Substance-Related and Addictive Disorders
Substance dependence is 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.
- Withdrawal is a set of unpleasant physical symptoms that are opposite of the effects of the drug. If using the drug causes a decrease in heart rate, a potential withdrawal symptom might be an increase in heart rate. Withdrawal symptoms are a result of the body’s compensatory responses and appear when use of the drug is abruptly discontinued.
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:
- 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)
- Other Substances
Prevalence and Age of Onset
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.
Repeated drug use can cause changes in the brain that may affect an addicted person’s self-control and ability to resist cravings. Drug relapse prevention is an essential part of the recovery process because people remain at increased risk for many years. More than 85% of individuals relapse and return to drug use within the year following treatment. Researchers estimate that more than 2/3 of individuals in recovery relapse within weeks to months of beginning addiction treatment. This rate is very similar to rates of relapse with other chronic diseases like hypertension, asthma, or type I diabetes.
Treatments & Support
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.
Behavioral and cognitive approaches are two common psychotherapeutic techniques used. Based on the assumption that addictions are learned behaviors, the patient learns how to handle stress and manage situations without alcohol. In cognitive therapy, patients learn to alter self-defeating thoughts and irrational beliefs that drive a person to use drugs and alcohol.
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 can include a combination of medication, continued psychotherapy, and twelve-step programs. People recovering from addiction often show significant mood and anxiety problems. If left untreated, these problems can play a role in a person returning to substance abuse, thus a variety of medications and continued psychotherapy is necessary to help the patient identify stressful situations and objects in the environment that can trigger relapse. Individuals who seek treatment are referred to some type of twelve-step program in which the basic foundations are biblical concepts of submission, forgiveness, and accountability. Recovering addicts are taught to significantly change the way they live in order to avoid a relapse.
Several medications have been developed to help the recovering patients 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 anti-craving 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. 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. “It was for freedom that Christ set us free; therefore keep standing firm and do not be subject again to a yoke of slavery (Galatians 5:1).” 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.
However, we must understand that a few Bible verses and a quick prayer are not going to break the grip of addiction. Relapse is common. 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.