Substance Abuse Treament

History and present of substance abuse

The substance described in this article refers to an antipsychotic substance that is usually classified as a drug, not medicine used for medical purposes.

Substance use has long been in the history of mankind. Excluding alcohol abuse, there are records of marijuana use in Chinese ancient medical literature thousands of years ago. There are records in the West that opium was used as a substance 3,500 years ago. In South America, substances such as cocaine extracted from coca, mescaline extracted from cactus, and psilocybin extracted from mushrooms have been used.

Substance use began to become a social problem, starting from the 1800s, when synthetic materials using the chemical structure of these substances were developed and available for mass distribution. For example, morphine was made from opium or heroin was developed, and cocaine was widely used as it was manufactured and sold by pharmaceutical companies. Amphetamines have been widely used since the mid-20th century, and methamphetamine began to be abused at about the same time. As the side effects of substance abuse gradually emerged, active control of substance abuse began to be established in most countries, and the legal system for overall control was established in the 1960s.

Causes

The problem of substance abuse is difficult to explain for just one reason. The causes vary from person to person, and there are many exceptions beyond the general case. Substance abuse is a combination of physical, psychological and social factors. Substance use is affected by personal past history and direct precedent events related to abuse. Substance use has immediate consequences, which have rewarding consequences and negative experiences. Rewarding consequences are a positive experience with substance use, such as feeling better or getting out of the withdrawal phenomenon, resulting in repeated substance use. Others use substances to avoid negative experiences, in which cases substances are used as a tool for temporary escape.

1. Biological causes

The use of substance causes physical changes. If a substance is used continuously, it may cause a permanent change in the brain and tend to rely on the substance. The degree of change by substance varies from person to person. For example, genetic factors can easily lead to substance abuse. In general, when a substance is used for the first time, if the person feels stronger pleasure than other people, or if negative feelings such as anxiety, depression, and tension are greatly reduced, these people may be genetically vulnerable to substance abuse.

When an addictive substance such as a drug is used, a neurotransmitter called dopamine is secreted from the brain, which temporarily improves mood. However, as time goes on, the feeling of depression, anxiety and other unpleasant feelings develops, and the addict finds the substance. The problem is that long-term abuse can lead to changes in the brain’s nervous system by substance use. When the substance is used, the changed nervous system persists for a long time, so even if the substance is discontinued for a long time, it is easy to return to the substance-dependent state when the substance is administered again. In other words, even a smoker who has quit smoking for 30 years can easily revert to the previous amount of smoking if he starts smoking again.

2. Psychological causes

Substance is one of the pleasure pursuit tools, and it has aspects that conform to human nature. In particular, early psychological studies studied substance abuse based on these principles of pleasure. In other words, researchers thought they used substances to relieve individual painful emotions and pursue pleasure. However, recent researchers believe that addicts use substances to address personal deficiencies. In other words, because people who use substances lack the ability to resolve painful feelings personally, or the ability to overcome their deficiencies physically, socially and professionally, they use substances to compensate for these deficiencies. In this regard, the theory that personality problems lead to substance abuse is also being proposed.

Substance abuse or dependence is common in adolescents and people who are personally immature. People who do not personally respond to social needs and who cannot adequately deal with internal conflicts or personal impulses are likely to fall prey to substance use. The personality traits of substance abusers published in many studies show that they are impulsive, curious about new experiences, rebellious against social norms, and lack the ability to accommodate frustration. Some have antisocial qualities, have been characterized by aggressiveness since childhood, and are often found to be cruel and violent.

It is also often seen as a family trait. It is very likely that your child will use the substance, especially if the parent is a substance abuser. It will also involve genetic factors, but the environmental impact of the family will not be negligible. In particular, relationships with parents are very important, and issues such as abandonment, divorce, overcontrol, abuse, and overprotection, as well as the death of parents, can lead to substance abuse. It has also been reported that it occurs in families that suppress children’s independence, or in families that do not have adequate fatherhood (eg, authority, dignity, standards). In addition, some families are too compliant with the dysfunctional family relationships caused by substance abuse, fearing new changes and tolerating substance abuse.

3. Social causes

Social factors such as social attitude to substance use, awareness of harm, peer reactions, legal and moral levels, substance price and availability can have a significant impact on substance abuse. These factors also have a significant impact on the transfer of alcohol, tobacco and marijuana to more dangerous substances such as cocaine and opiates. In particular, in the case of alcohol, it is reported that social, family, and religious environments or cultural traditions encountered during childhood are closely related to the occurrence of disorders related to alcohol use in adulthood.

Most environments in which substances are abused are said to have a high crime rate and unemployment rate, a disturbing social atmosphere, little hope, and a sense of defeat. It is also reported that people living in poor economically areas abuse substances to deny their despair.

In addition to the overall social climate, attitudes toward substances in small groups, such as the workplace or the home, can also be an important factor. A group that continues to have a culture where drinking or smoking is accepted as a symbol of masculinity is likely to promote the problem of drinking or nicotine abuse.

Indirect promotion of substances through mass media can also lead to abuse. Smoking or drinking scenes on the air can exacerbate the problem of abuse and curiosity for adolescents. However, if only social factors are too focused, substance abuse can be misunderstood that each individual is just a victim.

Diagnoses

In terms of substance use, the term of medical purpose and the term of the general public are mixed and the concept of this is often used vaguely. The term ‘addiction’ in society is not a medical term in a strict sense. As a medical term, ‘addiction’ refers to acute toxic state caused by substance. When people say that they are addicted to alcohol or drugs, the terms ‘abuse’ and ‘dependence’ are medically used. Here, we will focus on the concepts used medically.

1. Substance intoxication

Addiction, as the general public says, is a medically dependent state. In contrast, medical addiction is a condition in which a person’s characteristic symptoms after a certain substance is consumed are acutely induced. For example, in an amphetamine or cocaine addiction, an individual may have symptoms such as a faster pulse, enlarged pupils, increased blood pressure, sweating, or feeling cold. In the 10th edition of the International Classification of Diseases (ICD-10), addiction is defined as a condition in which disorders of consciousness, cognition, perception, emotion, behavior, psychophysiological function and response are temporarily caused by the substance administered.

2. Substance abuse

Substance abuse is the act of using a substance or administering a substance by itself in a manner that deviates from social norms, in addition to the medical purposes recognized within the culture in which you live. For example, a student preparing for an exam uses a stimulant to wake up. In other words, it is a case where an abuser knows that the use of the substance is basically harmful, but uses it for non-medical purposes.

3. Substance dependence

Frequently speaking socially ‘addiction’ is a substance dependence in medical terms. This condition develops resistance when a substance is chronically repeated, and when a substance is discontinued, a physiological or behavioral disorder characteristic of the substance appears. This is often called a withdrawal symptom. Some substances do not show unusual withdrawal symptoms, but the absence of this does not mean that there is no social harm. In addition, the state of dependence can be largely divided into physical dependence and psychological dependence. The absence of physical dependence does not mean that it is not a dependence state.

Physical dependence refers to a condition in which physical balance is broken by substance when an abuser repeatedly administers a specific substance. If the substance is discontinued, the broken state cannot be returned to normal immediately, resulting in an imbalance.

Psychological dependence means that when an abuser suddenly stops a substance while feeling psychological satisfaction due to the substance, he or she becomes psychologically uncomfortable. To resolve this, they constantly crave substances.

In most cases, a substance is often unable to be stopped because of fear of physical and psychological withdrawal symptoms rather than because of physical or psychological pleasure caused by the substance.

In the state of substance dependence, it shows the following characteristics.

1) Resistance

Resistance means that when the substance is used repeatedly, the degree of physical reaction by the substance gradually weakens, so that more than the original dose should be administered. For example, alcoholics feel better when they drink only one bottle at first, but as time goes by, the amount increases to two or three bottles to achieve the same satisfaction. The degree of resistance may vary depending on the substance type and mechanism of action, and in some substances, the degree of resistance may not be severe. For example, cigarettes are often kept below toxic doses, so they may be classified as less resistant.

2) Withdrawal symptoms

Physical or mental discomfort may occur when a person who is constantly using a substance suddenly stops administering or reduces the dose. Symptoms of withdrawal may vary depending on the substance used, but most often cause an unpleasant feeling. Most of these withdrawal phenomena prevent the substance from being stopped and continue to be used. Common withdrawal symptoms include mental symptoms such as anxiety, irritation, depression and irritation, and physical symptoms such as cold sweat or tremors. Depending on the substance, a more serious aspect may appear.

3) Compulsive use

Compulsive use is when you know the substance has a problem and cannot stop using it. For example, alcoholics were only going to drink half a bottle of alcohol, but they drink until they get drunk. In another case, smokers exceed the target amount even though they set the amount of smoking at a rate of 5 per day. In most cases, individuals try to control their use, but often do not adequately suppress it. It also takes a lot of time trying to save the material. Because of this, abusers give up or reduce important social, professional or recreational activities.

One of the characteristics of compulsive use is that you know that the substances you use are disrupting your health or other social activities, and you continue to use them.

Treatments

Since each substance has its own characteristics, treatment in the acute phase should be performed according to the characteristics of the substance. In addition, if there is another substance that has the effect of blocking the action of the substance being abused, administration of the substance with this blocking effect helps to suppress abuse of the substance being treated. Comprehensive treatment options for substance abuse include:

1. Motivation

At the same time, patients who want treatment need to stop the substance. Also, in many cases, they are treated under external pressure (family, work, social, legal, etc.) rather than voluntary treatment. In this case, the patient is likely to refuse treatment itself. Therefore, it is the beginning of treatment to motivate the patient to participate in treatment voluntarily.

2. Response training

The majority of substance abusers often use substances to conceal their defects. Therefore, it is helpful to acquire skills to respond appropriately to the social environment to reduce mental stress. In addition, self-learning in which situations the patient will use the substance and training appropriate countermeasures to avoid these situations can help prevent recurrence.

3. Suggestion of alternatives

The majority of substance abusers often segregate themselves from society and families and are trapped in a world of their own. Therefore, it is necessary to learn how to communicate with people around them through social relations and provide alternatives to find pleasure other than substance. Abuses need encouragement and support from people around them to act as a member of the family and society.

4. Relieving painful emotions

One of the main reasons why abusers fail after deciding to stop a substance is the unpleasant feelings arising from substance cessation. Therefore, the people around the abuser must help the abuser adapt to unpleasant emotions and help them understand and overcome the causes of those emotions.

Substance abuse or dependence is a disease that goes beyond the will of an individual. It’s not just that the abuser is unable to quit because of a weak will or personality problem. Therefore, if it is determined that the abuser is already addicted, the people around the abuser must seek professional help. It is important to be evaluated by experts because each person has different causes of falling into toxic substances. If found early and treated appropriately, the likelihood of an abuser recovering increases.

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