Addiction Identification and Treatments | Addiction Prevention | Addiction Disorders Sources

Substance abuse and dependence are serious afflictions that affect many members of modern society. A common misconception regarding the concept of addiction is that substance abuse and dependence are simply interchangeable. Although both concepts are characterized by the physiological and behavioral symptoms related to substance use, substance abuse and dependence are categorized slightly differently.

The difference between substance abuse and dependence is not always clear to the general public. Medical professionals, such as psychiatrists, follow certain criteria to differentiate between these two diagnoses, in order to correctly treat their patients. However, according to my mother who happens to be a psychiatrist, the diagnosis can understandably be tricky. “Quite often, people are not completely honest with themselves”, she says. Nonetheless, substance abuse is essentially a pattern of substance use that results in repeated unfavorable social consequences related to drinking or drug use. Those who abuse substances will generally fail to meet their obligations, participate in reckless activities, encounter legal troubles, and primarily, continue to use despite personal troubles. These individuals may be skipping class or work, driving while under the influence, getting sentenced to jail, or provoking arguments with partners. When a person has experienced one or more of these situations in a twelve month period, a clinician is liable to diagnose him/her with substance abuse.
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Substance dependence is generally thought to be more severe. It is characterized as the pattern of self administration that usually results in tolerance, withdrawal, and compulsive drug-taking (DSM - IV). When dependent, a tolerance for the particular substance develops, begetting a need for increased amounts of the substance to maintain desired effects. Withdrawal symptoms, one of the most distinct characteristics of dependence, occur when the use of the substance stops (i.e. nausea, sweating, anxiety, and irritability). Furthermore, the substance is frequently taken in larger amounts or over a longer period of time than was intended. Often, there are persistent attempts to quit using, but each attempt is unsuccessful. Significant amounts of time are spent in activities related to the use of the substance. Important social, occupational, or recreational activities are given up. Finally, the person continues the use of the substance despite knowledge of current physical or psychological issues that are likely to have been caused or exaggerated by substance use (i.e. depression or an affected liver).

In closing, although abuse and dependency are directly correlated, each concept differs in validating criteria.

Predisposing Causes
Like many other psychological disorders, there are multiple predisposing factors that enhance a person’s likelihood of becoming an addict. The most significant predisposing factors include environment, genetics, and personality types.

When I was seven years old, I was told that an environment is simply the conditions or surroundings in which someone or something lives. Therefore, the environment in which a person spends the majority of his time in will subsequently have an effect on his development. This explains why the environment in which a person is raised can both increase and decrease a person’s likelihood of becoming an addict.

The environmental factors that seem to play a role in initial drug use include family beliefs and attitudes, family involvement, family history, and peer groups. Parents who approve of drug use or underage drinking appear to predispose their children to substance abuse. Parents serve as role models for their child's behavior and quite often children don’t realize that they, at times subconsciously, “do as their parents do." It is therefore not surprising that children whose parents drink heavily or use illegal drugs are more likely to do so than children whose parents do not. On a related note, children whose parents or siblings are alcoholics or drug users are at a higher risk of developing substance use disorders than those without such history. According to the American Council for Drug Education (1999), having an alcoholic family member can double the risk of a son developing alcohol or drug dependence. Similarly, children who have family with a history of criminality or anti-social behavior are more likely to use substances than those who do not.

Minimal family support and involvement has been found to be of the strongest predictors of drug abuse in young adults. Incoherent family dynamics, ambiguous or inconsistent rules reg
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arding substance use, and increased family stress, such as financial and career strains, are some of the many reasons why parents may become disengaged from their child’s life. Incoherent family dynamics have to do with the, what I like to call “But dad, mom said…” phenomena. In other words, when one parent allows underage drinking or use of other substances, but the other parent does not, the child is sent mixed messages that can be difficult to interpret. This correlates to another very common dynamic within many families. Millions of parents present ambiguous or inconsistent rules regarding substance use. Unclear boundaries are both confusing and hazardous to the child, as they become unsettled and unable to distinguish what is age–appropriate. Increased family stress, whether it is financial, family, or career related, is a very common risk-factor within any given household as well. With the stress of everyday life, it is easy for parents to become sidetracked. As a result, they begin to lean on their children for support, neglecting their parental responsibilities. Children in a sense become their own parents. Consequently, children who are “self–parented” are far more likely to engage in drug use. Other reasons may include consistent family conflict and even domestic violence, sub par child supervision, and unrealistic developmental expectations.

Furthermore, peer groups are remarkably influential during the formative years. Adolescents involved with peer groups that engage in substance use are more likely to abuse substances later in life than adolescents who do not spend significant amounts of time with such groups. Peers who use substances have been known to initiate their peers into substances, as well as provide the goods, model unhealthy behavior, and shape attitudes about substances. Quite often, the peers who push alcohol and drugs do so because they hope to share the altered experience. It is common for these peers to deal as well, as a way of supporting his or her own substance use.

When scientists are researching addictive genes, what they’re truly looking for are the biological variations that may make someone more or less susceptible to addiction. For example, it may be difficult for people with particular genes to quit a substance once they start, relative to others. Or they may have withdrawal symptoms once they quit, while others do not. Factors that make it harder to become addicted may be genetic as well (Genetic Science Learning Center). However, an individual's genetic hard wiring will never burden them to inevitably become an addict. As stated before, environment is a prominent risk factor as well.

Moreover, scientists will never find one single addictive gene. Susceptibility to addiction is in part determined by the interaction of many genes. However, although there are many “addictive genes," it was in the early 1990’s when a significant advance in understanding the role of genetics in addiction occurred. Researchers Ernest Nobel and Kenneth Blum of the University of Texas, San Antonio discovered the bridge between a variation of the D2 dopamine receptor (DRD2 gene) to severe alcoholism. After further research, they concluded that those with the A1 variation of the DRD2 gene have significantly fewer dopamine receptors in the pleasure centers of the brain (Werblin, 2006). The A1 variation of the DRD2 gene is found in a large percentage of alcoholics, drug abusers, smokers, and those with other addictive, compulsive, or impulsive disorders. Furthermore, people with deficient numbers of these receptors were likely to become addicted to drugs that increase dopamine levels, such as methamphetamine, to compensate for the dopamine shortage. These findings propose that people with this particular genetic trait are much more susceptible to addiction and likely to fall into severe forms of addiction.

Several genes and environmental factors can add up or cancel each other out (Genetic Science Learning Center). In addition, not every addict will carry the same gene, and not everyone who carries an addiction gene or genes will become an addict.

Personality Types
Studies have shown that particular personality types and characteristics serve as predisposing factors for the development of substance–related issues. When compared to healthy subjects, those with substance use disorders have been characterized as having maladaptive personality traits (Allen, 1998). Research has shown that young children, adolescents, and college freshman who later became alcoholics were more impulsive, neurotic, nonconforming, and extraverted than those who did not develop drinking problems (Swendsen, Ph.D, 2002). Pessimism and obnoxious behavior are also commonly found characteristics in substance abusing individuals. Personality traits can help predict the likelihood of a person relapsing as well. Those who have been treated and are highly neurotic and minimally conscientiousness are far more likely to have a relapse within a 12 – month period. Personality theorists have further elaborated on personality traits, stating that they are largely heritable. This theory is supported by a growing field of study concerning behavioral genetics. Studies have shown that between 40% and 50% of the variation of personality traits are due to differing genetic factors (Conway, Ph.D., 2002).

However, aside from the concept that particular personality traits play an inherent role in the susceptibility of any given person becoming an addict, in addition, it may be that chronic substance use is associated with behavioral, cognitive, or affective changes that may be misinterpreted as stable personality characteristics (Conway, Ph.D., 2002). Substance use often induces anxiety and depressive syndromes which may attribute to the social withdrawal, irritability, and pessimism frequently seen in patients. Consequently, when the poor personality traits are thought to improve after extensive successful treatment, these traits may be acquired via use of the substance. These traits may develop as a form of “armor," protecting the individual from the painful emotions associated with substance use, facilitate the purchasing of substances, etc.

Other Non-Traditional Kinds of Addictions
Article on Spending Addictions (from Newsweek- Oct, 2011) - The New Science Behind Your Spending Addiction