About dependence: substance addiction, a booming social disorder

By Cristiano Antonino On Apr 12, 2023

Substance Dependence Disorder is a rapidly expanding disorder that is signaling itself for its variety over the years

The study of him began in the last century, identifying himself with specific narcotic substances, but for a decade he has greatly broadened his horizons, also introducing new and interesting concepts.

In fact, substance dependence increasingly tends to present itself in the form of “poly-abuse”, with dependence on multiple substances (Wish et al., 2006; Khong et al., 2004; Schifano et al., 1998) or to be associated with behavioral forms of addiction such as gambling, pathological online gaming, food addiction, etc… (Fanella, 2010).

With the term “drug addiction” the WHO (World Health Organization) defines a “chronic and relapsing disease that pushes the individual, in a forced way, to take substances in increasing or constant doses to have temporary subjective beneficial effects, the persistence of which is inextricably linked to the continuous intake of the substance”.

In the recent DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – one of the main diagnostic classifications in psychiatry), the category “addictive and substance use-related disorders” has experienced substantial changes compared to previous editions of the DSM: the categories of “abuse” and “substance dependence” were combined into a single disorder, measured on a continuum from mild to severe, whose criteria for diagnosis (nearly identical to the previous criteria), were merged into a single list of 11 symptoms.

In the same category appears the gambling disorder (in English “gambling”), indicated as an example of a new category of addictions: the “behavioral” ones.

This change reflects a new view that some behaviors, such as pathological gambling, activate the brain’s reward system with effects similar to those of drugs, which is why many authors are beginning to consider “substance addictions” and ” behavioral addictions” as clinical manifestations with different similarities between them and treatable according to similar approaches.

DSM 5 sets the following conditions for the diagnosis of a Substance Use Disorder (SUD):

Tolerance: phenomenon for which it is necessary to intensify the behavior of use (for example by increasing the amount of drug to be used or the frequency of use) to achieve the same effects on the body.
Withdrawal: it is characterized by the presence of emotional or physical symptoms that occur when the subject cannot implement the assumption behavior.
Interruption or reduction of social, work or recreational activities: the use of drugs and the onset of the disorder cause a series of damages on the functioning of the person who uses (conflicts with emotionally important people, work problems, influences on self-esteem , etc…) which increase in intensity, progressively damaging the patient.
Unsuccessful attempts to reduce and control use: it is common for the patient, before formally seeking help from a psychologist or services, to have attempted to reduce use on his own or to “control” it. Generally, a phase is observed in which the patient is firmly convinced that he can limit his own conduct on his own by creating a mode of use that is reconcilable (but only ideally) with the rest of his life, his commitments and his duties.
Waste of time: when the disturbance begins, or is beginning to begin, a criterion to look at is that of the time that the patient dedicates to research, use or recovering from the effects of the substance. The more the addiction is overt, the greater the time dedicated to the substance during the day, until it becomes the only activity present, in the most serious cases.
Loss of control over use: pathological substance use behavior tends to occur despite the negative consequences it has evidently brought about over time and despite the person’s awareness of them (the use behavior becomes “compulsive”).
Continuous use despite the awareness that drugs represent a problem: many patients do not stop even in the face of serious health risks or in the face of clear family crises.
Recurrent use with inability to fulfill duties: Many patients lose their jobs due to drug use, interrupt their studies, or become unable to fulfill their family or parenting duties.
Use in risky situations: over time the ability to estimate the risk associated with assumptions is progressively reduced, becoming compulsive assumptions it may happen to feel “forced” to use despite having to drive or perform tasks of precision that cannot be “rationally” reconciled with the state of alteration given by the substances.
Recurrent use despite this causing social or interpersonal problems: as previously stated, drug use becomes salient, even to the detriment of one’s emotional relationships.

Craving: an urgent desire for substances

Cognitive-behavioral psychology has made significant contributions to the therapy of substance addictions, both in terms of the theoretical understanding of the problem and in terms of treatment (Hayes et al. 2004).

The approach proposed by Carroll aims to promote abstinence by helping the patient to learn some practical strategies for coping with stressful events as alternatives to the use of substances (Carroll, 1998; 1999; 2000; Carroll and Onken, 2005).

This macro-objective is achieved through key elements which are:

Functional analysis of drug use: i.e. the understanding of how the use behavior occurs in relation to specific antecedent events and its typical consequences;
Recognizing the situations in which the person is most vulnerable to hiring (and learning effective strategies to implement);
Learning practical strategies for managing craving;
Psycho-education on “apparently irrelevant” decisions (DAI) related to the use of substances (all those choices that are apparently harmless and which instead constitute potential risk factors for a relapse);
Implementation of relapse prevention training (to prepare for emergency management)

In these circumstances, it is evident that a multi-disciplinary approach to the phenomenon of drug addiction is absolutely necessary, and that the mere distribution of soothing substances should be considered ineffective.

It is also evident that the growing complexity of the phenomenon is a factor that the rescuer must take into account, both in relating to a patient and in treating her.

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