To gather information on substance abuse and addiction, a literature review was conducted of online informational sources, including federal agencies, and numerous electronic databases for scholarly articles including (CINAHL, PubMed, Medscape, and Medline) published between 1999 and 2012. Categorical search terms employed included addiction, substance abuse, opioids, alcohol, prescription drugs, impaired nurse, cost of drug use, treatment of drugs use, and others.
The U.S. Department of Health and Human Services has selected substance abuse as one of the countries ten leading health indicator (Hutchison and Blakely, 2010). Reducing substance abuse is one of the Healthy People 2010 goals (Healthy People 2010, n.d.). Alcoholics Anonymous defines the chronic, relapsing brain disorder known as addiction as powerful, cunning, and baffling (ASBN, 2012). Society lacks the understanding that this disease is not a lack of willpower or morals but is an obsessive, compulsive, and complex disease that destroys the lives of families, friends, and individual users (NIDA, 2011). People are most likely to use when drugs and alcohol are easily accessible, convenient, and inexpensive leading to an impact on society that cost millions (Birckmayer et.al, 200; Goulding and Hudson, 2010).
The use of certain terms when discussing addiction and substance abuse provides a means for all that are involved to understand. The DSM-IV is the current version of the Diagnostic and Statistical Manual of Mental Disorders a set of standards for professional to make a formal diagnosis for dependence of substance abuse (DSM Library, n.d.).
Substance abuse and addiction has been used interchangeable for persons addicted to drugs (Kranzler, H. & Li, T., 2008; Maddux, J. & Desmond, D., 2000; ASBN, 2012). Although addiction involves physical dependence and tolerance, the physical dependence and tolerance does not involve the drug seeing and compulsive behavior of addiction making it difficult for physicians to identify the real issue (Shurtleff, 201; Maddux, J. & Desmond, D., 2000;). Substance abuse means using any type of illicit drug and intoxication, enhancement of the end result occurs with multiple drug use (Substance Abuse Prevention Curriculum Guide, n.d.).
The mind and mood altering drugs or chemicals of abuse are the substances that are referred to in a substance abuse or dependence (Bennett and McNeese, n.d.; Mosby’s Medical Dictionary, 2009).
Tolerance is the body’s need for larger quantities of drug for the same effect (Bennett and McNeese, n.d.; Mosby’s Medical Dictionary, 2009).
Abuse vs. Dependence
Substance abuse is when the improper use of substance is affecting a person’s life in a negative manner, such as decrease job function, poor parenting skills, and problems with law enforcement (Bennett and McNeese, n.d.; The American Heritage Dictionary of the English Language, 2003). Substance dependence is the beyond abuse where a person relies or dependents on a drug including increased tolerance, withdrawal, in ability to stop, devotion to using, and neglecting responsibilities (Bennett and McNeese, n.d.; The American Heritage Dictionary of the English Language, 2003).
Addiction is a compulsive and maladaptive dependence with resulting in psychological, physiological, sociological, and legal consequences (Bennett and McNeese, n.d.; American Heritage Dictionary of the English Language, 2003; Goulding and Hudson, 2010).
There is no individual risk factor that can predict whether a person will become an addict. That is based on the vulnerability of each individual in the area of genetics, demographics, family, social, and psychological (ASBN, 2012). The early age of initial use along with the combination of risk factors leads to a greater chance of addiction (ASBN, 2012; NIDA, 2011)
Drugs of Abuse
Alcohol is legal, socially acceptable, and has the least stigma of all drugs in the United States and worldwide (Alcohol Answers, 2009; Bennett and McNeese, n.d.). It is addictive and depresses the central nervous system (Bennett and McNeese, n.d.). Alcohol is a legal, addictive drug that depresses the central nervous system (Bennett and McNeese, n.d.). One drink causes impairment and driving while intoxicated is illegal in the United States (Bennett and McNeese, n.d.).
The social impact of the intoxicated person affects the drinker and all involved (Kelly, 2011; Chan, 2011; Harrington, et.al, 2010). Drinking alcohol is associated with child abuse and neglect, absenteeism from work, and violence (Kelly, 2011; Chan, 2011; Harrington, et.al, 2010). More than 30 conditions with alcohol as an underlying factor are listed in the World Health Organization’s 10th Edition of International Classification of diseases (Rehm, 2011). Chronic alcohol use is a poisoning that weakens the immune system and results damage to the neurological and physical systems that are irreversible (Bennett and McNeese, n.d.; Kelly, 2011; Chan, 2011; Harrington, et.al, 2010; Rehm, 201; Dawson, 2011).
Depressants are the illicit drugs that depresses the central nervous system(CNS)causing decrease pulse, respiration, and blood pressure (UNODC, 2012). The CNS system effect relaxes the person and decreases anxiety and tension (UNODC, 2011; NIDA, 2011). The drugs include alcohol and narcotics (UNODC, 2012).
Narcotics or opiates are derived from the opium poppy or may be synthetically manufactured includes codeine, oxycodone, heroin, fentanyl, and methadone (Goulding and Hudson, 2010; UNODC, 2012; Hall, 2009). The drugs are pain killers, anesthetics, and cough suppressants, used medically except heroin (UNODC, 2012; Hall, 2009). The route used is oral, nasal, intravenous, and transdermal (UNODC, 2003). Users experience constipation, dilation of blood vessels, constricted pupils, and decreased respiration that may lead to an overdose with produces shallow breathing, coma, clammy skin, respiratory failure, and possible death (UNODC, 2012;UNODC, 2003; Hall, 2009).
Sedative- hypnotics, referred to as sedatives, sleeping pills, or tranquilizers, are another type of CNS depressants (UNODC, 2003; Goulding and Hudson, 2010). The purpose is to decrease anxiety, relax, or promote sleep. These drugs categories include barbiturates (Seconal and Nembutal) and benzodiazepines (Valium and Librium) (UNODC, 2003; Goulding and Hudson, 2010). Symptoms associated with withdrawal from these drugs are seizures, convulsion, heart attack, or death (UNODC, 2003; Goulding and Hudson, 2010). Overdose is common when used with alcohol (Goulding and Hudson, 2010).
Heroin is a very addictive drug processed from morphine, a substance extracted from the seedpod of the Asian poppy plant. Heroin produces a feeling of euphoria (a “rush”) and often a warm flushing of the skin, dry mouth, and heavy feelings in the arms and legs. After the initial euphoria the user may go into an alternately wakeful and drowsy state. Heroin is the second most frequent cause of drug-related deaths.
The abuse of prescription pain medications and sedative hypnotics, such as, Klonopin and Xanax, prevalence rate has increase in the United States for persons 12 and over higher than any other illicit drug, surpassing even marijuana (Holmes, 2011). The Centers for Disease Control and prevention has identified these drugs as an epidemic due to the rate of increase of use. United States is the epicenter for prescription drug use with 80% of Americans using drugs for the first time that were prescribed for someone else. The increase in these drugs has shown a decline in cocaine, cannabis, and heroin causing more persons to die from opioid overdose than motor vehicle accidents (UNODC, 2012; Holmes, 2012).
Using a prescription drug in a manner other than the intended prescription constitutes drug abuse. Some of the more commonly abused prescription drugs are: Pain-relieving narcotics (Percodan, Codeine, Vicodin, Percocet) Tranquilizers and sedatives (Halcion, Xanax, Ativan, Valium, Phenobarbital) Muscle relaxants (Soma) Prescription amphetamines (Ritalin, Cylert, Adderall) OxyContin
Cocaine was considered a safe recreational drug in the 1980’s and 1990’s with declining use with the turn of the century (NIDA, 2006; SAMHSA, 2001; The Harvard Mental Health Letter, 1999). Cocaine is a powerful and addictive drug that approximately 21 percent of persons eventually become addicted after the first use (Prevention Handbook, n.d.; The Harvard Mental Health Letter, 1999; NHSDA, 2000. The route of use for cocaine is nasal, smoke, or intravenous. At small amount the drug can produce increased energy, alertness, and euphoria (Prevention Handbook, n.d.; The Harvard Mental Health Letter, 1999; NHSDA, 2000).
The central nervous properties of dilates pupils, constricts blood vessels, increases blood pressure, body temperature, decrease appetite, loss of sleep, and increased pulse (Prevention Handbook, n.d.; The Harvard Mental Health Letter, 1999; NHSDA, 2000) . Although the use has declined, the drug is still the most frequently encountered illicit drug with the following medical complications: cardiac arrest, stroke, and respiratory failure (Prevention Handbook, n.d.; The Harvard Mental Health Letter, 1999; NHSDA, 2000).
Cannabis or marijuana is one of the most used drugs in the United States and considered a gateway drug (NIDA, 2012). Chronic use cause respiratory issues of cancer, asthma, or other lung diseases. The prevalence of marijuana use has increased among all populations from 13.7 percent in 2009 to 14.1 per cent in 2010 (36,37 ). Long term effects includes loss of ambition, apathy,, difficulty concentrating, and decrease in school and work performance.
Marijuana (weed, or cannabis) is one of the most common drugs of abuse . Marijuana looks like a dry, shredded green/brown blend of flowers, stems, seeds, and leaves of a particular hemp plant. It usually is smoked as a cigarette, pipe, or in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana. The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol), which quickly passes from the lungs into the bloodstream, and on to organs throughout the body, including the brain. Some of the short-term effects of marijuana use include problems with memory and learning; bizarre or distorted perceptions; difficulty in problem solving; loss of coordination; and increased heart rate. A study has suggested that a user’s risk of heart attack more than quadruples in the first hour after smoking marijuana.
The amphetamine like drug, methamphetamine rate has doubled from 1990-2002; 71 percent of new users of inhalants in 2002 were under the age of 18; Club drugs MDMA and GHB have leveled off but are not just used in the club culture; Ecstasy use has risen and has been associated with brain damage , kidney failure, and elevated body temperature; Rohypnol association with sexual assault has led to legislature that has made it the least available club drug. From 1998 to 2000 the number of the easily overdosed drug GHB emergency room visits quadrupled to approximately 5000 (Brown University Health Education, n.d.).
Methamphetamine (meth)is made in illegal laboratories and has a high potential for abuse and dependence. It is often taken orally, snuffed, or injected. Methamphetamine hydrochloride, clear crystals resembling ice, can be inhaled by smoking, and is referred to as “ice,” “crystal,” and “glass.”Use of methamphetamine produces a fast euphoria, and often, fast addiction. Chronic, heavy use of methamphetamine can produce a psychotic disorder which is hard to tell apart from schizophrenia (methamphetamine induced psychosis). The drug also causes increased heart rate and irreversible damage to blood vessels.
Ecstasy (MDMA)is the so-called “party drug,” It has both stimulant (like cocaine) and hallucinogenic (like LSD) effects. Ecstasy is neurotoxic (poisonous to brain cells), and in high doses it causes a steep increases in body temperature leading to muscle breakdown, and possible organ failure. Side effects may last for weeks after use, and including high blood pressure, faintness, confusion, depression, sleep problems, anxiety, Hallucinogens
Hallucinogens have existed for years. the drugs includes LSD, PCP, ketamine, and amphetamine variants(MDA,MDMA, and ecstasy). The use of these drugs takes you “on a trip” leading to pleasurable or a terrifying experience. The drugs are not always distinguishable by their color, odor, or taste. The CNS effects increases heat rate, respiration, pulse, blood pressure , and temperature leading to possible stroke, convulsions, heart attack, respiratory failure, or coma. Ketamine has been used as a date rape drug due to the dissociative anesthetic properties. Hallucinogens may lead to insanity or mental health disorders. and paranoia.
Acid (LSD)LSD, also called “acid,” is sold in the street in tablets, capsules, or even liquid form. It is clear and odorless, and is usually takenby mouth. Often LSD is added to pieces of absorbent paper divided into small decorated squares, each containing one dose. LSD is a hallucinogen and a very powerful mood-altering chemical.
Over the Counter Drugs
Many different types of over-the-counter drugs and other substances can be abused. Just a few examples include: Inhalants (paint thinners, nitrous oxide, model glue, magic marker fluid, spray paints, propane, butane, etc.)Dramamine, Mouthwashes, Diet aids Cough and cold medications (especially those containing DXM, like Drixoral Cough Liquid Caps, Robitussin AC, Dectuss, Phenergan etc.)
Inhalants are common household products that are huffed or sniffed that give a high or head rush. Included in this category of drugs are insecticides, paints, and aerosols products that when consumed causes lightheadedness. The drunken high is usually not long but due to the nature of the vapors may cause headaches, unconsciousness, suffocation, violent behavior, and death. Replacing the oxygen with inhalants depresses the CNS and may lead to the user to stop breathing. Long term use of inhalants causes brain damage, weight loss, and fatigue. Adolescent believe inhalants are safer.
Concepts of Substance Abuse
Four Dimensions of Addiction
A disorder that is chronic continues for a long time. The opposite of chronic is “acute,” which means relatively sudden and short. Let’s look at other examples of chronic vs. acute disorders
Chronic: diabetes, hypertension, epilepsy
Acute: flu, food poisoning, concussion
Notice that “acute” disorders are treated once and they’re gone. “Chronic” disorders are managed, not cured.
A disorder that is primary means that it is not the “result” of something else. It is a disorder in its own right, requiring specific treatment. For example, a man may start drinking to control the painful feelings of depression. However, when that man becomes an alcoholic (addicted to alcohol), he now has a separate and “primary” disorder that needs treatment. Treating the depression does not mean the alcoholism will also go away.
A disorder that is progressive tends to get worse over time. With drug addiction, we see that the consequences of the addiction tend to worsen over time. One important mechanism of this progressive quality is tolerance, which we’ve discussed. The development of tolerance tends to ensure that a person has to get more, spend more, hide more, and use more over time. Later we’ll look at some of the particular consequences of progression, including medical problems.
We say that addiction is incurable because the biological changes involved in addiction tend to be permanent. As a result, an addict will never be able to safely use the drug of abuse (or any other drugs of abuse). An alcoholic will never be able to “drink normally.” Likewise, a cocaine addict will never be safe using stimulating drugs (for example, ephedra, which is an over-the-counter stimulant). A person addicted to one drug can easily switch over the another drug and still be an addict. This is called cross-addiction(more on this later). We said “incurable” not “untreatable.” Remember the comparison with diabetes? We don’t cure diabetes, we manage it with proper diet, blood sugar monitoring, and other acts of discipline. Unfortunately, the addict rarely wants “discipline.” That’s what makes it so hard. By definition, an addict wants to keep using!
Stages of Change
In order to determine the proper intervention the “stages of change” model is a means of describing the process to overcome addiction (Hartney, 2013 ; Norcross, J. C., Krebs, P. M. and Prochaska, J. O., 2011), The stages suggest that a person will go through the changes in sequence, but realistically they jump between stages and the stages will be different for everyone (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O., 2011).
This is the first phase of change where the persons has not had any negative consequences and does not see the addiction as problem (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O, 2011). The experience is still pleasurable and leaves the person close-minded to any conversation on any negative consequences (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O., 2011). During this stage the person needs encouragement to see the personal risk and self-awareness
Contemplation is the stage where the person thinks or contemplates changing the addictive behaviors by quitting, moderating use, or cutting down (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011),). A person in this stage requires being give encouragement on the analysis of the pros and cons of the addictive behavior to promote a new goal (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011),).
After a person has contemplated a person makes preparation to follow through on the changes that were contemplated (Hartney, 2013Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011). At this phase a person is trying to make decisions on how to proceed forward (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011),). The stage is a time for encouraging the need for social support and taking small steps.
The action stage is a time for following through on the preparations made by possible entering treatment for detox (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011),). Living without the drugs and the drama of addiction is a strange feeling with the change of lifestyle(Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011), ). This is a real change of addictive behaviors which needs reinforcement and support to handle feelings and self-efficacy.
The maintenance phase is the time to seeks changing addictive behaviors through abstinence and changing behaviors (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011), ). The person learns how to cope and not return to old behaviors when there is a resurfacing of addictive behavior (Hartney, 2013; Norcross, J. C., Krebs, P. M. and Prochaska, J. O. (2011),). Helping the person via support, encouragement, and internal reward reinforcement is required.
Biological Bases of Addiction
Addiction is associated with permanent changes in the brain’s neurochemistry. The addict is biologically “programmed” to need the drug in order to feel normal. This point that “addicts just want to keep using” brings us to an important point about addiction and its biological roots. Let’s take a quick look at what happens in the brain of an addict (without getting too technical).
We’ve seen now how repeated drug use causes permanent biological changes in the brain. An important implication of these changes is this: An addict can never assume it’s safe to resume using addictive drugs. Using even once will get the addict back to Square One. 12-Step programs call this “waking the tiger.”
In 12-step programs, a person commemorates the beginning of sobriety with a “sobriety date. “If a person relapses, he or she starts with a new sobriety date. This tradition emphasizes the fact that addiction never “goes away.”
First let’s take a look at a part of the human brain which has been called the “reward center” deep in the brain. This area includes specialized neural pathways which process experience of pleasure.
The reward center seems to process many experiences of pleasure, such as eating and sex. Experimental rats trained to stimulate their own reward centers with electric switches have been known to press on the switches thousands of times per hour! They neglect all other activities in order to keep stimulating themselves. (11) ). Cocaine is a central nervous system stimulant that causes the distribution of the chemical dopamine that is affects the brain’s pleasure center by causing constant signals of pleasure creating the intense cocaine high(The Science of Mental Health, 2003)
Now, you may not be surprised to learn that many drugs of abuse stimulate the reward centers. As a result, using mind-altering drugs is pleasurable. The addict is almost like one of those experimental rats, stimulating itself again and again, neglecting anything else.
Repeated use of certain drugs of abuse can result in depletion of brain chemicals that allow the experience of pleasure. What happens next is this: more and more of the drug becomes necessary to generate pleasure, and other sources of pleasure lose their effects. Eventually, the addict can’t even feel just normal without the drug. As a result, the addict needs the drug to feel normal, and without it, they feel bad! It’s no longer a matter of pleasureâ€¦it’s a matter of avoiding pain. This is the mechanism for tolerance.
The brain chemicals that help generate pleasure are called dopamine, a brain chemical belonging to a group called neurotransmitters. For example, both alcohol and heroin result in a build-up of dopamine, resulting in (temporary) pleasure. ). Cocaine is a central nervous system stimulant that causes the distribution of the chemical dopamine that is affects the brain’s pleasure center by causing constant signals of pleasure creating the intense cocaine high(The Science of Mental Health, 2003)
As we discussed above, the brain adapts to this higher level of dopamine in the system. It’s almost as if the body tries to “normalize” the new levels of pleasure by “raising the bar” to experience pleasure. These changes are referred to as neuroadaptation. In other words, neuroadaptation means that it gets harder and harder to experience pleasure as you use more drugs. Addicts get the point that only their drugâ€¦.in ever-increasing amountsâ€¦makes them feel good.
Trap of addiction
In a sense, addicts get trapped by their own drug. They started using it to feel good, but end up needing it just to avoid feeling bad.
Addicts can learn to experience pleasure in ways other than using. Unfortunately, research and clinical experience shows that the biological changes are permanent. This is why addiction is considered incurable, as we discussed before.
Giving up drugs isn’t just a matter of giving up on the pleasure. It can be a very painful experience because of cravings. As we’ve discussed, the brain becomes “used to”the drugs of abuse after repeated use. If an addict stops using, the brain (and the mind) will put pressure on the person to start againâ€¦to restore the balance. This pressure is experienced as cravings. Cravings can be very painful and difficult to resist. Managing and resisting cravings are an important aspect of treatment.
Cravings are painful but manageable with training and discipline. A helpful thing to remember with cravings is that they come and go like a wave: they approach, get stronger, reach a crescendo, and then taper off. Knowing this, a person can “ride out”the cravings by several means: Distract herself with something interesting (movie, game, etc) Contact someone else for support (sponsor, supportive friend) Go to a safe place where giving in is less likely
In many different treatment models, addiction is seen as a disease. It may be hard to appreciate why at first, because it seems different from other types of “diseases” like cancer or bronchitis. One of the reasons for defining addiction as a disease is in order to ensure that addiction is treated as a healthcare problem, thus allowing addicts access to the healthcare system. (13)Addiction is widely considered a disease, by such organizations as the World Health Organization (WHO), American Medical Association (AMA), and American Psychiatric Association (APA).
Defining addiction as a disease carries several implications which tend to increase the healthcare available to addicts: it follows a predictable course of development, it causes disorder of bodily functions (affecting not only the brain but typically the liver, pancreas, and other organs), it causes significant mortality and morbidity (alcoholism is one of the leading causes of death in the U.S.),it can be tracked and measured by epidemiological research, it has a significant genetic loading .
We won’t settle the question of the Disease Model here. However, now you are familiar with the idea and some of the arguments on both sides. At any rate, the Disease Model is so prevalent today that most treatment programs you are likely to encounter in the State of Nebraska use the model. What’s more, the Disease Model is supported by the world’s largest organization devoted to helping people with addictionâ€¦Alcoholics Anonymous (and other 12-step programs such as Narcotics Anonymous).
Psychology of Addiction
Progression of addiction
We’ve already discussed how addiction is a progressive disorder (getting worse over time). As such, we can identify certain characteristics of “early stage”and “late stage”addiction. However, it’s important to keep in mind that some people progress quickly to more serious problems, while others follow along progression.
A person uses drugs of abuse to achieve a feeling of euphoria or to relieve stress. Using is escapist, sociable, and fun. However, the person begins to need more and more. The fun begins to go out of the situation as the person realizes she cannot feel normal without her drug. The person begins to feel guilty and ashamed, and increasingly uses denial.There may be the first damaging consequences (problems at work, in the family, etc). (16)
Using drugs feels more like a necessity of survival than a form of recreation. The problems often begin tomount, and the person becomes increasingly unable to function. The addict loses interest in anything besides using. If the addict has been able to hide her using, this becomes more and more difficult as the addiction progresses.Typically, the later stages of addiction are characterized by increasing physical problems and illness. For example, an alcoholic may experience liver failure or hepatitis.
Defense Mechanisms are psychological strategies for dealing with stress. These strategies are used by the mind (often unconsciously) to keep us from being overwhelmed with stress. Defense mechanisms are normal and necessary. We can’t worry about everything at once, or we couldn’t function! There has to be some “filter”for keeping things from becoming too intense or too painful. However, sometimes defense mechanisms become so rigid that we lose our flexibility, and we find it hard to changeâ€¦even when change would be good. (17)
All defense mechanisms distort reality to some extent, because they “tailor”reality to feel a little more comfortable. The question becomes, just how much distortion is safe?In addiction, defense mechanisms often distort reality to a dangerous extent. It gets harder to cover up the truth when the consequences start to pile upâ€¦broken families, legal charges, ruined careers .Also, the defense mechanisms in addiction can harm the addict’s loved onesâ€¦some of them start to wonder if they are the crazy ones, because the addict is so adamant that they have no problems. Let’s look at a list of some of the defense mechanisms that are commonly used to promote addictive behavior.
Denial is an example of a defense mechanism that is often seen with addiction. The defense of denial is to deny the truth. Denial is useful to an addict because it serves to cover up the extent of the problem, and allow the using to continue.Remember that in addiction, people become “biologically programmed”to need their drug at all costs. Denial is a powerful way of “keeping the pressure off”so the addict can continue to use.
is another example of a defense mechanism that is often seen with addiction. The purpose is to make the irrational sound rational through the uses of justification and excuses. Many addicts have a ready supply of rationalizations to use on themselves and others, such as:â€¢”I’m not hurting anybody.”â€¢”I can stop anytime I want (I just don’t want to yet).”â€¢”I had a hard day today. I deserve a drink.”â€¢”It relaxes me.”
is a behavior that also serves to protect the addiction. Although drug use may start out as a social behavior, addiction ends up driving a wedge between the addict and others. Efforts to hide and maintain the addiction distances them from loved ones, and the company of non-addicts becomes too intrusive and painful. As a result, some addicts end up shooting themselves up in dark rooms, or drinking alone, far from others. Others sink into a drug “subculture,”in which there are no true friendships, but only alliances of convenience in the continuing drive for self-gratification.
It can be very convenient to point the finger at someone else, when we want to avoid notice! Blaming takes the heat off by putting it on someone else. Naturally, this is painful and frustrating for others, and self-defeating to the addict.â€¢”If my husband had fixed that tail-light, I wouldn’t have gotten this DUI.”â€¢”If you lived here, you’d drink too.”â€¢”If my wife/husband treated me right, I wouldn’t have to do this.”
involves “watering down”the problem by acting cavalier about the consequences, or dismissive of the wreckage caused by addiction.â€¢”All my DUIsare five years apart.”â€¢”I never drink before noon, I can’t be an alcoholic.”â€¢”At least I don’t use as much as X.”â€¢”I may miss some work, but I still get more work done than all those other slobs.”
The disease model of addiction, discussed above, encourages us to think of “relapses”in addictive behavior. A relapse is a return to a previously abusive level of using or drinking. The very idea of “relapse” suggests the idea of the disease model, because it describes addiction as a chronic condition that never goes away, but can only lay dormant. Relapse is a very important concept