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Substance Abuse, Addiction and Alcoholism

Addiction and alcoholism are not moral issues. They are defined as chronic, progressive, and ultimately fatal diseases by the American Medical Association. Do we fault a diabetic for being diabetic, or a cancer patient for having cancer? Obviously not. Then why should alcoholism and drug addiction be viewed differently? The answer is simple. They shouldn't...!

Addiction and Alcoholism

Addiction takes many forms, but has some unique features regardless of the substance or behavior of choice. It is characterized by a compulsive craving or desire for the substance, impulsive behaviors, and continued use and abuse despite negative social, physical, and emotional consequences.

Addiction means, most simply, a repetitive compulsion to ingest a particular substance or engage in a particular activity that results in pleasant feeling or “high” in the short-term, but which has harmful long-term consequences to a person’s health, mental state or lifestyle.

Like many other chronic diseases, addiction can have periods of remission (absence of behavior) and relapse (recurrence of behavior). If left untreated, however, addiction can lead to long-term physical, emotional and social damage or, even, death.

The most well-known types of addiction are drug addiction and alcoholism; these addictions are often known as substance dependence. Substance dependence includes compulsive and repetitive use of alcohol or a drug that could result in tolerance, requiring more and more of the substance in order to achieve the same desired effect. Moreover, addicts often suffer from withdrawal symptoms when they (try to) abstain from substance use.

A lesser form of alcohol and drug addiction is called substance abuse. The American Psychiatric Association defines substance abuse as
  1. continued use of a substance despite the fact that it causes social or interpersonal problems;
  2. repetitive use that causes inferior job, school, or home performance;
  3. repeated use despite physical dangers; or
  4. substance use that results in legal problems, such as possession or DUI charges.
Substance abuse and addiction are a major financial burden to our society. The health, crime, and productivity-related costs of substance abuse and addiction are huge. Broken down, the cost of drug addiction, nicotine addiction, and alcoholism are roughly equal.

However, there are several other types of addiction that are just as detrimental to those suffering from them and society in general, including sex addiction, internet addiction, video game addiction, food addiction (compulsive eating), tanning addiction, gambling addiction, and shopping addiction. Simply put, people with these behavioral addictions cannot stop repeating the behaviors, even in the face of negative consequences.

This article contains information on the disease concept, the cycle of addiction, facts about substance abuse and addiction, and general information on the treatment for diseases of alcoholism and addiction that I hope you will find helpful.

Myths and Facts about Substance Abuse and Addiction

If you have a substance abuse or addiction problem, the situation is not hopeless despite what many people believe. However, it is important to differentiate the myths from the facts when it comes to substance abuse and addiction.

Myth #1 – Substance abuse and addiction are the same

Fact:  Substance abuse is not the same thing as addiction. The fact is that although many people, even some professionals, use ‘addiction’ and ‘abuse’ interchangeably, they are not the same. The differences are:

➧ Substance abuse occurs when you use drugs in spite of knowing that they can be harmful to your health, your work, your relationships, and other important aspects of your life.
Addiction, on the other hand, occurs when you have developed a psychological or physiological dependence on the substance.

➧ With substance abuse, you are likely to experience the pleasurable effects of the substance just as you did when you first started using it.
On the other hand, if you are addicted, you will typically need increasing amounts of the substance in order to achieve the desired effect – in other words, to get “high”.  This is because you have developed a tolerance for the substance.

Myth #2 – An addiction is merely a bad habit, over-indulgence, or a moral weakness

Fact:  An addiction is not just a bad habit; nor is it merely a problem of overindulgence or an indicator of flawed morals. An addiction can be as serious as a medical condition such as diabetes or atherosclerosis. The factors contributing to substance abuse and addiction include social circumstances, personality traits, exposure and availability of the substance, and genetic susceptibility.

People who struggle with substance abuse and addiction are often not lacking in morals.  One can become addicted to alcohol or other substances because many are highly addictive.  Use of drugs/alcohol can cause biochemical and structural changes in the brain. It is really more an issue of biology rather than morality as to why so many people find themselves abusing or addicted to one or several substances. Unfortunately, this means that abusing a substance only a few times due to curiosity or recreation can lead to compulsive use and cravings.

Myth #3 – Overcoming an addiction just takes willpower

Fact: Sheer willpower alone is not enough to disentangle yourself from a serious substance abuse problem and especially from an addiction.  No matter how strong your inner resolve, you will probably need professional help to recover successfully and avoid relapse. Structured treatment is usually the best approach.

Myth #4 – Substance abuse and addiction affect only the low-income population

Fact:  Individuals from every socio-economic group have problems with substance abuse and addiction. It is a prevalent problem which crosses all social classes. Although some age groups, races, genders, and social-economic groups are at a higher risk, ultimately every person is at risk under the right circumstances.

Myth #5 – In order for treatment to be effective, you must want it

Fact:  Many people who successfully complete treatment did not want treatment.  Two of the main reasons people seek substance abuse treatment is because it is court mandated, or their loved ones are pressuring them to get help. The most successful substance abuse treatment often occurs as a result of pressure from loved ones, regardless of why the pressure was applied. Don’t wait until your loved one voluntarily seeks substance abuse treatment – it may never happen.

Myth #6 – Many people relapse because treatment doesn’t really work

Fact:  Just as with treatment for other conditions, treatment for substance abuse and addiction can’t guarantee results for any particular person.  However, this is no reason to dismiss treatment. The reasons for relapse vary from one individual to the next, but the major reason is a lack of commitment. Other reasons include peer pressure and the fact that the root cause of the problem may not have been dealt with while in treatment.

Myth #7 – Treatment is the same regardless of the substance used

Fact:  While there is much overlap when it comes to alcohol and drug treatment, aspects of treatment may vary for different substances. For example, many a time serious addiction to alcohol or certain drugs requires medical detox as the initial step in treatment. This is not required for many substances.

Myth #8 – People who get treatment and then relapse are a lost cause

Fact:  People who relapse after treatment are not hopeless at all. The fact is that occasional relapses happen to many individuals following substance abuse treatment. Once out of treatment, it is important that the individual receive emotional support/follow up, especially during the months immediately following treatment. Also, they are much more likely to succeed if they don’t return to the very environment or situation which contributed to their substance use.

Difference between Substance Abuse and Addiction

Some people assume that substance abuse is the same thing as addiction, but it is not. While both are dangerous and difficult to discontinue without help, they have different diagnosis criteria. Knowing the facts about drug abuse can be the key to getting the most effective help for your particular problem.

Drug abuse often occurs as the first step toward addiction. Substance abuse begins when someone tries an illegal drug or starts using a legal drug in a way in which it wasn't intended. Addiction begins with drug abuse and ends with a compulsive, uncontrollable need to use the drug and the inability to quit. This is when you can no longer deny the need for drug abuse help.

Symptoms of Substance Abuse

  • Using substance to change how one feels about themselves and/or some aspect(s) of their lives
  • Needing to set limits on how much and how often one uses drugs or alcohol after experiencing problems associated to it
  • Problems at work with lateness, absenteeism or mistakes being made
  • Scholastic difficulties
  • Difficulties at home; coming home late, sleeping a lot, forgetting chores

Addiction Symptoms

  • Continuing to use despite any negative consequences associated with using
  • Setting limits on amount or frequency of use but unexpectedly exceeding those limits
  • Breaking promises to themselves and/or others that they will use in moderation
  • Feeling guilty or remorseful about using but still failing to permanently alter use
  • Resenting, discounting and/or disregarding any comments or complaints about their using
  • Drinking while driving; DUI's, accidents
  • Legal problems and financial problems
  • Deteriorating relationships
  • Mood swings; anger, depression
The first step to getting the help you need is determining if you are suffering from drug addiction or drug abuse. The facts above should help you decide where you stand. If you are suffering from drug abuse, it is important to get the right kind of treatment before it turns into an addiction.

Addiction and the Brain

Addiction is a complex disease that is often misunderstood by laypeople. People generally tend to think that drug addicts or alcoholics lack the willpower to stop drinking or ingesting drugs. However, research has shown that recovering from substance addiction is not just a matter of willpower. Drugs and alcohol, when consumed, cause changes to the structure and function of the brain. Eventually, these changes will weaken a person’s self-control and judgment, while increasing the compulsion to use drugs or drink.

Addictive substances attack the brain’s communication network, wreaking havoc on how nerves transmit information by imitating chemical messengers or over-stimulating the brain’s reward circuitry. Heroin and marijuana, for example, are similar to our normal neurotransmitters and trick the brain’s receptors into sending abnormal messages. Cocaine and methamphetamine, on the other hand, cause the nerves to release large amounts of neurotransmitters, which can disrupt the brain’s normal communication system.

Further, most drugs also impact the brain’s reward system with an overabundance of dopamine, the neurotransmitter responsible for emotion, motivation, and pleasure. This causes the person to feel a sense of euphoria after taking the drugs, a feeling that addicts quickly come to crave. As substance use continues the brain produces less dopamine or reduces dopamine receptors after each dose, requiring more and more of the drug to get the same euphoric effect. This phenomenon is known as tolerance.


Alcoholism, often referred to as alcohol dependence, is a medical disease that causes alcohol cravings, an inability to stop drinking, physical dependence resulting in withdrawal symptoms once one stops drinking, and tolerance – the need to drink increasingly larger amounts of alcohol to get the same effects.

Other mental illnesses, such as depression, can occur at the same time as alcoholism, and sometimes the abusive drinking began as a way to cope with such an underlying disorder. [See hereDual Diagnosis]

Alcoholics can be any age and many refuse to acknowledge that they have a drinking problem.

It is true that millions of people are able to drink alcohol and not become addicted. Typically, an acceptable amount of alcohol intake is two drinks for a man and one drink for a woman, per day. However, it is not necessarily the amount of alcohol one drinks that is the deciding factor as to whether one is an alcoholic. Some people who drink only a little alcohol can be diagnosed with alcoholism. Conversely, some people who drink much more may not have an alcohol problem at all.

As with many mental illnesses, individual variations in diagnosis, treatment, and ability to stay sober abound.

Some compare alcohol cravings to the human need for food or water. Like other addictions, familial obligations, health concerns, or legal issues will usually not be enough incentive for an alcoholic to stop drinking.

Alcoholism worsens the longer a person continues drinking. Left untreated, alcoholism can turn chronic, meaning that the person will never stop drinking without intervention; it can damage mental health, physical health, or lead to death.

It is believed that whether or not a particular individual will develop alcoholism depends on a combination of genetics and lifestyle factors (friends, career, stress, availability of alcohol, etc.).

Symptoms of Alcoholism

Like any other disease, alcoholism has a set of common symptoms that can be helpful when trying to diagnose a drinking problem. Symptoms vary from person to person, and not all alcoholics will exhibit all symptoms of alcoholism. In the early stages of alcoholism, a person may drink alcohol to escape thinking about personal problems and, as a result, shift the obsessive thinking to thoughts of alcohol. Many early stage alcoholics will plan activities around the ability to drink and may start to hide alcohol or sneak drinks.

Although not everyone needs to drink excessively to be deemed an alcoholic, many alcoholics experience “black outs,” where they can’t remember periods of time. As the disease progresses, more and more alcohol needs to be consumed in order to approximate the early effects of alcohol, although some say they always feel as if they are chasing something they seem no longer able to achieve.

In the middle stages of alcoholism, those suffering from the disease will rarely admit to others that they even have a drinking problem, but will try to take steps to get the drinking under control on their own. For instance, many will set a limit on how much they can drink per day or per week, but will often breach that limit. Others will set parameters on when they can drink, such as never before noon or never on Sundays. They usually cannot stick to these “rules,” and some progress to drinking as soon as they wake up in the morning.

However, someone can meet the diagnosis of alcoholism that does not drink during the day, and some alcoholics are binge drinkers, meaning they confine their abusive drinking to discrete time frames, such as the weekends. Some reports indicate that binge drinking is more hazardous than daily maintenance drinking. Those in middle stage alcoholism will begin experiencing personality changes and mood swings.

In the late stage of alcoholism the alcoholic becomes completely dependent on alcohol, to the point where they experience heavy withdrawal symptoms if they do not drink for a short period of time. A typical symptom of withdrawal is the Delirium Tremens (DTs).

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Drug and Alcohol Intervention

An intervention is a process that involves the people closest to an individual suffering from addiction. Together, these family members and friends work as a unit to attempt to get the individual to accept help for their disease. It is a course of action that places an emphasis on dignity and respect. It is important for the alcohol or drug intervention environment to be non-judgmental and non-threatening to ensure the individual feels safe to freely discuss their addiction.

Who Conducts the Drug and Alcohol Intervention?

The interventionist who conducts and manages the meeting is a substance abuse specialist who is trained to teach family members and concerned friends how to approach the individual with love and compassion. This is important in order to connect to the sufferer's authentic self and cut through the walls of resistance and denial that have been built up over time. An interventionist understands that addiction is a disease with a lifestyle that no one freely chooses or enjoys.

What Happens During a Drug Intervention?

  • Each person will prepare to talk about how the user's behavior is affecting them and disrupting their lives in letters read one-by-one to the individual.
  • Each attendee is strongly urged to create a list of actions that they will no longer tolerate, finance, or participate in if the individual doesn't agree to check into rehab for treatment.
  • Once the letters are read, he or she must then decide whether to follow through with entering the rehabilitation center or face the consequences of the promised losses that were stated.
If the individual in need of treatment agrees to go to rehab, the interventionist will arrange transportation and accompany them to treatment center. After the drug intervention, the interventionist will continue to follow up with both the family and the individual throughout the entire treatment process.

  Read more here on → Drug and Alcohol Intervention

Treatment for Addiction and Alcoholism

Till date, there is no cure for drug or alcohol addiction. However, these can be effectively treated through counseling, twelve-step programs, medications, residential rehabilitation treatment, or a combination of these. The goal of treatment is to help those with addiction issues stop taking the addictive substances, explore and address the psychological reasons behind the alcohol and substance use, and develop an ongoing treatment plan to help ensure that the person not relapse back into active substance use.

Drug rehabilitation and alcohol rehab centers were founded to provide treatment to help all those in need with treatment, sober living options, and access to a vast network recovery resources and referral sources.

Initially, someone who is actively drinking or using drugs likely need to go through a medical detoxification ('detox') process, which allows the body to safely withdraw from the effects of alcohol/drugs under the supervision of a medical professional. Sometimes drugs are used to ameliorate the symptoms of withdrawal, and are then tapered down until the patient is completely drug-free. It is only after the body has been cleared of alcohol/drugs that true rehabilitation can begin.

Therapy or 12-step programs offer support for long-term maintenance of sobriety. It is unlikely an alcoholic/addict would be able to drink alcohol or take the addictive substances again in moderation.

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Community education and outreach are the keys to educating society about drug addiction and alcoholism, and dispelling the commonly held misconceptions of the true nature of these debilitating conditions. The cycle of addiction is a downward spiral that ultimately leads to jails, institutions, and death. The purpose of drug and alcohol treatment programs is to arrest the disease's progression before it gets to this point, before all is lost.

Unfortunately, all too often this is not possible. Due to the generally high cost of substance abuse treatment, the social stigma associated with abuse, and commonly held misconceptions that these diseases are some sort of mysterious moral issue, far too many alcoholics and addicts die each year having never had a fair chance at treatment and recovery.


  1. Very interesting perspective. A lot of people will find that it is easier to get hooked on substance abuse than to get off the hook. While there are a large variety of ways to get treatment, the most effective treatments are the ones where the victim is really interested in kicking off the addiction. One workbook that I can recommend for victim or a loved one suffering from addiction can have is this workbook, Cognitive Behavioral Therapy Worksheets for Substance Abuse by Portia Cruise. You will find it on Amazon as a paperback.


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