Etiology of Substance Abuse

“Drugs are a bet with your mind.” (Jim Morrison). People start taking drugs by their own choice. In early stages they feel stress-free and euphoric but as life goes on they start getting dependent on it and face difficulty to depart it from their lives. A true feelings and perceptions which abuser has for them are “I am sick and tired of being known as an addict.” (Arun et al.2004). To live with these perceptions are challenging but to abandon drugs is even more challenging for them. According to (DSM-IV), “Substance use disorders are now defined as maladaptive patterns of substance use leading to inability to control, use despite significant consequences”.

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According to National Institute of Drug Abuse (2014), Substance abuse has a lot of effects on society and cause deaths. Use of substance abuse in adolescent, adults and elderly people is creating problem to fulfill their responsibilities and its consequence are very much destructive. According to Annual prevalence of drug use in Pakistan (2012) as cited in UNODC (2013), an expected 5.8 percent of the people in Pakistan utilized illicit substances in the previous 12 months. 11 % of substance utilization was present in Khyber Pakhtunkhwa, 6.5 % of substances used in Sindh and 8.5 % of illicit substances used in Punjab. Substance abuse is referred as terrible deed as it violets societal standards and values by accelerating savage acts. This topic has a huge impact on individual lives, socioeconomic status, health care system and their psychology. Moreover in my clinical rotation, I encounter 25 years old lady being hospitalized for attempt to suicide. During our discussion, she confesses that her husband is a substance abuser since 2 years and despite the fact she was pregnant, her husband beats him so badly that her baby abort. As this incident touches my heart which endorse me to write about this topic.

This paper would profit the readers in a manner especially to those individuals who are indulge in substance abuse so they will know what elements cause substance abuse and how its perilous impacts effects on their lives. It will also talk about, what therapies individuals can approach to depart illicit substances from their lives.

Some individuals are at higher risk of substance enslavement. No single variable can anticipate dependence on substance abuse. According to the recent Drug Use in Pakistan Technical Summary Report (2013), “an estimated 6·45 million (5·8%) people aged15–64 years in Pakistan used plant-based or synthetic drugs, or prescription drugs for non-medical purposes in the past 12 months”. (pp.2153). Alternately, there are a few causes that make an individual more inclined to it. The etiology of substance abuse in youth is divided into three classes i.e. Familial, Social, and Individual. Familial factors include childhood mal-treatment in which children could have physical, sexual, emotional abuse and neglect by parents so they grope dismissed and end into substance abusive behavior. According to Whitesell et al. (2013), “29% of children who experienced maltreatment participating in some level of substance”. (p.3). Additionally if any family member is abusing drugs in front of child so they imitate same behavior as they perceive parents their role model. Research shown that parental substance abuse increases genetic predisposition for substance use disorder (Dunn et al. 2002). In my opinion parental training plays an essential part in guiding child about substance abuse matters and lack of education can incline a child for substance abuse. Other factors are marital status of parents, child perception that parents approve of their substance use. (Whitesell et al, 2013).

Social elements that may include deviant peer relationship in which adolescence joins those gatherings who uses illicit substances. Teenagers who experience childhood in unsteady community conditions are really less vulnerable to deviant peer relationship. (Whitesell et al, 2013). In my opinion individuals affiliate themselves with distinctive gatherings and they imagine that utilizing substances make them popular. Research also supports that youths who classify themselves as famous have indicated to have expanded predominance of substance utilization when contrasted with those who don’t recognize themselves” (Whitesell et al, 2013). According to Taylor et al. (2009), bulling is related to substance abuse behavior. 12 % individuals who suffered from bulling experienced life time use of alcohol. (Taylor et al, 2009). There are many individual factors that end up in substance abuse. One of them is depression; it encompasses feelings of sadness, pain, despair, or anger. In my opinion people use to abuse substances to cope from depression but it is also as vice versa because after usage of drugs depression cans occur. According to shafiq et al. (2006), In Pakistan 65% can lead depression I have seen many people in my community who are using illicit drugs because they feel that drugs can alleviate their stressful feelings.

Transition of individual from adolescence to young, middle and older adult hood has increases burden in everyday life. Life stressors like financial burden, loss of job and poverty may trigger the use of illicit substances. According to Drug Abuse Master Plan (2010-2014), “In Pakistan 32 % of the opioid users were unemployed in the past six months” (p.7). People with mental problems also suffered from substance abuse problems. Research suggests that about 50 % of the individuals with psychiatric issues likewise experience the substance abuse problem. (chrome et al., 2009).

Substance abuse has a lot of devasting impacts on abusers lives. They can be divided in to three domains i.e. physically, socially and psychologically. Physical impacts are, as abusers use syringes for administration of drugs and due to lack of syringes they apply contaminated syringes on each other which make them vulnerable to blood borne diseases like HIV and hepatitis C. As study also supported that, In Pakistan73% people uses same syringes as there more syringes are not available. (UNODC, 2013). High risk sexual behaviors are observed among drug abusers i.e. un- protected sex which leads to further sexually transmitted disease i.e. In Pakistan “36% reported having sex with those clients who are HIV positive”. (UNODC, 2013). As drugs impact our central nervous system so it causes different psychological impacts like anxiety in which people have feeling of uneasiness and disturbance in sleep is also common. Substance abuser can suffer from different mood disorders like bipolar disorder. According to moal et al. (2007), Study has revealed that more or less 35% of addicts met lifetime criteria for a mood issue and 45% for an anxiety issue. Substance abuser also suffers from aggression. (Moal et al. 2007). There are many social impacts of substance abuse. In my opinion Isolation can be one of them and on the other hand, absence of acknowledgement from society additionally makes them evade social collaborations. As I have observe in my community that couples fighting is very common and it can further cause separation. Usually people indulge themselves in so much addicted behaviors so they lose their jobs and financial burden increases. According to Angres et al. (2008), Substance abuse negatively impacts public safety, reduces workers, productivity, and contributes to higher healthcare costs, premature deaths, and disability. (pp.696).Abusers have risky behaviors which also detoriate their health. Prendergast (2009) affirms that substance abusers are involved in different criminal acts. Generally individuals crave for drugs and to satisfy their need they involved in criminal acts like robbery so they can purchase their drugs. Leisure et al, (2007) affirms that drug abusers are usually involve in gambling which increases financial burden.

In substance abuse relapse is commonest among individuals. According to yaqub (2013), “Studies have revealed that the relapse rate in Pakistan is around 90%”. In theory brain reward mechanism in which addictive substances trigger brain reward circuit which in turn initiate certain behaviors. The effects of these abusive drugs on mesolimbic dopaminergic system are very serious and associated with creating rewarding effects. If this system does not work properly so it may create certain addictive properties. Dopamine expands extracellular; focus overriding the control of motivated and objective regulated behavior, which motivates them to take drugs. Certain medications are known to alter dopamine discharge and reuptake which modify reward system and increases uptake and relapse. (Eps et al. 2012).

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The congnitive behavior model of relapse tells about the high risk situations in which person is prone to have relapsed. He describe eight categories like how person interact with different people (“affect, coping, self-efficacy, outcome expectancies”) and certain environmental factors like (“asses to drugs, cue exposure and society influence”). It depend on individual that how he cope with these situations and it depend on him whether he uses substances or not. If individual decided and involve in substance abuse so they may suffer from AVE (Abstinence violation effect). AVE includes two things one affective response, in which person feels embarrassed and disgrace because he thinks he is responsible for this and second is cognitive domain which is based on attributional therapy, in which person perceived that this lapse is due to my personal factor and I cannot control them so he may have greater chances of relapse and if he thinks that it happens because of external factor and I can control it so relapse chances are deceased. (Marlatt and Witkiewitz, 2007). On my clinical I have encounter patient 15 years old with relapse of substance abuse. He verbalized me that he had left substance abuse for 3 months but because it was easily available and my friends influenced him so he took drugs and end up in relapse. If we related it to cognitive therapy of relapse environmental factors influence him to end up in relapse which created feeling of guilt and embarrassment

It is recommended that government should arrange certain awareness programs on substance abuse. Not only have that media played vital role in substances promotion so government should band those advertisement. Government should create certain institutions and build certain rehabilitation centers in community which are in reasonable cost. More over certain therapies can help patient to quit substance abuse .These therapies are :

In Motivational enhancement therapy, counseling approach is used and attempts to modify the behavior of substance abusers. MET is derived from Trans theoretical Model of Change. In this model counselor tend to change person behavior by five levels. In first level of Precontemplation individual does not consider his/her behavior problematic and don’t try to change it. In level two Contemplation people consider his challenging and think to modify it. In third level Preparation, person in this stage plans for a particular change. They assess and select measures for behavioral change. Another level is Action; in which individual is modify his behavior. The last level is maintenance in which individual try to maintain his new behavior and try to adjust new behavior in his surroundings. (Prochaska et al, 1992).

Contingency Management Therapies is based on operant conditioning which was proposed by skinners in which desire behavior is achieved by reward and punishment. The positive behavior which have given reward will be more likely to repeat for example when client has positive behavior so we can provide different gifts and voucher and if undesirable behavior exist so punishment should be there. (Carroll & onken, 2005).

Moreover with therapies we can likewise provide certain interventions. Substance abuse is a problem which can’t drive away instantly and it requires significant time for individual to recuperate from it. At community level we can take some measures to prevent substance abuse. According to National Institute of Drug Abuse, you have to develop a community plan in which the first step is “Assessment”. In assessment we will identify the population who are abusers and who are at risk for becoming abusers like people with low- economic status. In second step is “Build” we will try to identify resources for example we need for different awareness programs in community. Than third we will build “Short term goals” than after achieving short term goals we will run projects and simultaneously observe efficacy of preventive plan. According to National Institute of Drug Abuse affirms that Family-based preventive projects ought to strong family attachment and connections examining and uses different family approaches to alleviate on substance abuse.

In conclusion substance abuse is tremendously common issue among individuals. There are numerous reasons which are responsible for substance abuses in youth are familial, social and individual factors. As Age progresses, the risk of consumption of substances in adults also increases. The reasons behind substance abuse in adults are unemployment, poverty, traumatic events and any psychiatric problem. Substance abuse has a considerable amount of negative impacts physically, socially and psychologically. Even after treatment, some individuals again end up with state of relapse. Cognitive behavior therapy of relapse tells us about the risk factors that lead relapse. Some more therapies like motivational enhancement therapy and contingency Management Therapies help us to modify behavior of substance abusers. In my opinion we can develop insight in abusers and can modify their behavior. I would like to end up with quotation “Addiction should never be treated as a crime. It has to be treated as a health problem”. (Ralph Nader).