Substance-related addiction is one of the most pressing challenges facing the healthcare sector in the United States (U.S) today. Hedden et al. (2015) cite that approximately 21.5 million adult Americans were battling one form of substance disorder or another in 2014. The most quoted forms of addiction were those related to drugs and alcohol. For instance, out of those found to have a substance use disorder, 80% were struggling with alcohol while up to 7 million were battling drug use disorders. The survey also established that in every eight people that had a drug use disorder, one was simultaneously struggling with both drug and alcohol use disorders. These statistics act as pointers to the cost implications of addiction in the U.S. Comer (2016) cites that substance misuse costs the U.S more than $600 billion annually. This cost is related to healthcare, legal and criminal justice pursuits, as well as the cost associated with lost workplace participation and production. Two controversial issues characterize the discourse on substance-related disorders . On the one hand, there are conflicting views about whether or not an individual with a substance-related disorder is capable of controlled drug use. On the other hand, there are conflicting positions on the issue of whether or not a person with a substance-related disorder has a disease. This essay is aimed at sharing thoughts on these two controversial topics.
Substance-related disorders are varied and can be grouped into different types of substances. These include cannabis, inhalants, stimulants, alcohol, tobacco, sedative, hallucinogens, opioids, caffeine and other substances. A common characteristic of these drugs is the fact that their mode of action involves activation of the brain’s reward system, subsequently producing feelings of pleasure in the drug user ( Comer, 2016 ). Therefore, substance-related disorders arise when the use of a drug whether prescribed or recreational becomes extreme resulting in distress or impairment. Except for caffeine, an official diagnosis of substance abuse disorder applies for the different classes of substances. Substance-related disorders can be categorized into two. These are substance-use disorders and substance-induced disorders ( Comer, 2016 ). Substance-induced disorders include withdrawal, intoxication as well as various mental disorders such as sleep and psychotic disorders that can be as a result of substance use. Substance-use disorders are distinguished by the continuous use of substances by an individual even when these substances are responsible for substantial challenges in such vital areas as the individual's school, family or work ( Comer, 2016 ). The disorders also result in an underlying change in the user’s brain which may prevail even after detoxification. The changes in the user’s brain have far-reaching consequences which can be exemplified by intense cravings for drugs and repeated relapses. Apart from substance use, there are other addictive disorders whose health implications cannot be overlooked. A notable case in this regard is eating disorder ( Jackson & Chen , 2015; Griffith , 2012 ). This disorder is fuelled by objectified body consciousness (OBC) which is characterized by body shame and body surveillance. In their study, Jackson & Chen (2015) established that sociocultural models and OBC are the risk factors for exacerbating eating disorders among late adolescent Chinese women while only sociocultural indices were the key risk factors for men. About 42% and 33% female and male gymnasts respectively suffer from eating disorder ( Griffith , 2012 ). Besides the need to improve performance, this disorder is fuelled by the need to maintain a particular image owing to pressure from coaches, peers as well as parents
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With assistance, an individual with a substance-related disorder is capable of pursuing controlled drug use. Despite the fact that recovering drug addicts may be at risk of relapse for years or their entire lives, addiction can be treated and managed successfully. A notable approach in this regard is controlled use. For instance, in their study, Bujarski et al. (2013) explored the controversial topic of abstinence and non-abstinence approaches to alcoholism. The scholars examined controlled drinking (CD) in this regard. Consistent with their hypothesis, the study results showed that patients whose drinking goal was controlled drinking had the worst outcome. However, the same patients consumed fewer drinks per drinking day compared to those whose goal was complete abstinence even though the scholars had hypothesized that the latter would boast better treatment outcomes. This justifies the effectiveness of CD. The findings are corroborated by Koerkel (2006) whose study was aimed at assessing the stability of change post CD treatment. Koerkel (2006) established that even those with high alcohol intake showed a stable and massive reduction in weekly consumption of alcohol from pre to post-treatment as well as during follow-up. Therefore, controlled drug use is possible for individuals with substance-related disorders.
A person with a substance-related disorder has a disease. This is because the person is characterized by a compulsive substance seeking and use behavior which is difficult to control irrespective of its harmful consequences (Comer, 2016). Repeated use of substances results in changes to the individual’s brain in which case his or her self-control is severely challenged. Likewise, frequent substance use interferes with his or her ability to ignore the intense urges of taking them. Specifically, drugs alter the brain's reward circuit. This is achieved by flooding it with dopamine which is a chemical messenger. Ideally, the reward system is responsible for controlling the body's ability to feel pleasure and is responsible for motivating a person to pursue behaviors that are necessary for survival. Thus, the overstimulation of the reward circuit by drugs results in an intensely pleasurable ‘high.' It is this feeling that motivates frequent substance use. With continued substance use, the brain responds to the high levels of dopamine by reducing its production as well as the response to it by cells in the reward circuit. Due to a reduced high, the person is forced to consume more of the particular drug so as to fill the gap. The changes to a drug user’s brain can be persistent (Comer, 2016). Thus, drug addiction can be termed as a ‘relapsing disease’ which is not only chronic but also complex.
References
Bujarski, S., O'malley, S. S., Lunny, K., & Ray, L. A. (2013). The effects of drinking goal on treatment outcome for alcoholism. Journal of consulting and clinical psychology , 81 (1), 13.
Comer, R. J. (2016). Fundamentals of abnormal psychology (8th ed.). New York, NY: Worth
Griffith , J. ( 2012, May 3). The Perfect Image - A documentary on eating disorders [Video File]. Retrieved from https://www.youtube.com/watch?v=hRuCI5PvApU
Hedden, S. L ., Kennet, R., Lipari, R., Medley, G. & Tice, R. (2015). Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health . Substance Abuse and Mental Health Services Administration, Department of Health & Human Services.
Jackson, T., & Chen, H. (2015). Features of objectified body consciousness and sociocultural perspectives as risk factors for disordered eating among late-adolescent women and men. Journal of counseling psychology , 62 (4), 741.
Koerkel, J. (2006). Behavioural self-management with problem drinkers: One-year follow-up of a controlled drinking group treatment approach. Addiction Research & Theory , 14 (1), 35-49.
