Millions of people experience symptoms of substance abuse, but a question remains controversial: is it a disorder or a choice? There are arguments for and against, but the important thing in any discussion is recognizing a problem and finding ways to treat it.
What is Substance Abuse?
Substance abuse refers to a pattern of using a substance to the point where it “causes significant problems or distress. This may be missing work or school or using the substance in dangerous situations, such as driving a car. It may lead to substance-related legal problems or continued substance use that interferes with friendships, family relationships, or both.”
According to one report, nearly 53 million people have “used illegal drugs or misused prescription drugs within the last year.”
What Substances Are Most Often Abused?
The most abused substances include:
- Alcohol. According to one report, almost seven percent of Americans “will develop Alcohol Use Disorder.”
- Marijuana often creates a sensation of euphoria.
- Prescription medicines, like pain pills, anxiety pills, or stimulants. Barbiturates, benzodiazepines, and hypnotics are also included.
- Methamphetamine.
- Synthetic cannabinoids or synthetic cathinones.
- Cocaine and other stimulants.
- Opiates.
- Hallucinogens.
- Inhalants.
Each of these substances has unique symptoms, many of which overlap depending on what’s being used. Fortunately, the symptoms of substance abuse can be treated.
What Are the Risk Factors?
- Family history of addiction, especially among blood relatives.
- If you have a mental health disorder such as depression, you’re more susceptible to substance abuse.
- Peer pressure is a considerable risk factor, especially among young people.
- Family problems and lack of healthy relationships between a child and parent or between siblings can raise the chance of addiction.
- Drug use at an early age can affect “the developing brain and increase the likelihood of progressing to drug addiction.”
Why Does Substance Abuse and Mental Illness Happen At The Same Time?
There may be three reasons for co-occurrence:
- The presence of common risk factors.
- Mental disorders can be a contributing factor, with studies discovering that people with a mental disorder may use drugs or alcohol to self-medicate. The effects are temporary, and symptoms typically worsen over time.
- Substance use and substance abuse disorders can influence the development of mental disorders over time, sometimes triggering changes in brain structure and function, which make a person more vulnerable to a mental illness.
Is Substance Abuse a Disorder or a Choice?
Whether substance abuse is a conscious choice that someone can make is open to debate. The U.S. National Institute of Mental Health classifies it as a mental health disorder. Addiction: A Disorder of Choice by Gene Heyman, as summarized in a U.S. National Institutes of Health report, comes down on the side of those who consider it a choice. The same report notes that while the author identifies patterns to support his argument, those patterns are “not appropriate in the global, long-term, rational sense” and instead may be used as a framework for further research into the cause of addiction possible treatment options.
The question of whether substance abuse is a disorder of choice is worthy of more study, and the answer may remain murky for the foreseeable future. There is sufficient evidence on both sides of the argument. What we do know, however, is that the progression of substance abuse has many influencers and stages that it moves through.
Cultural and societal factors play a role in what’s deemed acceptable use; public laws determine the legality, and questions of what kinds of substance use are “normal” are still controversial. The most likely causes include environmental stressors, genetic vulnerability, peer pressure, personality traits, and psychiatric issues.
Substance abuse disorder usually progresses along four stages:
- Experimental or recreational use.
- Regular use causes disruptions to everyday life and becomes used to numb bad feelings.
- Problematic or risky use.
- Addiction when the user can’t handle daily life without using the substance in question.
Diagnosis & Treatment
A family medical professional or licensed mental health specialist normally diagnoses substance abuse. The final diagnosis depends on what’s being abused, how often and how long it’s been used, the amount of time between usage, and symptoms like weight, physical appearance, attitude, and many others. There is no specific test for diagnosing substance abuse, but some diagnostics may uncover an illness or condition influencing its symptoms – and leading to potential treatment. Diagnosis also includes reviewing symptoms with criteria in the Diagnostic and Statistical Manual of Mental Disorders.
There are many treatment options, like detoxification, psychotherapy, and ketamine therapy.
