Substance Abuse, What Is It?
The Substance Abuse Continuum
Substance use disorders (SUD) are not always static. They can and may change as the individual's biochemistry changes. Substance use and abuse have been identified as learned behaviors that exist in or can be classified along a continuum from abstinence to excessive use and dependence (Budney et al., 2003). Although this continuum has been identified, it is an artificial construct. There are not many clear delineations between each stage of the continuum (Doweiko, 2014). It's also not determined that an individual will progress from one stage to the next. One may remain in one stage, never moving on to the next. At the same time, another progresses swiftly through all the stages of the continuum. This means one individual may remain in the "rare to social use" stage, never moving on to "heavy social use/early problem use."
In contrast, another person moves quickly through these two mentioned stages and continues to "late problem use/early addition" and "middle to late-stage addiction." The direction of movement through these stages may also change as an individual ceases using a substance for an extended period of time and then re-enters the continuum. An individual can move up and down the continuum (Doweiko, 2014). As indicated, an individual's placement on the continuum is not permanent and may change over time.
Substance Abuse vs. Substance Use
The reason an individual uses a substance varies from person to person. This is dependent on the individual's environment and biochemistry. Some examples of why an individual may use a substance include expressing a previously forbidden impulse, coping with emotional and/or physical pain, exploring alternative realities, creating a feeling of euphoria, expressing rebellion, and many other reasons have been noted that have lead individuals to begin using a substance (Rasussen, 2008). The continuum of substance use shows a progression from use to abuse, but is there a clear definition between use and abuse? There is much diversity in how one defines addiction. There are no universal definitions of abuse, problematic use, and addiction. The only agreed-upon notion is that physical dependence on a substance signifies addiction (Doweiko, 2014). How does one combat something that cannot be defined?
The closest thing to a universal definition is the Diagnostic Manual of Mental Health Disorders, 5th Edition (DSM-5). This tool is used by medical professionals to decern if a patient has a SUD.
"The specific criteria identified in DSM-5 can be grouped into four general categories (American Psychiatric Association, 2013)
1.Impaired control over substance use
2.Multiple attempts to quit or desire to stop/reduce substance use
3. Most of the individual's activities center around:
(a) obtaining the substance
(b) using the substance
(c) recovering from the effects of the substance: This includes social, vocational, and legal consequences of substance use or using a substance(s) under risky conditions.
4. Pharmacological effects of the drug(s) on the individual, including "craving" for the substance when it is not actively being used."
Contributing Factors of Substance Abuse Costs in Society
Substance abuse might not be at the forefront of your thoughts when you consider your annual cost. But alcohol use disorder costs each adult and child in the United States $638 per year according to previous research (Doweiko, 2014). This data was configured from the annual economic impact of alcohol use/abuse/addiction in the country, which was estimated to be at least $185 billion per year in the early 2000s (Doweiko, 2014). Of this $185 billion, $26 billion was from direct health care costs and $37 billion from lost productivity due to alcohol-related premature death. These numbers alone indicate a substantial and costly burden on society due to substance abuse, specifically Alcohol Use Disorders (AUD). These numbers only increase as other substances are reviewed. In this county, $264 billion has been spent annually on the purchase of illicit drugs; meanwhile, another $200 billion is spent annually fighting the "war on drugs" (Doweiko, 2014).
Studies have deduced that the global economy loses $880 billion per year due to illicit drug use. When AUDs are added into the equation, an additional $880 billion dollars per year is lost to the global economy (Doweiko, 2014). Within the United States alone, it's believed that $375 billion per year is extracted from the economy due to drug and alcohol disorders.
Is Substance Abuse Blown out of Proportion or Underrated by the Media?
Within the United States, 16% of the population over the age of 12 is addicted to nicotine, alcohol, or illegal drugs (Doweiko, 2014). With data like that, it hard to believe that substance abuse information is "blown out of proportion" by the media. In fact, it tends to imply that the coverage of such information is lacking. If there were adequate coverage and education, would this number be so high? Another jarring detail of this statistic is the age grouping; this population includes individuals as young as 13. More emphasis could be placed on educating younger audiences on the adverse side effects of substance use and finding help if they're actively dealing with a SUD.
In the early 2000s, the United States made up less than 5% of the world's total population. Even with this small number, the states are responsible for consuming 60% of the illicit drugs produced on earth (Doweiko, 2014). Our country seems to be leading the way for SUDs. Since there are multiple reasons that an individual seeks out substance use for the first time, it's difficult to pinpoint the cause of these substantial numbers. However, the main reasons for beginning substance use are to alter one's reality, to relieve pain, and to experience pleasure. It seems, the United States has a more significant issue at hand, a need to escape reality. Perhaps a focus on improving quality of life vs. "a war on drugs" might be a more efficient and meaningful cause. If the media paid more attention to what was being escaped, maybe more individuals would focus on finding pleasure within their life versus having to use substances to alter their realities. These substances affect the central nervous system, the part of the body that handles stress response and feel-good hormones. Nearly 25 million people around the world abuse central nervous system stimulants at least once per year (United Nations, 2012). In March of 2020, Finland was named the happiest county in the world by the United Nations (Hetter, 2020). In a survey conducted in 2019, fewer than 1 out of 100 adults had tried either a synthetic cannabinoid or a cathinone during their lifetime (Finland Country Drug Report 2019). It would be interesting to compare in-depth the number of substance use disorders between the two counties. Maybe there is something to learn from the standard of Finish society in finding the key to happiness outside of substance use?
Food for Thought: Do you consume alcohol, marijuana, or other substances to reduce pain, experience alternate realities, or feel pleasure? What is lacking from your life that causes you to seek these substances out?
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.).Washington, DC: American Psychiatric Press.
Budney, A. J., Moore, B. A., Vandrey, R. G., & Hughes, J. R. (2003). The time course and significance of cannabis withdrawal. Journal of Abnormal Psychology, 3, 393.
Doweiko, H. E. (2014). Concepts of chemical dependency (9th ed.). Bellevue, WA: Cengage Learning.
Finland Country Drug Report 2019. Retrieved September 13, 2020, from https://www.emcdda.europa.eu/countries/drug-reports/2019/finland/drug-use_en
Hetter, K. (2020, March 20). During a pandemic, what does being the world's happiest country mean? Retrieved September 13, 2020, from https://www.cnn.com/travel/article/worlds-happiest-country-wellness-2020/index.html
Rasmussen, N. (2008). On speed. [electronic resource]: the many lives of amphetamine. New York University Press.
United Nations. (2012). UNAIDS world AIDS day report|2012. New York: United Nations Publications.
