Why do People use (abuse) drugs, alcohol and other substances?

Alcohol and drug usage has become a common practice in the lives of many Americans. I refer to the various "drugs of choice," including street drugs, prescription drugs, hard liquor, beer, wine and other forms of alcohol as "substances."

When clients question whether they are alcoholic or addicted to drugs, I often encourage them to explore the extent to which substance use interferes with their daily lives. Many people seeking treatment may already know they have a problem with substance use and abuse. For those who may not know or realize their addictions, ask yourself the following questions:

• Do I spend time thinking about using substances that I should be spending thinking about other things?
• Do I deliberately use substances to feel better, relaxed, more confident or less depressed?
• How often do I engage in the use of substances?
• How often is my drug and alcohol consumption a pre-meditated escape from my feelings?
• Have I experienced black outs or physical withdrawals?
• Have I been arrested for DUI, disorderly conduct or drug possession, or have I experienced other problems with the law?
• Have my credit and financial status been impacted as a result of my drug and alcohol use?
• Have I ever committed a crime as a result of being high or drunk or in order to get money to buy drugs and/or alcohol?
• Do I experience severe mood swings between euphoria and depression?
  Have my relationships deteriorated due to substance use?
• Do I need larger quantities or more frequent usage of substances in order to get the same result that I used to?

If you have answered yes to several of the above questions, you may have a substance abuse problem.
 

What is an addiction?

An addiction consists of an abnormally strong urge to repeat destructive behavior, becoming compulsive about the need to have a "fix" of something. Any such dependence has periods of physical and psychological rewards, but has serious negative consequences that most always outweigh the benefits. The addict will likely realize at times, that they are not only out of control, but that they yearn to repeat the set of behavior(s). The fact that they are self-destructing their life and in many cases destroying the lives those around them is secondary to the need to continue with the addictive behavior. An addict may very well want to stop the addiction, but feel they cannot.

How many cigarette smokers really want to continue smoking? Much of time, smokers will state that they want to quit, they have tried to quit, but they can't. They feel they cannot quit because they are physically and psychologically addicted to nicotine, as well as the whole smoking process (hand-to-mouth, anxiety reduction, etc). Not surprising, some smokers, drinkers, drug users and overeaters contend that they do not want to change their behavior.

Some alcoholics, drug users and over-eaters realize that they have an addiction. Those who admit they have a problem will likely also admit that they are unable to stop and probably have made unsuccessful attempts to do so in the past.
 Denial

People who participate in addictive behaviors, as in some of the examples described above, may not be able to admit they have a problem or do not recognize their substance abuse is a problem in any way. They may even see the damaging side effects of their behaviors, such as hangovers, financial upset, engaging in risky behaviors, marring their bodies or straining their relationships as acceptable. Denial is such a powerful defense mechanism that a false sense of control is often experienced by the addict. Until the substance abuser admits they have a serious problem, treatment is less effective . If an addict doesn't want help, treatment will probably be unsuccessful.
 

Treatment for Substance Abuse

"Abstinence," means voluntarily restraint. To abstain means to restrain oneself.
Can you refrain from the use of substances? Can you restrain your usage while using? If you cannot answer these questions definitively, ask yourself the following questions now:

• What drives me to use substances?
• Can I control my use of substances and my desire for more?
• Can I stop using substances without repercussions?
• Can I stop using substances through my efforts alone or do I need help?
• If I abstain from drugs and alcohol, does that mean my addiction is gone? 

Therapy can help you to answer these questions.

Substance abuse is really the manifesting symptom of a complex underlying series of problems. The drive to use and abuse substances usually stems from a need to mask feelings. This drive to feel a certain way (or not feel a certain way) can cause many difficult secondary problems. These mostly stem from disregard for responsibilities, family, friends, children, co-workers, and most of all, self.

The drive to get the substance and become soothed by the substance undermines personal success, growth and the potential to have real, satisfying relationships with other people. Life can be stressful, challenging and sometimes unfair to everyone. Therefore, there are times when negative emotions are appropriate. These can include but are not limited to: sadness, depression, loneliness, insecurity, fear, annoyance, hurt, rage, agitation, etc. . The addict gravitates toward the illusion of relief from these common unpleasant emotions through the use of substances.
 
 
The 12-Steps

One of the more common, successful treatments for alcoholism and substance abuse is the 12-Step Program. This philosophy has been applied to the recovery process for over 65 years. Since substance abusers and alcoholics isolate and may be accustomed to not talking, trusting, or feeling, attending meetings (small or large) with other addicts who are working through their recovery is a critical part of becoming sober. A sense of support and structure is often lost in the midst of substance addiction.

A 12-step program can reintroduce these components of healthy living. There are a wide variety of different 12-step meetings which are attended by a diverse cross section of persons in addiction recovery and are often focused on specific issues. 12-step followers are at various levels of recovery, such as length of time being sober and the level to which they have evolved away from their addictive lifestyle. The principles of the 12-steps are the same for most substances.

The premise of the 12-step philosophy is about taking responsibility for your actions and behaviors and accepting the consequences of addiction.

Addicted persons look for reasons and excuses to abuse their substance of choice. The majority of these reasons are projected upon others. Alcoholics Anonymous, Narcotics Anonymous and other similar "AA" recovery groups are aimed at reinforcing an individual's efforts to become sober and maintain sobriety. The first of the twelve steps is to admit you have a substance problem, taking some initial responsibility.

The idea of "turning over" the addiction to a "higher power" is also part of the acceptance that you really cannot change or recover successfully on your own. The subsequent steps follow-up until the addictive behaviors are "worked" through.

Some of the exercises and processes of the 12-steps, include behavioral exercises such as making inventories and keeping a journal. Logging the ways your addiction grew beyond your control and recording how other people/relationships were hurt and abused along the way can have great therapeutic value both through the process and in hindsight. Some of the larger meetings may have a guest speaker who will share stories about their personal recovery process.

Typically, you will find a "Sponsor," or mentor to assist you through your recovery process. A Sponsor is usually someone you may have met at one of the meetings who has experienced recovery and worked through the 12-steps themselves. Millions of people have become sober by adopting 12 step philosophies.

12-Step Programs and Psychotherapy

Private individual or group psychotherapy can be combined with 12-step programs to accelerate the recovery process.

 Co-Dependency

Similar in the way that people become dependent upon drugs and alcohol, they may also become addicted to other people. The term Co-dependency describes this condition. Co-dependents experience a fallacy of satisfaction by taking care of another individual. They alternate between devotion to and resentment of this person. Love/hate vacillation is common in all forms of addiction, hence the term "co-addict". Co-addict refers to the partner, spouse, significant other, friend or family member that enables the addict to continue to engage in their behavior.

A typical scenario might entail the caretaker walking on eggshells, covering up, hiding, cleaning, or taking whatever action is necessary to effectively maintain the substance abuser's addiction. Meanwhile, the Co-Addict or Co-Dependent (who could also be a substance addict themselves) "loses" him or herself emotionally with grave consequences. The Co-Addict feels a sense of resentment and develops a passive-aggressive response with increasing self-loathing. They are getting their rewards in a maladaptive fashion, by enabling another person's unhealthy, self-destructive behaviors. These negative feelings and reactions occur in lieu of setting proper boundaries **(See BOUNDARIES section for more details).

The caretaker expends energy nurturing others, at the expense of taking care of him or herself. Healthier boundaries would mean that the would-be caretaker lets the addict deal with their consequences and has clarity about who is responsible for the addict's behaviors. There is little or no gratitude for the caretaker's efforts, which can engender rage and resentment towards the addict. These destructive feelings end up "leaking out" somewhere, usually exacerbating the caretaker's own substance use and greatly increasing their depression.

Psychotherapy is an excellent forum for the development of healthier boundaries and resolution of co-dependency issues.