Substance abuse is a problematic concern in the United States today. According to the National Institute of Drug Abuse (NIDA), in 2017, approximately seven percent of the United States population was identified as having some type of substance abuse disorder (Boland et al., 2022). As we examine the cause, it is often linked to biological and environmental factors. These factors may include a person’s genetic makeup, developmental stage, gender, or ethnicity, which account for forty to sixty percent of substance abuse addiction (“Drug Misuse and Addiction,” 2020). There is a greater risk of substance use and dependence among individuals with a known family history, teenagers, individuals with mental health disorders, and men also have a high incident rate than women (“Drug Misuse and Addiction,” 2020). Combining genes with factors such as lack of parental supervision, peer pressure, the desire to experiment, poverty, witnessing violence, abuse, and easy access to substances also often leads to substance abuse and addiction (“Drug Misuse and Addiction,” 2020). There is no cure for addiction, but there is a treatment to manage the problem. People with a history of addiction are at risk of relapsing at any time. It is a continuous battle but can be stabilized with the appropriate treatment (“Understanding drug use,” 2022).
Physical and Mental Findings
Alcohol use disorder has contributed to approximately 88,000 deaths in the United States annually and is known as the fifth leading factor for premature death and disability worldwide (Boland et al., 2022). The are several potential mental and physical findings when examining a patient with alcohol abuse. Alcohol can cause impaired thought processes and judgment based on the alcohol’s blood level. As the level increases, clumsiness and motor incoordination become a concern. With a blood level of 0.2 percent, a depressed mood may be present, and as the level rises even more, the person may become confused or fall into a coma. The patient may complain of tiredness during the day even though alcohol causes one to relax; it is known to cause periods of awakening with decreased long periods of sleep (Boland et al., 2022). Alcohol also affects the liver by increasing levels of fats and proteins, causing fatty liver, alcoholic hepatitis, or cirrhosis. If the patient presents with abdominal or epigastric pain symptoms, then gastritis, esophagitis, gastric ulcer, or other concerns should be considered. Since alcohol decreases absorption and food digestion, the patient often has a vitamin deficiency, poor nutrition intake, and hypoglycemia (Boland et al., 2022). Alcohol use and abuse affect the body in many ways, and presenting symptoms should not be overlooked.
Triggers to Compulsive Substance Use
Addiction is a chronic disease that is difficult to control even when there may be harmful consequences (“Understanding drug use,” 2022). Triggers to substance addiction and compulsive substance use are often due to stressful events such as physical, mental, verbal, or sexual abuse, poverty, the environment, and peer involvement. If there is easy access to the substance and others are using it, it is hard for someone with an addiction to walk away and have self-control. As previously mentioned, it is an ongoing battle to fight addiction because of the changes to the brain that substance abuse has caused.
Neurobiological Mechanisms to Addictive Behavior
The neurobiological mechanisms that underlie addictive behavior are the substance’s effect on the brain’s “reward circuit,” causing increasing dopamine. The increasing dopamine in the reward system causes pleasurable behaviors to cause craving and repeat use of the drug. With repeat use of the drug, the brain adapts to it, and the reward system cells begin slowly responding, leading to tolerance. The slow reward system response and tolerance cause the craving for more substance to get the feeling they did when first using. As the abuser continues to use the substance, a decrease in learning abilities, judgment, decision-making, stress tolerance, memory, and behavior changes are seen due to brain chemical and circuit changes with long-term substance usage (“Understanding drug use,” 2022).
Medication Treatments and Psychotherapeutic Interventions
When treating a patient with substance abuse and addiction, it is essential to ensure they are medically clear and stable. There are several medications used to treat alcohol dependency. Naltrexone blocks opioid receptors causing a decrease in alcohol cravings and heavy drinking (Boland et al., 2022). Acamprosate is an N-methyl-D-aspartate (NMDA) receptor antagonist, which assists in decreasing mood swings, anxiety, and insomnia associated with alcohol withdrawal symptoms (Boland et al., 2022). The third medication is Disulfiram, an alcohol-sensitizing agent causing flushing, sweating, nausea, and tachycardia if taken with alcohol. These symptoms hopefully decrease the desire to consume alcohol and hopefully support the patient in abstinence (Boland et al., 2022). Medications are essential to treatment, but inpatient or outpatient treatment programs, psychotherapy, and support programs such as Alcoholics Anonymous (A.A.) are also vital to recovery. Therapy sessions such as Cognitive Behavior Treatment (CBT) help the client recognize mal-behaviors and examine ways to change. The goal of these sessions is to learn how to function without a lifestyle of alcohol abuse. The A.A. meetings also help patients build a relationship with peers for group support without the use of alcohol (Boland et al., 2022).
In treating opioid abuse, methadone can be given in the inpatient or outpatient setting and is considered a synthetic narcotic substitute for heroin. Studies have shown a decrease in heroin and illicit opioid use with compliance with the medication (Boland et al., 2022). Buprenorphine can also be used for opioid abuse treatment. The drug is an opioid agonist that can be given as a monotherapy or in combination with naltrexone. Buprenorphine can be given inpatient and outpatient. However, if given outpatient, it should be under supervision because of the risk of the first dose causing withdrawal symptoms (Boland et al., 2022). As mentioned in treating alcohol abuse, psychotherapy and support groups are also essential to treatment. These sessions may include CBT, individual and family therapy, social training, and support groups such as Narcotics Anonymous (Boland et al., 2022).
Boland, R. J., Verduin, M. L., Ruiz, P., Shah, A., & Sadock, B. J. (2022). Kaplan & Sadock’s Synopsis of Psychiatry. Wolters Kluwer.
U.S. Department of Health and Human Services. (2020, July 13). Drug Misuse and Addiction. National Institutes of Health. Retrieved September 21, 2022, from https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
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