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Substance Abuse

"The Incurable Malady or Is It?"
By: Ivan Olegario, MD, MDevComSubstance Abuse

With the Philippines at war with drug addiction, many have asked whether this is a war of futility, or not. Besides, hasn’t this problem been around for centuries? And hasn’t more developed countries fought this menace before, and failed?

This article will not go into the politics of things, but will instead look at hard facts. To begin with, I offer you two:

Fact 1: Substance abuse ruins lives. Whether we are talking about alcoholism, nicotine addiction, or illegal drug use, substance abuse has lead millions of people worldwide into illness, poverty, and death, dragging their loved ones along with them down a painful path.

Fact 2:Helping substance abuse sufferers is a worthwhile endeavor. This point, we will discuss later in more depth.

What is substance abuse?

  • Substance (or drug) abuse and drug addiction are two different but closely related things.
  • Substance or drug abuse is the use of a drug in amounts or with methods that are harmful to themselves or others.
  • Addiction is when a person becomes dependent on a substance, such as alcohol, nicotine or illegal drugs, and this is usually characterized by unpleasant symptoms when they are unable to take the said substances.

While both are harmful by definition, addiction can be so much more harmful in the sense that the addict has an impaired capacity to stop the harmful behavior.

The National Institute of Drug Addiction (NIDA) has a slightly different definition of addiction: “Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” According to this definition:

  • Addiction is a prolonged brain disease.
  • It is prone to return.
  • People with addiction have difficult-to-control urges to look for and take drugs.

NIDA adds: “It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting and can lead to the harmful behaviors seen in people who abuse drugs.”

Not everyone agrees with the definition of NIDA. In an article published in the Scientific American, Dr. Sally Satel, an expert in psychiatry at the Yale University School of Medicine, hesitates on fully adapting the definition of NIDA. She explains that the term "brain disease" makes it seem like drug addicts are helpless victims to their disease. She emphasized that drug addicts can undertake many methods of battling drug addiction—a stance that the NIDA agrees with. In fact, many people who were addicts in their teens and 20s have been able to overcome their addictions by the time they were 30s, all on their own (meaning, without professional help).

The last point is encouraging, but both Satel and NIDA emphasize that the best chances of success in fighting drug addiction are with the expertise and support of professionals and loved ones.

Curing the malady

There have been many studies already on drug addiction and most of these studies show that several factors contribute to the likelihood of success of drug addiction treatment and recovery: good self-control, a loving family, positive relationships, a nurturing community, education, etc. With all these several factors working together, it is almost impossible to say with 100% accuracy which drug addicts will succeed or not with professional help. Nevertheless, we can all agree on another fact:

Fact 3: All drug addicts can be helped (treated) and most have a reasonable chance of long-term success. However, many will require long-term support and lifelong abstinence (not even a milligram of drug) on the part of the drug addict. Nowhere is the saying “Success is falling nine times and getting up ten” more relevant than in the treatment of and recovery from drug addiction. Interestingly, this quote has been attributed to Jon Bon Jovi, founder and frontman of the rock band Bon Jovi. He admitted to taking drugs very early in life but was able to stop early as well.

Experts admit that relapse (return of symptoms, such as drug cravings and actual drug use) is common. However, they point out that the relapse rates of recovering addicts are just as high as the relapse rates of other chronic diseases, such as diabetes, hypertension (high blood pressure), and asthma. If we don’t give up treating these diseases despite relapse, why then should we give up when a drug addict relapses? It is therefore emphasized: Relapse does not mean treatment failure. Instead, it means that treatment just needs to be revitalized or reinforced, or adjusted, perhaps with the addition of other forms of treatment.

Treatment cocktail

As with many severe, chronic medical conditions, the use of more than one treatment intervention is beneficial. These interventions can be mixed and matched, based on the specific characteristics of the drug addict and his/her addiction, preferably under the supervision of a professional such as a psychiatrist or therapist. These include:

Behavioral therapies. These are treatments that attempt to change the behaviors of people with drug addiction. For example, since emotional stress is an important trigger of drug cravings, a form of behavioral therapy could be relaxation techniques to cope with emotional stress. Other forms of behavioral therapies may be used to squash cravings, while others may be used to heighten self-control.

Cognitive Behavioral Therapy adds a more mindful component to behavioral therapy. In this treatment, the drug addict is assisted into changing his/her way of thinking about drug use. An example would be mind exercises such as mental visualization that will raise the awareness of situations that could lead to drug cravings and active avoidance of such situations. These exercises can also be used to visualize coping mechanisms, such as visualizations of “saying no to drugs” or “feeling disgusted” at the thought of drugs.

Contingency Management is a systematic use of positive reinforcement (rewards or privileges) for remaining drug-free, or for attending and participating in counseling sessions, or for taking treatment medications as prescribed.

Motivational Enhancement Therapy is interventions that aim to boost a person’s motivation to stop drug use and enter treatment. These could include “intervention” sessions where family members and loved ones all converge to coerce a drug addict to accept therapy.

Family Therapy is most useful for youth addicts, or those where the drug problem is rooted in poor family interactions.

Additionally, medications can be used to treat negative withdrawal symptoms experienced by the addict as the drug leaves the addict’s system.

In closing, experts, including both NIDA and Dr. Satel, highlight that recovering from addiction requires strong self-motivation. This can be done with the realization that their lives, their future, and those of their loved ones, are being hurt by drug addiction. With the right attitude, lots of support from loved ones, the right professional help, and tons of patience and dedication, substance abuse is now a curable malady for many.

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