help the recovering individual avoid using again. These medications take two differing approaches to relapse prevention. First, disulfiram (Antabuse) is an alcohol-sensitizing medication. When combined with alcohol, it increases the level of acetaldehyde in the blood, leading to nausea, vomiting, headache, flushing, and other unpleasant effects. While this medication discourages alcohol use, it does not eliminate the desire or craving for alcohol. Second, calcium acetylhomotaurinate (Acamprosate) and naltrexone (ReVia) are anticraving medications. People using these medications don’t get sick when they drink, but they often get less pleasure out of drinking and are less likely to want to drink again. Calcium acetylhomotaurinate appears to reduce cravings by affecting the GABA neurotransmitter system. Naltrexone interferes with dopamine, the neurotransmitter that produces pleasurable effects in the brain’s reward system, thus blocking the high normally produced by alcohol. Naltrexone is also somewhat effective in treating relapse in opiate (e.g., heroin) addiction.

 

A Spiritual Perspective

Because one aspect of the substance-related disorders is spiritual bondage, when ministering to those struggling with addiction it is important to focus on the freedom believers have in Christ. The Scriptures are clear that even Christians can become enslaved or mastered by sinful desires (1 Corinthians 6:12; 2 Peter 2:19). We must remind our addicted brothers and sisters that Christ came to set us free from bondage to sin. We can use Isaiah 61:1 to illustrate this truth: “The Spirit of the Lord God is upon me, because the Lord has anointed me to bring good news to the afflicted; He has sent me to bind up the brokenhearted, to proclaim liberty to captives and freedom to prisoners”.

Christ’s redemptive work is complete, and in Him we are truly free from sin. Many believers, however, choose to live in bondage to their own fleshly desires rather than in freedom. Paul admonishes us in Galatians 5:1: “It was for freedom that Christ set us free; therefore keep standing firm and do not be subject again to a yoke of slavery.” We must help those struggling with addiction to see that they can choose either to live free in Christ or to be a slave to their fleshly desires. Christ’s redemptive work has transformed them into a new creation if they have received Him by faith (1 Corinthians 6:9–11), but they still must choose whether to be controlled by wine or to be controlled by the Spirit (Ephesians 5:18).

In addition, we must understand that a few Bible verses and a quick prayer are not going to break the grip of addiction. Relapse is common; so when we minister to those struggling with substance use, we must be prepared to walk alongside of them long term—through the good times and the bad.

  

Finding Care

The links and information below will provide you with a starting point in terms of finding mental health care providers, treatment facilities and support groups for those struggling with an addiction.

Mental Health Care Providers

When assisting an individual it is important to help them find the right type of mental health care provider. These links will assist you in beginning your provider search. Knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment, as well as, being able to better support them once they begin receiving professional treatment.

An individual struggling with an addiction will most likely need to see both a clinical psychologist / therapist for psychotherapy (talk therapy) and a psychiatrist for medication.

By providing your zip code the following search engines will give you information about local mental health care providers.

Clinical Psychologists / Therapists Psychiatrists


Treatment Facilities

In some people, addiction can become so severe that inpatient treatment is needed. Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get the addiction under control

By providing your zip code the following search engine will give you information about mental health treatment facilities in your area.

Substance Abuse and Mental Health Services Administration Recovery.org

Support Groups

Recognizing that community is one of the factors necessary for successful recovery, attending support groups can be a powerful and meaningful way to connect with others facing similar challenges. Support group experiences allow people affected by mental health difficulties and disorders to connect in a safe and supportive environment. Support groups are led by trained facilitators and teach coping skills, help reduce anxiety, build resiliency and provide a place for people to share common concerns and receive emotional support.

These links will give you information on support groups in your area.

Alcoholics Anonymous Narcotics Anonymous Celebrate Recovery  National Association on Mental Illness


Supporting the Family

Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers. Many times the caregiver needs as much support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with addiction.

These links will give you information on caregiver (family) support groups in your area.

Al-Anon National Alliance on Mental Illness – Family Support Group National Alliance on Mental Illness – Family to Family Support GroupGrace Alliance




Educational Resources

Here are some links to aid you in learning more about addiction. The more information you have, the better you will be able to help those seeking your guidance.

National Institute on Drug Abuse Mental Health America


Downloadable Resources 

First Step – What to do once a diagnosis has been made.

Daily Steps – Developing a holistic mental health care plan.

Difficult Steps – Navigating destructive behavior and legal issues.