03 Feb Understanding Drug Abuse and Addiction
As a result of scientific research, we know that addiction is a disease that affects both brain and behavior.
Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior.. What people often underestimate is the complexity of drug addiction- that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.
Drug abuse and addiction are a major burden to society, Estimates of the total overall costs of substance abuse in the United States- including health – and crime – related costs as well as losses in productivity – exceed half a trillion dollars annually. This includes approximately $181 billion f or illicit drugs, $ 168 billion for tobacco, and $185 billon for alcohol. Staggering as these numbers are however, they do not fully describe the breadth of deterioration public health and safety – implications, which include family disintegration, loss of employment , failure in school ,domestic violence , child abuse and other crimes.
What is drug addiction?
Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and causes harmful consequences to the individual who is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structures and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time changes in the brain caused by repeated drug abuse can affect a person’s self -control and ability to make sound decisions , and at the same time send intense impulses to take drugs
It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment, medications if available with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and co- curing medical, psychiatric ,and social problems can lead to sustained recovery and a life without drug abuse.
Similar to other chronic relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully and as with other chronic diseases, it is not uncommon for a person to relapse and abuse drugs again. Lapse, however, does not signal failure- rather, it indicates that treatment should be reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.
N.S. Miller and Gold (1991) speculated that addiction is similar to an acquired drive state in that it “creates a tension that must be reduced. Biological characteristics that underlie drug dependence can be grouped into two; one that accounts for drug dependence in terms of changes that occur in the brain due to chronic drug use and one that examines individual differences in liability to drug dependence because of genetic characteristics.
Apart from biochemical (genetic characteristics) factors contributing to addiction, there are other factors that contribute to the initiation maintenance and progression of alcohol and other drugs disorders. Individual’s expectation of the drug effects, contribute to the desire to use drugs to a large extent. Expectancy studies show that individuals who expect greater effects from alcohol and drugs in terms of tension reduction, euphoria and avoidance of negative effect states are more likely to use and abuse drugs. Expectancies are likely to play a significant role in the initiation of alcohol and other drugs disorders especially for adolescents. In today’s society, adolescents are exposed to many messages that may reinforce positive expectancies of alcohol and other drugs use from peers, adults role models media, mass marketing through T.V. radio, movies, and magazines. Messages like “imara daima Kama simba”,(pilsner) “smooth all the way,”(embassy cigarette) “Guiness for power” (Guinness)“Smirnoff, the purest spirit” create false expectancies not to mention the many myths surrounding alcohol and other drugs use.
Researchers have been studying the learned expectancies each of us has about what alcohol is for and what it does. We learn much of what we expect alcohol to do even before we take our first drink, from books, movies, and other people. One study reported that men who have strong expectations that alcohol will lead to increased social and physical pleasure and to sexual enhancement are most likely to drink heavily, whereas among women the heaviest drinkers are those who believe that alcohol will reduce tension. Rays &Ksir 2004.
The Role of Family Dysfunction
Family dysfunction also plays a causative role in the development of alcohol and other drugs (AOD) problems. Kaufman, 1994; McCrady & Epstein, (1996), steinglass (994). if the family structure is threatened by marital discord or other stress, some individuals may adapt by using AOD. Families are viewed as units governed by rules. In many cases, these rules are implicit or unspoken but serve to maintain a balance or homeostasis within the family unit. The principle of homeostasis is central to family systems theory and refers to the families attempts to maintain stability and balance within the system. Any action or behavior on the part of one family member affects the entire system. To the extent that this behavior becomes a destabilizing force within the family, the system adjusts to restore a sense of homeostasis.
To maintain a semblance of homeostasis, family roles, the family rules and boundaries must be maintained. In alcoholic families, family roles, rules and boundaries are ignored and not enforced.
From parental beliefs come parental rules, like beliefs, parental rules evolve over time. Rules are the manifestations of beliefs. They are the enforcers, the simple “do’s and don’ts. In a family living with an alcoholic, alcoholism becomes a family disease described as codependency. The disease is characterized by a preoccupation that family members have with the addict especially an investment in trying to change the behavior of the addict. As a result no time is spared to develop and enforce explicit rules. Rules are implicit, unclear and inconsistent. Unspoken family rules are like phantom puppeteers pulling invisible strings and demanding blind obedience. They are unseen, convert rules that exist below the level of awareness-rules such as; “don’t be more successful than your father”, “don’t be happier than our mother”, “don’t lead your own life;” “don’t ever stop needing me”, or don’t abandon me”. Unspoken rules have a tenacious hold on our lives. To change them we must first understand them. Forward with Craig Buck (1989).
As alcoholism or addiction progresses within the family system, family rules often become increasingly rigid and inflexible. Children growing up in alcoholic environments often have difficulty identifying their feelings or trusting their perceptions. Living within these types of rigid family structure encourages them to deny the validity of their own perceptions and feelings. Steinglass (1979, 1981). Steinglass found that families with a drinking alcoholic were the most rigid in their functioning. The family environment then becomes a predisposing factor to AOD.
Family boundaries in alcoholic families also become infringed upon. In alcoholic families, traditional boundaries or patterns of relationships (husband – wife or parent-child) often become disrupted. An example would be a mother whose son begins to abuse drugs. In an attempt to rescue her son, the mother becomes over involved and exhibits both smoothening and enabling behavior. She attempts to rescue her child, becoming over protective, and makes excuses for him. The father, on the other hand, may go to the other extreme, becoming overly punitive or completely disengaged. As time progresses, the mother become more aligned with her son and the father feels more like an outsider. In this way traditional family boundaries and alliances become disrupted.
The roles describe functions that individuals play to maintain the homeostasis within alcoholic families. A classification of different roles might include the chemically dependent person, the chief enabler, the family hero, the scapegoat, the lost child, and the mascot. Thombs( 1994). The different roles serve the functions of restoring the disrupted homeostasis although to very little success.
The disease of alcoholism poisons the atmosphere in a family and infects every member, coloring every relationship and influencing every action. Life in a home dominated by alcoholism is one of extremes, polarization, and secrecy. Most families make precarious and usually unhealthy adjustments to the presence of drug and substance abuse. Family members can despite their best intentions, behave in a way that allows the drug abuse to continue. They may protect the alcohol-dependent member, make excuses or accept the explanations, endeavor in a variety of ways to cover up. All this is called enabling. Enabling behaviors can evoke twinges of guilt, anger despair, frustration and shame. To draw from a family system approach commonly used in psychotherapy, the enabler and the alcoholic are in an “escalating equilibrium.” This means that the behavior of each reinforces and maintains the other, while also raising the costs and emotional consequences for both.
Modeling of substance use by parents and other family members have been shown to affect the chances of substance use behavior especially in adolescents. For example, parent’s drug use has been associated with the initiation and frequency of alcohol and cannabis use. Hawking et al (1992).