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Reasons for Using Substances

Contributor: Yvette McBride Thomas

People like to feel good. Many experiences in our world are geared toward altered states of consciousness–natural highs. These “natural highs” are derived from many experiences: roller coaster rides, skydiving, white water rafting, dancing, or anything else that can produce an adrenaline rush. Our enjoyment of these sensations begins at an early age. Small children will spin around in circles or scare each other in order to feel this altered state of consciousness. Unfortunately, “artificial highs” from drugs or alcohol are easier to obtain than natural highs, and drugs are readily available to children at an early age. The following seem to be the most common reasons for drug use today.

Parental or Guardian Influence

As seen in the previous section, the “pill for every ill” attitude that is seen in the home has a major impact on children. Approximately 80% of children’s values, morals, work ethic and attitude are derived before age 8. A child is exposed to his/her parents for the majority of his/her life before age 8. Therefore, parents will have the greatest influence on their children. A child learns many lifelong habits and attitudes from his/her parents. Unfortunately, in about 80% of cases, a child’s first exposure to alcohol and drug use is in the home. Children may see a parent drinking alcohol, popping pills or doing other drugs. Parents may have a liquor cabinet, a steady supply of beer in the refrigerator, or other drugs in the home. The influence of a child’s parents cannot be emphasized enough. Parents need to understand this and be proper role models for their children. What is the subliminal programming that is occurring every time a child opens the refrigerator and sees beer? It becomes the norm. We are not saying that parents should never drink beer in the home, but rather that they must assess the role that alcohol plays in their home.

Unfortunately, too, some children are exposed to illegal drugs from the time of their birth. Worse, some are exposed even before birth, if the mother uses during pregnancy. Such babies may be born addicted to drugs (i.e., “crack babies”). Infants may be exposed to drugs in the mother’s breast milk or in the home environment. One client in drug treatment described a baby picture of himself, in which a bottle of beer and a marijuana “joint” were photographed with him in his crib. He grew up believing that drug and alcohol use was normal for everyone. He began using at age eight and was chemically dependent and involved in the courts by age 17. Another client in treatment, an adolescent, shared a story of being beaten by her father-for smoking his marijuana. She had the black eye to prove it.

Peer-Group Influence 

Most people are aware that during the adolescent years, a person’s most influential group is their peer group. When their peers are using substances, teens often feel a need to use them as well, in order to gain acceptance, to be “tight” with their friends. Using substances because “everyone else does” may not seem to be a valid reason to adults, but to high school and junior high students, it is compelling. Failure to join in can cause a teen to become an outcast from the group-the worst fate imaginable to many teenagers. So they will often do whatever it is that their friends are doing so that they can fit in.

Even “good” kids may submit to peer pressure. For many adolescents, using drugs or alcohol can make them feel rebellious, as if they are being independent and carving out their niche in the world. It may also make them feel “grown up”. As a person grows older, he/she may decide to continue using or to stop using for many different reasons. He/she may outgrow the peer group influence but may not outgrow the substance involvement.

To Get An Effect or To Get High (Pleasure)

The majority of people using substances do so to get the mood-altering effect or some type of pleasurable sensation. Many available substances will induce a feeling of euphoria. People who use substances for pleasure, who have few problems with their substance use, are often labeled “social” users. These individuals can drink or get high on weekends just to feel good and have no resulting problems. Other persons who get involved in this type of substance use will eventually develop major substance abuse problems. No one can predict before beginning use if he/she will become drug- or alcohol- dependent.

Curiosity and Boredom

Curiosity is the most familiar reason given for first trying a substance. Curiosity is quickly satisfied. Therefore, if the person chooses to continue using the drug, he/she does so for other reasons. With the current availability of many substances, people are aware that if they want to try substances, they can. Young people are naturally curious; they are attracted to new and exciting things. Adolescents want immediate gratification and often don’t look at the possible consequences. This also leads them into trying many different drugs, to experiment with the different highs. This need for immediate gratification also allows them to get bored very easily. Obtaining and using illegal drugs is often viewed as exciting or “cool” by adolescents and can take up a large amount of time, thus alleviating their boredom.

Internal Issues

Internal issues correlate with serious substance abuse problems. Internal pressures to use include: stress, low self-worth, depression, anxiety and nervousness. Low self-esteem has been found to be a major factor in an individual’s choice to begin using substances. Alcohol and drugs are called mood-altering substances for a reason. Drugs alter (change) the mood (emotions) of the individual. They may either exacerbate an existing problem or create a new one. Many drugs also contribute to additional internal issues, such as depression, anxiety, or low self-esteem. Once again, substances may provide an easy but temporary method of dealing with these internal issues but usually cause additional problems. Often, the user doesn’t realize that substance use does not solve problems. When the substance wears off, the problem is still present, and often there are additional problems resulting from the substance use.

External Pressures

An individual may use substances to escape external pressures. These external pressures–situations with which an individual may feel uncomfortable-may include school problems, work difficulties, family problems, peer pressure, relationship issues, etc. If an individual feels upset about a certain situation and gets drunk or high, he/she may feel relief from the problem. This escape, however, will only last for a limited period of time. When the individual is no longer high, the problem will return. Using drugs or alcohol as an escape is only temporarily effective–and very dangerous.

An individual may begin to regularly rely on the drug or alcohol as a coping mechanism. This leads to addiction and produces an individual who has no other coping skills for difficult situations. Often, the use of drugs creates additional external pressures and exacerbates the existing ones. A vicious cycle occurs: the individual uses drugs or alcohol to deal with existing problems and the use causes more problems. The individual then uses more drugs to deal with these new problems. This additional use then causes more problems, which leads to more use. It is a never-ending cycle of use and problems.


Understanding Substance Abuse and Addiction

Contributor: Yvette McBride Thomas

Intrapersonal Abuse and Addiction

  • Intrapersonal abuse involves the misuse of objects or substances that were produced for one purpose, such as healing (prescriptive medication) or entertainment (video games), but are exploited excessively to the detriment of the person involved.
  • The result is that often an addiction (a state of physiological or psychological dependence) occurs with excessive amounts of time and effort being devoted to the object or substance.
  • Three C’s of addiction conceptualize its core characteristics: loss of control over addictive behaviors; compulsive use; and continued use regardless of negative consequences.

Substance Abuse and Addiction

  • The habitual misuse of intoxicating and addicting substances, such as alcohol, drugs, and tobacco.
  • Drugs – any substance other than food that can affect the way a person’s mind and body works, including stimulants, depressants, and hallucinogens.
  • Abuse and addiction cause mental, physical, emotional, social, and spiritual damage.
  • A major public health issue found across all demographic areas.

The Nature of Substance Abuse and Addiction

  • Occurs frequently as a mental health problem in the US.
  • One of 10 adults in the US has a significant problem related to alcohol use.
  • Alcohol abuse/addiction is believed to be greater among Native Americans.
  • A significant percent of patients who are hospitalized abuse alcohol.
  • Health care costs are doubled among alcoholic families.
  • Drug abuse/addiction among adolescents affects development and well-being more than crime, social pressure, grades, or sex.
  • Approximately 3 million teenagers are addicted to or abuse alcohol,
  • Half a million are marijuana users, and
  • One out of 10 teenagers has tried cocaine.
  • Substance abuse/addiction affects more than just the individual.
  • Other than the abuser, up to four others are being adversely affected including family members, friends, or associates.

Polysubstance abuse/addiction

  • Abuse of two or more substances at the same time is a growing problem.
  • Social conditions may evoke other substance abuse/addiction, such as smoking.
  • Conditions related to smoking
    • Unsatisfactory life rooted in poverty and hopelessness
    • Peer pressure
    • Poor school performance
    • Parental smoking
    • Minority ethnic status
    • External locus of control
  • Addiction
    • A behavior pattern with biological, psychological, sociological, and behavioral components .
    • A persistent and intense involvement with and stress upon a single behavior pattern, with a minimization or even exclusion of other behaviors, both personal and interpersonal.
    • Addiction is characterized as a preoccupation with one object that controls behaviors and limits other actions over time.
  • Reference:
    Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.


    The Effects of Drugs

    • Drugs come from plants either as by-products of them or developed chemically.
    • In the US, $150 billion is spent on legal pharmaceutical drugs.
    • All pharmaceutical drugs have at least three names.
      • chemical name of a drug is the organic chemistry chemical description of the molecule.  Most will never know or understand this name of a drug they are taking.
      • generic name of a drug is the official name of the drug.  It is still a detailed chemical name but much simpler.
      • brand name is for a specific formulation and manufacturer.
    • The big difference between the generic name and the brand name is that a generic name is public domain while a brand name is trademarked by the company that developed the drug.  The developing company gets to name the drug but it must be FDA approved.
    • One drug can be a painkiller, a controlled substance, a schedule II substance or just morphine.
    • Categories of psychoactive drugs are:
      • stimulants
      • hallucinogens
      • marijuana
      • depressants
      • opioids
      • psychotherapeutics
      • nicotine.
    • All drugs have defining characteristics.
    • The Physician’s Desk Reference has color photographs of most legally manufactured drugs; it also includes information like dose and potency.
    • The placebo effect is usually thought of in terms of a sugar or fake pill.
    • Many drugs effects are influenced by the users experiences, mood, how tired they are, in addition to other substances in the system, such as food to other drugs.
    • Dose-response refers to the correlation between the response and the quantity of drug administered.
      • The response may vary due to factors such as tolerance.
      • With a dose-response curve we hope to be able to answer a verity of questions; from what is an effective dose or a lethal dose.
    • Toxicity, in early animal studies, is measured in how many animals die as a result of taking the drug.  After more studies, the therapeutic index is set as LD50 / ED50.
    • The margin of safety is the difference between doses necessary for an intended effect and toxic unintended effects.
    • Potency refers to the amount of drug necessary to cause an effect, while toxicity is the capacity of a drug to upset or destroy normal body functions.
    • The forms and methods of taking drugs greatly effect how the drugs will interact with the users system.
      • Oral ingestion is the simplest way the drugs enter the body, but also the most complicated way to enter the bloodstream. Oral ingestion must make it through the acid in the stomach while avoiding neutralization by food and drink.  When the drug gets past the stomach it still has to go through the liver, as well as other organs.
      • Inhalation is when the drug is smoked or “huffed”.  Nicotine, marijuana, crack are most effective when delivered this way.   It is also rapidly absorbed due to all the capillaries in the lungs consequently moving quickly into the blood.  This is the fastest way to get psychoactive drugs into the system.
      • Injection put the drug into the system as well.
        • Intravenous injection puts the drugs right in the vein, so the onset of the effect of the drug is fast.  You can so put a high concentration of drugs in because it does not have to pass through a membrane.
        • Intramuscular injection puts the drug into the muscle and subcutaneous goes just under the skin.
      • Topical application is not used as often because many drugs are not absorbed effectively through the skin.
    • After drug administration, the body eliminates the drug through metabolism and excretion.
    • The drug will either leave the system or be changed so much that it will no longer have an effect on the body.
    • Prodrugs have been developed to start working only after they have been altered by the body.
    • The body has adaptive processes such as tolerance and dependence to protect against potential harm.
    • With drug disposition tolerance the more the drug is used the faster the metabolism or excretion.
    • Behavioral tolerance (conditioned tolerance) is when the behavior of the user changes even if the bio-chemical reaction in the body does not. There is strong evidence that tolerance effects are maximized when the drug-taking behavior occurs consistently in the same surroundings or under the same circumstances.

    The Actions of Drugs – Slide show

    Drugs, Society, and Human Behavior, by Carl Hart, Charles Ksir, and Oakley Ray
    Drugs, Behavior, and Modern Society by Levinthal, C.

    Drug Use in Today’s Society

    • Drug use is taking an aspirin for a headache, or a single dose of cough syrup for a cough or a hit of acid.
    • How the drug is taken has an effect on how the body reacts.
    • How much and how often are points that make the difference between normal use and abuse.
    • Four principles of psychoactive drugs:
    1. Drugs are not bad or good; they are not evil, they are a substance. By itself a drug cannot do anything until it enters a body. Some drugs help the body function when taken correctly but can cause harm when misused or abused.
    2. Every drug has multiple effects. No part of the body works independently from the rest; all systems are connected. When a drug is taken it affects all parts of the body it passes through.
    3. Both size and the quality of the drug affect the effects of the drug. The better the quality, or the larger the dose the larger the response or the more severe the response.
    4. The effects of a drug depend on the person. Not only personality, but age, race, weight… all  of them influence how the body takes in and responds to the drug.
    • History tells us that humans have used, misused and abused some plants or substances for as long as humans have been around.
    • Four pharmacological revolutions
    1. 19th century – vaccines. This is the first time drugs were used to help stop the number one killers at the time: communicable diseases. For the first time there were drugs that were powerful and have selective beneficial effects. This helped people have faith in medicine stopping illness.
    2. WWII – antibiotics. Not only did they help cure diseases but also helped prevent infection. This got us to the point that we are now; we expect to take something to fix everything.
    3. 1950’s – anti-psychotic drugs. This was the first time that drugs were used to treat psychotic disorders. This changed the way people saw and treated mental illness. We have new drugs that effect how we think, our emotions, and perceptions.
    4. Oral contraception – now we have control of our body through chemicals. Some drugs are not meant to treat anything but to control and change the way the body was meant to work.
    • Then there were many social changes in the US: The Beatles, civil rights, Vietnam, LSD, etc. Drugs became more common and accepted.
    • In 1971 Nixon declared the first “War on drugs”; yet during this time the legal drinking age was lowered and penalties for having marijuana were eased.
    • In the 80’s tolerance lessened. The legal drinking age was raised to 21 again and penalties were stiffened on all drugs, including marijuana.
    • Perception of the risk – when the perception of the risk is low the use is high and vice versa. This differs from perception of availability.
    • Longitudinal studies are one way we have looked for antecedents of drug use.
    • Evidence tells us not to do things but we do them anyways; from eating too much, driving too fast,drinking too much, texting while driving, and driving while intoxicated
    • Cultural trends influence what drugs are being used.


    Drug Use: An Overview – Slide show (recommended)

    Drug Use as a Social Problem – Slide Show


    Drugs, Society, and Human Behavior, by Carl Hart, Charles Ksir, and Oakley Ray

    Drugs, Behavior, and Modern Society by Levinthal, C.


    Contributor: Yvette McBride Thomas

    Diagnosis— the meaning or interpretation that is derived from assessment information and is usually translated in the form of some type of classification system.

    • A description of a person’s condition and not a judgment of a person’s worth
    • A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are mental disorders that people have. For this reason, the text of DSM-IV…avoids the use of such expressions as ‘a schizophrenic’ or ‘an alcoholic’ and instead uses the more accurate, but admittedly more cumbersome, ‘an individual with schizophrenia’ or ‘an individual with alcohol dependence’” (DSM IV-TR, APA, p. xxxi).
    • Diagnoses are important for:
      1. Insurance company reimbursement
      2. Developing a proper treatment plan
      3. To be able to communicate with other professionals, counselors must be able to speak about, understand, or report a client diagnosis
    • Diagnostic decisions are an evolving process and not a static event.
    • Diagnosis and treatment planning are now such standard components of counseling practice that a failure to diagnose on some level or a lack of professional diagnostic training may be construed as unethical (p. 335).

    Nota bene:

    • Dual diagnosis—a substance abuse diagnosis with a co-occurring mental health diagnosis in the same individual.
    • Substance abuse counselors (e.g. LCDCs, ADCs) do not diagnose mental health disorders. We can only diagnose alcohol/drug addiction problems.

    Resource: Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.

    Understanding Addiction

    A competent substance abuse counselor must have a basic understanding of addiction. She/he must have knowledge about:

    • the terms and concepts related to theory, etiology, research, and practice,
    • criteria and methods used to evaluate models and theories (we should always question what we learn),
    • how to apply those theories and models appropriately,
    • how to access literature on addiction-related topics, i.e, research skills.

    While doing this, the substance abuse counselor must possess certain attitudes, such as:

    • being open to information that may differ from personal beliefs,
    • appreciate the complexity in understanding addiction,
    • value diverse ways of thinking expressed in theories and models,
    • flexibility to form personal concepts through critical thinking.

    The substance abuse counselor must be able to recognize the social, political, economic, and cultural context surrounding addiction and substance abuse. This is important because different living environments create the conditions for people to have both risk and protective factors that may lead to or prevent substance abuse and addiction. Knowledge in this area includes:

    • Concepts of social, political, economic, and cultural systems and their impact on drug use/abuse.
    • The history of licit and illicit drugs.
    • Risk and protective factors for substance use/abuse.
    • Statistical information about substance abuse disorders in the general population.

    Substance abuse counselors must be able to describe the behavioral, psychological, physiological, and social effects of all psychoactive drugs on the person using and significant others. Knowledge in the following areas is necessary:

    • Pharmacology of addiction.
    • Initiation, intoxication, harmful use, abuse, dependence, withdrawal, craving, relapse, and recovery.
    • The relationship of substance use and infectious diseases.
    • The relationship between substance use and mental disorders.

    Substance abuse counselors must be able to recognize overlapping symptoms for substance abuse, medical conditions, and mental disorders, also known as co-occurring/comorbid disorders, or dual diagnosis. Knowledge is required in:

    • Normal and abnormal human growth and development.
    • Methods from differentiating substance use disorders from medical conditions or mental disorders.

    It is important that the substance abuse counselor does not jump into conclusions before all the assessments and clinical evaluations are completed. Whenever a client’s case is outside of the counselor’s expertise, she/he must be willing to refer the client to the most appropriate care.

    TAP 21

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