As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
According to the National Institute of Drug Abuse, addiction is defined as, “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.”
People may be addicted to a variety of substances such as: alcohol, cannabis, hallucinogens, stimulants, and prescription drugs. Current data suggests that opioid and heroin abuse is on the rise and of concern across the United States. Data as recent as 2013 suggests that in the United States, as many as 24 million people aged 12 and over report using “illicit” or illegal substances.
Origins of Substance Use
Most often, substance abuse and addiction start with voluntary use. On occasion, introductions to substances may include peer pressure, coercion, or even force. Recreational use can turn into substance misuse, or addiction, depending on a wide range of risk factors. Some risk factors include:
- The availability of drugs
- Family use or history of addiction (and biological predisposition)
- Lack of a support network (or in youth, parental supervision)
- Poverty
Use of substances can produce both immediate and long-term results in certain cases. Short term effects may include everything ranging from dissociation to euphoria to impaired cognitive function and hallucinations depending on the substance used. It has been found that long-term use or misuse of certain illicit drugs may exacerbate other mental or emotional conditions. Potential long-term consequences of illicit drug use are:
- Memory issues or deficits
- Declining mental function or difficulty concentrating or processing information
- Negatively impacted decision-making or problem solving skills
- Learning difficulties
Diagnoses of Substance Use Addiction and Addictive Disorders
Some of the most common addictive disorders include Alcohol, Tobacco, Cannabis, and Opioid Use Disorders among others.
Alcohol Use Disorder
Alcohol Use Disorder, more commonly known as alcoholism, is characterized by an ongoing pattern of use of alcohol despite negative consequences. These can cause both internal or external distress or impairment and may influence areas such as personal relationships, work, or other social obligations.
In addition to the negative consequences that come with persistent alcohol use, those with Alcohol Use Disorder may also find themselves spending a significant amount of time thinking about alcohol or ways in which to acquire alcohol, but this may not be the case for all.
Over time, individuals also experience a need to drink increasing amounts of alcohol in order to reach the substance’s effects, known as tolerance. Withdrawal is also a hallmark of Alcohol Use Disorder and may include symptoms not limited to nausea/vomiting, insomnia, anxiety, hallucinations or other unexplained sensations, hand tremors, and seizures.
Tobacco Use Disorder
The characteristics of Tobacco Use Disorder are very similar to Alcohol Use Disorder. Those diagnosed with Tobacco Use Disorder may experience negative consequences of ongoing use such as disruption in social, employment, or home obligations. In addition, use may persist despite those negative consequences.
In addition, the concepts of tolerance and withdrawal are also present. Individuals with Tobacco Use Disorder may need to use increased amounts of tobacco to get the same desired effect or may get no desired effect for continued use of the same amount of tobacco.
Cannabis Use Disorder
Similar to other addictive disorders, individuals with Cannabis Use Disorder may experience an increased tolerance for the substance as well as difficulty in cutting down or stopping use. Individuals with Cannabis Use Disorder may find themselves increasingly absent from social engagements or other obligations. They may also experience disinterest in other recreational activities, which may lead to increased isolation from others and declining relationships. Additionally, due to ongoing misuse they may also experience difficulty at home, work, school, or other obligations.
Individuals who misuse cannabis also experience withdrawal effects when they stop using the substance. Examples of withdrawal symptoms can include irritability, aggression, anxiety, depressed or low mood, restlessness, decreased appetite, and weight loss. Other physical symptoms such as general discomfort, sweating, fevers or chills, headache, and more may also be experienced.
Opioid Use Disorder
Opioid Use Disorder involves the persistent use of opioids (e.g. Vicodin, Percocet, etc.) despite the negative consequences associated with addictive disorders, which have been mentioned previously. In addition, those with Opioid Use Disorder may also misuse substances in environments that pose a significant risk of physical harm.
Inhalant Use Disorder
Although not as common as some of the other addictive disorders mentioned here, Inhalant Use Disorder can also be very dangerous and disruptive to an individual’s life. Individuals who live with this condition may find themselves using more of the substance than initially desired, implying a lack of control with their use. They may experience cravings, or urges, just like other addictive disorders and may experience similar life disruptions, such as difficulties in their home, school work, or other obligations. They may also continue to avoid and isolate from others. Individuals who use inhalants may also experience physically negative consequences, yet continue with their use. Increased need for greater amounts of inhaling substances is also a feature of Inhalant Use Disorder.
Treatment
As addiction is thought of as a chronic condition, it has been considered a condition without a true cure. Individuals who move through treatment may instead set their sights on an ongoing process of behaviors that maintain abstinence from the drug, or in some instances, reduced consumption. This process of maintaining the benefits and positive changes following treatment is called recovery.
Medical Treatment
Substance misuse and addiction can lead to a variety of health problems such as heart conditions, and liver and kidney function decline. As such, primary medical services, and even sometimes, crisis intervention is needed. Overdose, or acute intoxication, can be incredibly dangerous and require emergency medical services and immediate detox.
For some misuse, short-term hospitalization is indicated. However, in other instances longer-term treatment such as a detox program are needed. Due to the dangerous effects of withdrawal, certain cases may require around the clock medical supervision. In some cases, withdrawal can be deadly.
In some instances, a higher level of care than outpatient, or in-office therapy, is indicated. Those who do not require medical detox but can’t be fully served by traditional outpatient therapy may benefit from an intensive outpatient program, also known as partial hospitalization, which provides a higher level of care. Your therapist may recommend these services in addition to outpatient therapy.
Due to the co-occurrence of other conditions, medications such as mood stabilizers, SSRIs, and antipsychotics may be recommended for those living with addiction disorders. Additionally, some medications that de-incentivise addictive behaviors may also be prescribed, depending on individual circumstances.
Therapy
Talk therapy is often a form of treatment for addictive disorders and substance misuse. Both individual and group therapy, as well as self-help groups such as Alcoholics Anonymous may be recommended for best results, depending on an individual’s needs.
Cognitive Behavioral Therapy or CBT is often a hallmark treatment for addiction. With this approach, a mental health professional will help someone who is addicted identify triggers for use and healthier coping strategies to replace urges to use. Some therapists are also trained and adept at helping increase motivation to avoid undesired substances. Surprisingly to some, your therapist may also talk with you about your motivations and the benefits of use. This can often be very helpful in individualizing treatment and creating stronger alternative coping strategies.
Homework between sessions may be a large part of addiction treatment as environment plays an important role in the ability to maintain abstinence or sobriety.
A note about relapse
As addiction is commonly thought of as a lifelong condition, and the process of recovery ongoing, it is common to experience relapse. Relapse is commonly defined as a “slip up” or sliding back into undesired behaviors (substance use/misuse). Relapse is a common experience among those who live with addictive disorders and is thought of as a common and expected part of substance abuse treatment among medical and behavioral health providers. With proper support and intervention, people living with addictive disorders can successfully navigate the sometimes tenuous process of recovery, and relapse.
Relapse prevention medication may help deal with cravings and help manage some of the deficits created by substance use. Currently, relapse prevention medications exists for those living with addiction to opioids, tobacco, and alcohol.
The Harm Reduction Philosophy
In addition to traditional psychotherapy techniques, some therapists are trained in a philosophy called harm reduction that does not require complete abstinence from the addictive substance(s). Mental health professionals trained in harm reduction are also taught skills to help increase motivation in working towards your desired relationship with whatever substance you may be struggling with. Harm reduction can help you create a new relationship with substances overall, as well as better help empower you to make conscious decisions about your level of use. It will also aim to increase overall safety and decrease negative consequences of substance use.
Support Groups
Support groups are one of the most recommended interventions for individuals in recovery from addictive disorders. Support groups such as Narcotics Anonymous, Alcoholics Anonymous, and Cocaine Anonymous offer a safe space for ongoing support where individuals are led by peers in recovery. In addition to these groups, Al-Anon family groups provide support for loved ones and family members of those living with alcohol addiction as they recover as well. In some locations, you may also be able to find Nar-Anon (narcotics anonymous) groups for loved ones and family members of those living with narcotic addiction.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions You Might Have For Your Talkspace Therapist
- How do my family dynamics affect my addiction?
- Would harm reduction help me?
- How do I find a support group?
- What kind of homework are you going to give me?
- What happens if I relapse?
Sources
Abuse, N. I. (n.d.). Treatment Approaches for Drug Addiction. Retrieved April 27, 2017
Abuse, N. I. (n.d.). Understanding Drug Use and Addiction. Retrieved April 27, 2017
Abuse, N. I. (n.d.). What are risk factors and protective factors? Retrieved April 27, 2017
Association, A.P.. "Substance-Related and Addictive Disorders." Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 227-283.