| Contents | Previous | Next |
Substance abuse refers to anything that can be ingested into the body that affects the central nervous system and causes behavioral changes. That includes any substance, such as alcohol or drugs, taken in excessive amounts.
The most commonly used problem drugs are psychoactive mind-altering drugs such as barbiturates, minor tranquilizers, amphetamines, heroin and marijuana. Adults can purchase alcohol legally. Barbiturates can be prescribed legally by a physician, while street drugs, such as cocaine and heroin, are illegal.
There are varied theories about addiction of chemicals, and research is continuous. The World Health Organization and the American Medical Association consider alcoholism addiction to be a chronic, progressive disease.
In the past, excess and dependence, particularly of alcohol, were considered to be a moral weakness, but today research and studies indicate that addiction is more complicated than just a lack of willpower. Addiction is the compulsive act of doing or using something out of habit, and the common element is that the addict engages in a relationship with the object, event or substance to produce a mood change.
Addiction is different from occasional or even heavy abuse, the difference being the personality changes and a negative lifestyle. Only certain individuals will become addicted. These people probably have a genetic predisposition to the disease of addiction or a strong desire to change their mood, or both.
It starts with the high that is experienced after taking the drug. Everyone is affected in a different way, depending on his or her chemical makeup and mood when taking the drug. The addict's feeling is intense. He can count on it. The drug eases his anxiety and produces a change that is always predictable.
Well-adjusted, healthy individuals have learned coping methods to reduce stress. They exercise, walk or swim, read a book, or even scream to release the tension. The healthy person's values and outlook are different from the addict's. Healthy people have positive goals and associate with people of similar mind. People who have busy, worthwhile lives don't have the time to be intoxicated. They get their emotional and intimate needs from other people, themselves, or from the community. A balanced combination of these relationships gives them a healthy, fulfilling nurturance.
When the addict was a child, many of his coping mechanisms were suppressed by his parents, teachers, or other significant person. He was told to "keep quiet" or "do as I say this very minute." His normal emotional growth was stunted, and he went from childhood to adolescence to young adulthood without learning stress-relieving techniques. When introduced to drugs, he discovered instant stress relief. May be a couple of drinks to release sexual inhibitions. It soon became a habit to take a couple of drinks to be comfortable in social situations or when bored. Before long, he had crossed the line from social drinking to addictive drinking.
The more intense the discomfort from anxiety, frustration, boredom, or loneliness, the greater the dose required to overcome it. How much the person craves the desire for change will determine the dose of any drug capable of giving him the desired feeling. When a person feels a lack of satisfaction in life, he is especially vulnerable.
Craving is the result of a decrease in opioids in the brain. There is an urge or desire to increase them, and so a person will satisfy this craving through the use of substances such as alcohol, heroin and morphine. Anything can ignite this craving.
Craving can be initiated by the sight or exposure to the drug. A billboard sign picturing handsome men enjoying a cold beer can encourage one to dash out and buy some. A drive by a favorite haunt can create the urge to stop and have a drink. Television and movies show happy people imbibing. A magazine advertisement is a constant reminder that a glass of wine will guarantee an exciting evening.
Tolerance develops relatively slowly with alcohol but progresses rapidly with drugs, and it varies from person to person. A glass of wine at bedtime will progress to two glasses. One cocktail before dinner becomes two cocktails. The heroin or barbiturate abusers sometimes quadruple their intake of these drugs after only a few days of intravenous injection.
Physical dependence and tolerance occurs soon after the administration of most narcotics and many sedatives. At this time, the person is forced by the dependence to continue taking the drug, despite the understanding that he or she is in trouble. There is a compulsion to take the drug, and the user wants to avoid the withdrawal symptoms. The person now has a psychological or emotional dependence as well as a physical dependence on the drug.
Sarajane lived alone and had a difficult time getting to sleep at night. She asked her doctor to give her a prescription for something so she could relax and have a better night's sleep. He prescribed a mild sedative, which relaxed her at first, but then she would take two at bedtime. Sarajane's tolerance increased, and she was soon taking two and maybe three pills to induce sleep.
She fractured her arm and the orthopedic doctor prescribed Darvon for her without the knowledge of the sedatives she was taking.
One night, when her daughter was visiting, she had a few glasses of wine. She took her usual sedatives, plus some Darvon, and she overdosed. She was fortunate, because her daughter was there to discover her. The quick increases in her tolerance suggest that the adaptation processes which produce dependence probably began with the first dose of these drugs.
The ability to adapt physically and mentally to excessive quantities leads to dependence. This signifies psychological reliance on the mood change that the drug provides. They like the feeling. When they do not take the drug, increased tolerance and dependence induce withdrawal symptoms.
The person is forced to continue taking the drug in order to avoid the symptoms of withdrawal. When that happens, he will become shaky and agitated. His cells now have the addictive reaction, and he has to maintain the tolerance level to function normally. He cannot allow the drug in his blood level to drop below his tolerance point. So now he takes the drug because he has to. Whether a person will become dependent or not is tied into his built-in tolerance level.
Intelligence or education about the damage caused by the abuse does not deter the individual from becoming entrapped. The physician and the nurse are just as susceptible as the construction worker.
Ann fell in with the wrong crowd. She would meet her friends and they -would entertain with "pot parties." Everyone exchanged drugs, and they thought they had a great time!
Ann was a staff nurse at the local hospital and was able to obtain drugs to exchange. Most of her time and energy on the job was taken up with where to get the drug and on which patient she could sign out a drug for. How could she caver it up? The outcome was that her performance at work suffered, and it wouldn't be long before she was found out.
Cross-addiction is exchanging one harmful dependency for another. It may not happen immediately, but over a period of time the addict has the same problem. Another thing that can occur is a return to the chemical of choice. The resolve to abstain is weakened by drug-clouded reasoning.
Tom knew he had a problem with cocaine. What started out as an occasional pastime advanced into an expensive habit. He was besieged with problems at work and in his marriage. He stopped buying cocaine but started to drink alcohol. The intake of alcohol tripled in a few months. Driving home from work after stopping for a few drinks, he had an automobile accident. That never happened with cocaine! Tom admitted that "maybe I did have a little too much to drink that night," but he wouldn't do that again. His resolve was challenged when his wife left him, and the pressure of his work led him to purchase cocaine again "for a little bit of relief." He rationalized that alcohol was more of a hazard for him. He didn't understand he had to abstain from all drugs.
If a person can drink as much as he wants without getting sick or "hung over," or enjoys the taste, he is most likely to become entrapped by the chemical dependence. The alcoholic feels better, he's more relaxed and is under the mistaken notion that his mind is clearer.
Is the make-up of the addict different from that of other people? Yes. Body chemistry has now been shown to be different in someone who can become addicted. Current research reports the theory that addictive disease is a biogenetic illness which is primarily physiological. This biochemical error has not been identified as yet, but it is passed down from generation to generation. The person has poor coping skills and a faulty perception of reality. He will deal with his addiction through rationalization and denial.
Denial is the main coping mechanism of substance abusers. The process starts very slowly. First they think stress is the problem. Then they blame the wife, husband, children, teachers or boss. They excuse their behavior and can no longer tell what is real or what is imagined. As long as there is denial, the very things they are trying to avoid—pain and loneliness—become the result.
Sam is addicted to drugs and as a result has had many unfortunate experiences. He makes excuses and always has someone to blame. He does not seek help because of shame, fear and confusion. He rationalizes that he can handle the drugs. He doesn't recognize his gradual loss of control and has a long lists of alibis. The fact that he is dysfunctional and unable to hold down a job is explained away with "the boss doesn't like me," or "they don't give you decent material to do a good job." He is conscious only of his need for relief and the obsessive desire for the drug.
Denial can be said to be a character trait of the substance abuser. Drug use can be seen as the only way the addict knows how to survive. It is used to ward off painful reality and low self-esteem.
Because of his denial, the person is totally unaware of how the addiction affects every aspect of his life. Loss of job, trouble with the law, dissolution of marriage, strained relationships with family, loneliness and isolation—none of this is acknowledged by the substance abuser.
Drug choice is determined by availability, cost, or it may be only a matter of environment. Anyone who lives with people who indulge in alcohol frequently, or who finds himself in the company of people who practice drug taking will find it simple to ease into the habit himself.
Slowly over time, the person's addictive logic develops into a belief system. This delusional belief system controls the substance abuser's life, and the logic gives him a way to cope. The logic says, "I need this to feel better." One thing all substance abusers have in common is the need to feel good.
Because substance abusers experience a mood change when they take the drug, they feel their emotional needs have been met. This is an illusion, an illusion of relief and fulfillment. They are really building a defense system to protect the addictive belief system against criticism from others. This defense system is the reason it is hard for the addict to end the addiction.
Many addicted people recall being depressed as children or during adolescence. When they experiment with drugs, the temporary relief from the depression is remarkable. But it is only temporary relief. The drug eases the depression and then aggravates it. A typical case history of this phenomenon could be Kurt Cobain's history. He was the leader of a rock group called Nirvana.
Kurt was a very sensitive, happy little boy of seven when his parents were divorced. He was traumatized by this occurrence. His grandmother said it changed him overnight. In high school, he began performing with a group of his friends. His haunting voice and talent with the guitar soon made him popular. But because of the "pain in the pit of his stomach" he spent his days drinking and doing drugs. He was quoted as saying, "Heroin is the only drug that quenched the fire in my gut."
The group was successful and traveled the world over. Kurt, however, continued in his addiction. After an overdose of tranquilizers and champagne, he collapsed and was in a coma for days. When he recovered, his wife and friends intervened and he entered Exodus Recovery Center, a drug treatment facility in Marina Del Rey, Calif. The tug of the addiction was too strong, however, and he left there after three days. He disappeared, and a few days later was found with a single shotgun blast to his head. Reportedly, his blood contained heroin and valium. He was twenty-seven years old.
This sad tale is reflected in the suicide note he left. "It's not fun for me any more. I can't live this life. I don't have the passion any more." Poor Kurt. He had a baby daughter he loved, a successful career, money, loving fans, everything to live for, but he couldn't pull himself out of the cycle of addiction. He was chronically unhappy, and nothing could fill that void except destructive drug abuse.
The substance abuser develops ritual-like habits in connection with taking the drug. These rituals are very important to him. He may always sit at the same table in the bar room at the same time every day and join the same friends. This connects and binds him to others with similar beliefs and values. Or it may be that the minute he gets home, he goes to the refrigerator, gets a beer, sits in the same chair and turns on a favorite television program. The substance abuser likes rituals. It strengthens the ties to what it represents. It is a value statement. Rituals give the illusion of stability.
There have been studies that support the theory that there is no addictive personality. The person's personality changes because of the addiction. When a person is preoccupied in addictive ways, it forces him to isolate himself from others. Some traits he may exhibit are impulsiveness, poor judgment, irritability, self-pity and sometimes the emergence of unreasonable resentments. It is a progressive, self-centered illness. If the person continues down this destructive path, his life will start to break down under the stress of pain, anger and fear.
Addiction is continually changing, and it inflicts continuous changes on the addict. Finally, physical deterioration will occur, and unless some kind of intervention occurs, death will be the last phase.
Why do people take drugs? They take drugs because they like the pleasant sensation it gives them. They feel stimulated, confident, alert and euphoric. All anxiety and inhibitions are gone. Their emotions are exaggerated by the drug, and they receive a feeling of intimacy in personal interactions. They are revived with energy and physical well-being. Music sounds better, colors are brighter, and a sense of awareness is heightened.
People drink alcohol because they like the taste. They want the change in their mood. They also look forward to the camaraderie of drinking with "buddies."
To cause harmful effects, a drug must have certain special characteristics. It must be desirable, dangerous, and promote dependence. It will cause the person to say, "I want it. I don't care what it takes to get it, I need it."
People sometimes choose to believe that any medication prescribed by a physician is harmless. This is not always true. Many prescribed medications are very addictive and potentially dangerous for the recovering addict.
When talking to a physician, some people do not reveal their dependence and their need to avoid mood-altering chemicals. An honest, open interview will alert the physician to the person's needs. Many over-the-counter medications which contain alcohol, stimulants or depressants have the potential to become addictive.
A person's occupation and stress at work can directly contribute to a drug habit. Availability of drugs to a nurse or physician can be tempting.
Dan was a young doctor who specialized in emergency room care. The hours were long, and the stress high. One day when he was especially stressed and tired, he gave himself an injection of Demerol. It immediately made him feel better, and soon an occasional shot became a frequent occurrence. This dangerous habit progressed until one of his co-workers became suspicious and reported it. Dan was immediately sent to a rehabilitation center and fortunately he got his life back on track. He changed his specialty to a less stressful area, thus putting himself out of harm's way.
People with chronic pain are especially vulnerable to addiction. The insomniac looks for help to sleep, and a habit soon becomes an addiction.
The role of the nurse in identifying addictiveness is important. Skillful assessment of the patient is her responsibility.
Addicts can be manipulative, so be certain to set clear and consistent limits. Patients in withdrawal are in an especially fragile state. It is important to know what drugs they are withdrawing from so that treatment can be initiated. They may complain of headache, insomnia, confusion, exhaustion. Document irritability, anxiety, diaphoresis or tremors. Any evidence of seizures requires immediate attention.
If the patient has taken a combination of drugs and alcohol, he may go into respiratory arrest or develop dysarryhthmias secondary to overdose. Close observation is necessary.
It is the patient who comes in with another medical problem who will require keener attention. The patient's personal and family history is a factor in determining addictiveness. If he is awake, ask him if he takes drugs and what kind. Ask him what he does when he is stressed. How is his relationship with his family?
Assess his effect. A depressed person will have a flat or blunt effect. Talk to him about his current life situation. What does he do for relaxation or fun?
Understand that substance abuse is a maladaptive coping mechanism. Every person is entitled to kindness and respect. No matter what your personal attitude is toward drug addiction, you should put it aside. Talk to the patient in a matter-of-fact voice. You can alienate a person with your body language. He may rebuff your support, but let him know you care. Provide information about support groups. Your assessment, along with competent, empathetic care and referral can help the patient win his personal battle.
The nurse has an opportunity to make a significant impact on the patient, and with emotional support, counseling and treatment, can make the difference. Treatment and recovery are possible.
Addiction is the compulsive act of doing or using something out of habit, and the common element is that the addict engages in a relationship with the object, event or substance to produce a mood change.
There are three stages of addiction:
| STAGE I | The person experiences the high or mood change upon ingesting the drug. This feeling gets mistaken for intimacy, social comfort, or any number of things. The addict seeks serenity through a chemical. Denial is a coping mechanism, and drug tolerance is increased. The addictive cycle accelerates and continues because the person is getting the illusion of relief. |
| STAGE II | A behavioral dependency develops. Efforts to control or stop the drug use are futile. The person becomes committed to the addictive behavior. He blames others, lies, starts to ritualize the behavior, and the delusion or belief system is entrenched. Pain and anger fuel the process. He cannot maintain an intimate relationship with a person, and all energy is focused on the substance abuse. |
| STAGE III | This is where the addict experiences a breakdown in lifestyle and may lose his job, family and home. The substance abuser's addictive logic distorts reality and he continues to blame others. Physical deterioration happens, and unless intervention occurs, death or suicide is the end result. |