Drug and Alcohol Addiction

Although some of the problems of long-term alcohol and drug use might seem obvious, other potential health dangers aren’t often considered. Here’s a partial list of health risks associated with frequent and/or extended use of alcohol and drugs.

Alcohol can cause depression, anxiety, sleep problems, liver and throat cancer, dementia, heart failure, cognitive processing problems, digestive problems, anemia, fetal alcohol syndrome, and accidents.

Stimulants, such as cocaine (crack), amphetamines, methamphetamines (crystal meth, crank), and nonprescribed methylphenidate (Ritalin) can cause depression, psychosis, irreversible brain damage, seizures, heart failure, stroke, skin damage inside the nose, and nutritional problems.

Opioid drugs, such as heroin, codeine, opium, and morphine, often involve needle use, which can lead to problems like hepatitis, tuberculosis, tetanus, HIV, and abscesses.

Inhalants, solvents, and anesthetics, such as amyl nitrite and butyl nitrate (poppers) and ketamine (Special K), can cause severe memory problems, severe confusion, extreme fearfulness, and violence.

Cannabinoids, such as marijuana and hashish, can cause lung problems, lack of motivation, a lack of pleasure, and fatigue.

Psychedelics, such as MDMA (Ecstasy), LSD (acid), and PCP (angel dust), can cause memory problems, intense fear, and psychological dependence.

Depressants, such as the barbiturates secobarbital and phenobarbital, can cause depression, weight loss, irritability, and nutritional problems.

Antianxiety medications, such as diazepam (Valium), triazolam (Halcion), and lorazepam (Ativan), can cause confusion, a decrease in physical functioning, and difficulties with learning.

Many people with drug and alcohol problems also suffer with other related mental health problems, such as depression, dysthymia, bipolar disorder, panic disorder, social phobia, specific phobias, generalized anxiety disorder, and post-traumatic stress disorder. Many others also suffer with personality disorders such as antisocial, borderline, obsessive-compulsive, schizoid, dependent, and paranoid personalities. Plus, many people use both drugs and alcohol and therefore suffer from the effects of both substances.

A 1996 global study of disease found that alcohol use was the fifth leading cause of disability in the developed world among both physical and mental health problems. It’s estimated that approximately 9 to 13 percent of the adult population in the United States will struggle with an alcohol abuse problem at some point in their lives, and approximately 5 to 14 percent of the adult population will struggle with alcohol dependence during their lifetime. In general, it appears that men are twice as likely as women to develop either problem.

Similarly, it’s estimated that almost 4 to 8 percent of the adult population in the United States will struggle with a drug abuse problem at some point in their lives, and approximately 3 to 8 percent of the adult population will struggle with drug dependence during their lifetime. And again, it appears that men are more likely to develop either problem.

However, drug and alcohol problems clearly affect children and adolescents, too. According to a 2006 report from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, approximately 28 percent of adolescents aged twelve to twenty reported drinking alcohol in the past month. And of those responding, 19 percent were “binge drinkers” and approximately 6 percent were “heavy drinkers.”

A similar report issued by the same administration highlights the fact that adolescents aged twelve to seventeen are using drugs just as frequently. The report found that on any average day in 2006, 586,000 adolescents in the U.S. used marijuana, nearly 50,000 used inhalants, 27,000 used hallucinogens, 13,000 used cocaine, and 3,800 used heroin.

Unfortunately, fewer than 50 percent of those who need help for drug and alcohol problems seek treatment, and those who do seek treatment often wait as long as five to nine years before doing so. This is regrettable, considering that there are many programs and treatments available to help people with both problems.

Initially, many people find help for alcohol and drug problems in 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. These programs view addiction as a disease and focus on complete abstinence from drugs and alcohol. Many of these 12-step programs are centered on a belief in a higher power or God, but nonspiritual 12-step programs also exist.

An alternative to 12-step programs is the harm reduction model of treatment. Harm reduction treatment doesn’t demand abstinence from the very beginning of treatment. Instead, it helps the people reduce their drinking or drug use while simultaneously investigating the issues that are maintaining the addiction. Another option is treatment facilities such as detoxification centers and residential treatment centers, which can also provide structured support for the early stages of sobriety and medical assistance to ease the symptoms of withdrawal.

In conjunction with these treatments, psychotherapy can provide additional support for a person’s recovery. In research studies, cognitive behavioral therapy, motivation-enhancement treatment, interpersonal therapy, and couples therapy have all been shown to be effective in treating substance abuse problems.

One very effective cognitive behavioral treatment for drug and alcohol addiction is the community reinforcement approach, which is described in more detail below. This approach to substance abuse treatment focuses on the controllable factors in a person’s life that can be restructured to support sobriety. In various studies, the treatment has been shown to be both clinically effective and cost-effective. In one study, combining the community reinforcement approach with the use of disulfiram (Antabuse), a medication that promotes abstinence from alcohol, helped participants remain abstinent 97 percent of the time, even six months after the treatment ended. In comparison, people who participated in a 12-step program and were given disulfiram were only abstinent 45 percent of the time.

A number of medications have also demonstrated some effectiveness at treating substance abuse problems. Certain antidepressant medications can help reduce alcohol consumption and cocaine consumption, while medications such as methadone (Dolophine), levo-alpha-acetylmethadol (LAAM), buprenorphine (Buprenex, Suboxone), and naltrexone (ReVia) can effectively reduce heroin addiction.

Cognitive behavioral therapy (CBT) is a form of treatment that combines elements of both cognitive therapy and behavior therapy. Cognitive therapy examines the way people’s thoughts about themselves, others, and the world affect their mental health. Behavior therapy investigates the way people’s actions influence their own lives and their interactions with others. By combining the two, CBT examines the way people can change their thoughts and behaviors in order to improve their lives.

One CBT treatment for drug and alcohol addiction, called the community reinforcement approach, is often composed of five steps:

1. Conduct an assessment and provide information
2. Conduct a functional analysis of the drug or alcohol use
3. Practice sobriety
4. Gain needed skills
5. Prevent relapse

Step 1: Conduct an Assessment and Provide Education

The first step of the CBT treatment for drug and alcohol addiction is to conduct an assessment of the person’s symptoms and habits in order to clarify the nature of the problem.

Early in treatment, it’s also important to assess the person’s motivation to change his or her habits. Sometimes a person feels pressure to change from others, such as spouses, partners, or courts, despite the fact that the person himself or herself has no desire to change. This lack of motivation can quickly defeat the purpose of treatment, so the person’s motivation should be assessed. Examining the pros and cons of drinking alcohol or using drugs can sometimes accomplish this.

However, a person’s motivation can also be assessed by using the stages of change model, which highlights how likely a person is to make a change at this point in time. During the first stage, precontemplation, people don’t consider their behavior to be a problem and aren’t even thinking about changing it. In the second stage, contemplation, they’re aware that their behavior is causing some problems in their lives. They’re also willing to consider making changes, to weigh the pros and cons of change, and to talk about making changes; however, they haven’t committed to taking action yet. During the third stage, preparation, people are committed to changing their behavior within the next thirty days and have made a plan to change. In the fourth stage, action, people are participating in making those changes, and in the fifth stage, maintenance, they are actively taking steps to maintain those changes in their lives.

Once people have determined what type of addiction problem they’re struggling with, it’s important that they and their family members understand the basic nature and causes of the problem (as highlighted above). It’s also very important for everyone involved to understand the nature of this particular CBT treatment. The community reinforcement approach to treating addiction focuses on reorganizing people’s lives and finding appropriate social support in order to help them develop a clean and sober lifestyle. This treatment is very interactive and requires the person to do work outside of the therapy session.

However, it should be acknowledged that not everyone is ready or willing to create a completely sober or clean lifestyle. In such cases, elements of the CBT treatment might be used to create a lifestyle of moderation, or to help the person engage in what is known as harm reduction, in which the person limits the detrimental effects of drug and alcohol use.

For the person who is highly motivated to change (someone in the preparation or action stage), this might also be the appropriate time to join a 12-step program such as Alcoholics Anonymous, Narcotics Anonymous, or some similar social support program.

Step 2: Conduct a Functional Analysis of the Drug or Alcohol Use

The second step of the treatment is to perform a functional analysis. A functional analysis is a close examination of the events that happen just before and just after a person uses drugs or drinks alcohol. According to the CBT model, addictive behaviors are maintained because they are somehow rewarded. For example, a man who feels anxious about talking with other people might drink alcohol to make himself feel calmer, while a woman who experiences the painful effects of withdrawal might use more cocaine to make those feelings go away. In these examples, the anxious feeling and the effects of withdrawal are called triggering events, because they create the desire for alcohol or drugs. The desired aftereffects of the alcohol and drug use are the rewards that reinforce the behaviors and make them more likely to occur in the future. Both triggering events and rewards can be emotional (“It makes me feel better”), cognitive (“It helps me think more clearly”), behavioral (“I can’t perform well without it”), or interpersonal (“I can’t relate to others without it”).

Performing a functional analysis is very important because it helps the person identify both the triggers and the rewards of the addictive behaviors, and therefore highlights what needs to change in the person’s life in order to lead a healthier and sober lifestyle.

Step 3: Practice Sobriety

The third step is deciding to quit drinking or using, and then doing it, even if the person only commits to sobriety for a limited amount of time. The decision to stop is perhaps the hardest step of the treatment, and for some people it might require supervision by a medical professional. The effects of alcohol and drugs on the body can be very damaging, and for some people the symptoms of withdrawal that occur when quitting can be potentially dangerous. People are especially likely to require monitoring if they drink alcohol or use drugs such as benzodiazepines on a regular basis; if they also struggle with other mental health problems, such as severe depression; if they suffer with other physical health problems, such as a heart condition; or they have experienced symptoms of withdrawal in the past. Some people can be monitored on an outpatient basis, while others may need to attend an inpatient detoxification center. Either way, anyone who is quitting drug or alcohol use should consider getting a medical checkup at this point.

At this stage of the CBT treatment, the person might decide to practice sobriety for a limited amount of time, such as thirty days, in order to identify how he or she copes with sobriety and to determine what changes will need to be made in the long term. After that period of time is over, the person can work with the therapist to reassess what worked and what didn’t, and then they can create a new plan for a second period of sobriety that is perhaps even longer.

During these trial periods of sobriety, the person might also choose to use medications such as disulfiram (Antabuse), which causes people to feel sick if they drink. Medications like this can help people stay committed to the goal of not drinking and quickly build a feeling of success.

This step of practicing sobriety is recommended both for people who are choosing a lifestyle of sobriety and for those who are choosing moderation.

Step 4: Gain Needed Skills

In order to maintain these periods of sobriety or moderation, people usually need to learn new skills and create new activities to stay focused on the goal of a healthier life. Often, people will eliminate activities involving drugs or alcohol but then do very little to fill that time in their lives. As a result, their lives feel boring, misguided, or purposeless, which leads them back into their destructive habits. This fourth step of the CBT treatment is designed to help people develop coping skills that will lead to a more fulfilling life without drugs or alcohol.

The more basic of these skills involve learning nutritional and exercise habits to maintain a healthy body and lifestyle. Good nutrition and regular exercise can help people feel better both physically and mentally. They can also enhance self-esteem and help people fight off cravings for substances.

Time management skills and activity scheduling skills can help people restructure their daily life around satisfying, healthy activities. These newer activities are needed to replace old activities that focused on getting and using drugs or alcohol. To create these new activities, people need to engage in new interests, hobbies, or sports in order to occupy the time formerly spent getting and using drugs or alcohol. Scheduling new activities is also helpful because it helps the person avoid people, places, and situations that trigger the urge to use drugs or alcohol. Along these lines, another part of recovery is exploring new opportunities to meet people who aren’t engaged in drug or alcohol use.

Effective relaxation and mindfulness exercises can also help people tolerate cravings and feel better in general. Skills such as progressive muscle relaxation, mindful breathing, and safe-place visualization can help people quickly relax when they are nervous or agitated or feel the urge to drink or use drugs.

Communication and interpersonal skills can help people make better decisions, interact with others more effectively, be more assertive, create appropriate personal boundaries, and improve relationships. Communication skills are also essential for helping people learn to say no to others and how to refuse offers to drink alcohol or use drugs.

Similarly, problem-solving skills can help people make healthier choices, make difficult decisions, and avoid problematic situations that can lead to feeling overwhelmed.

Anger management skills can help people resolve conflicts and avoid explosive situations that can lead to drug or alcohol use. They are also critical for preserving valued relationships.

Emotion regulation skills can help people manage and soothe difficult, troubling emotions, instead of giving in to urges to use drugs or alcohol.

Cognitive-restructuring skills can help people identify and correct self-defeating thoughts that can trigger urges to use drugs or alcohol.

If moderation rather than abstinence is the goal, the person should learn skills that promote moderation and reduce the harm of use. It can be helpful in these situations for the person to write down the rules he or she intends to follow, and then to keep a diary of drug or alcohol use to determine if those self-imposed rules are being obeyed. If the rules prove too hard to follow, it might be an indication that the problem is more serious than was thought and that professional help might be needed.

At this point in treatment, some people might also need relationship, family, or couples counseling to repair damaged relationships.

Some people might also want to explore or reconnect with spiritual or religious beliefs in order to feel supported during their recovery. This often happens in 12-step programs, but it can also be addressed on one’s own.

And, finally, some people might need training in job skills in order to find a job or maintain the job they already have. However, this might require the help of a professional vocational skills counselor.

Step 5: Prevent Relapse

Finally, the last step in the CBT treatment for drug and alcohol addiction is preventing relapse. This occurs once sobriety or steady moderation has been maintained. According to the leading researchers on relapse prevention, relapse most often occurs when people in recovery place themselves in high-risk situations with which they cannot cope. For example, this includes going to bars and other places where alcohol or drugs were used or bought, or interacting with old friends who continue to use drugs or alcohol. In these situations, relapse is likely if the person lacks the skills to deal with those situations. What makes this situation even worse is the fact that when relapse occurs, people often view themselves as a failure and continue to drink or use as they once did, rather than seeing the relapse as a temporary setback. The key to preventing relapse, therefore, is to avoid high-risk situations and to restructure one’s life in such a way that it provides alternative, low-risk, fulfilling activities.

In addition, the person should be prepared for relapse. The truth is, nearly everyone in recovery experiences relapse, especially early in recovery. According to one study, 66 percent of people in recovery for drug and alcohol addiction experienced relapse within three months of getting treated. This statistic is not meant to scare anyone, but it does highlight the fact that the key to recovery is to be prepared for relapse when it happens, not if it happens. A person can be prepared by developing the coping skills highlighted above, in step four, and by having a plan for what to do after relapse happens. Rather than giving up, the person should get back into treatment, conduct a functional analysis to understand what caused the relapse, and get professional help if needed.