Substance Use Problems - What is it and How does it happen?

‘Addiction’ is a word that over time has been used to describe many and varied, shall we say seemingly impulsive, compulsive, and obsessive behaviours. Not to be confused in anyway with OCD (Obsessive Compulsive Disorder) although similarities may be seen to exist. Behavioural patterns and psychological consequences of a substance use related issue can also mimic other independent mental health problems, leaving the afflicted individual chasing remedies for consequences rather than addressing the underlying problem. Substance related problems can often co-exist with, or develop other mental health problems, where many individuals adopt self-medicating behaviours.

When looking at ‘addiction’ or ‘dependence’ relating to substance use the DSM-5 (Diagnostic and Statistical Manual of Mental Health Disorders) has moved away from these terms preferring to categorise substance use related problems on a scale ranging from mild to severe which depends on the dysfunctional patterns, and the biopsychosocial impacts of an individual’s substance use. What does all this mean, simply if it’s a problem then it’s a problem! And here is what is often the issue when it comes to an individual’s insight, often the reward whether organic i.e. the ‘high’ and neurological adaption (physiological dependence), or benefit ‘beliefs’ associated to their use out-way their ‘beliefs’ associated to the direct impacts of their substance use.

A term often used to describe this phenomenon is denial. More accurately termed from my experience, it is the formation of a combination of a psychological, and physiological dependence associated with shame avoidance (nobody generally wants their life to be this way, behaviour is often incongruent to values; shame is the most uncomfortable and isolating emotion of our rich emotional experience). A consequence of this, is that individual rationalisations, justifications, and excuses all assist in the maintaining the motivation towards continuance of substance use behaviour.

Just as another twist our developed social norms associated to substance use in Aotearoa New Zealand tend to normalise and symbolise substance use as a manner of social attachment, a rite of passage, and a mechanism of reward and relieving stress and discomfort. Those that choose not too, for whatever reason, often experience exclusion and are stigmatised for this difference in socially normative behaviour, we need to look seriously at these factors for the future health of our people and communities. These domains are reflected in the high prevalence of substance use in Aotearoa New Zealand and the on-going problematic effects on individuals, families and our communities.

Clinically What is it; as defined in the diagnostic criteria of the DSM-5

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following symptoms within a 12-month period.

• The substance was taken in larger amounts or over a longer period than intended
• A persistent desire or unsuccessful efforts to reduce or control use
• A great deal of time spent in activities to obtain the substance or recover from its effects
• Craving or a strong urge to use the substance
• A failure to fulfil role responsibilities at school, work or home
• Continued use despite having persistent or recurrent social, or interpersonal problems that are caused or exacerbated using a substance
• Recurrent substance use in situations that are hazardous
• Substance use is continued despite knowledge of the physical and/or psychological problems caused or related to substance use
• Tolerance - defined by either; the need for higher consumption to achieve intoxication or desired effect or a markedly diminished effect when consuming the same amount
• Withdrawal – a noticeable level of physical and psychological discomfort when the substance is not used.

As a general guide;

Mild Substance Use Disorder is defined by meeting 2-3 symptoms

Moderate Substance Use Disorder is defined by meeting 4-5 symptoms

Severe Substance Use Disorder is defined by meeting 6 or more symptoms

This takes us back to the point, that if it’s a problem, it’s a problem, and unless addressed with effective treatment, generating insight, motivation and commitment to a change process, inclusive of the learning of management skills things don’t get better. Effective treatment works!

Hope is to be attributed to tomorrow, today is all about action – Buddha

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