Describe the features of, and major factors contributing to, drug and alcohol abuse and dependence

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Drugs and alcohol play a major role in society today and with many people indulging in legal and illegal substances, however abuse and dependence does not favour one or the other. The features of drug and alcohol abuse and dependence can be defined as impaired functions of behaviour caused by persistent substance use. Abuse has negative consequences that can cause psychological problems such as distress. In contrast dependence is a much more serious disorder which involves tolerance and withdrawal creating physiological and psychological implications. There are many contributing factors to substance abuse and dependence; such as increased tolerance and learned responses. Further studies also suggest a chemical disturbance which can maintain dependence. Genetic research studies suggest a predisposition to substance disorders which work in conjunction with environmental factors mainly within the family. Peer pressure amongst adolescents can be a major contributor in instigating the initial onset of drug use. In addition the pleasure seeking personality can play a pivotal role in the downward spiral of substance use. The psychopathology of abuse and dependence follows certain criteria not only for substance abuse or dependence as a whole but for each individual substance category. Here the broad features of abuse and dependence and the main contributing factors are described.

Abuse of or dependence on drugs or alcohol are known as substance disorders, this does not imply that a person is suffering a mental disorder, but rather that the substance impairs management of day to day functioning because their use has become out of control. (Widiger, & Smith, 2002). The main features of substance disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (American Psychological Association, 1994) which is used by professionals for diagnosis. The criteria for substance disorders come under two distinct headings; substance abuse and substance dependence which can be used to describe substance disorders relating to legal substances such as alcohol and illegal substances such as cocaine. Abuse can be psychological without having physiological dependence therefore diagnosis is given when substance use is continuous and is shown to be having negative consequences regarding everyday functioning. People who persist in substance use can increase the possibility of being late for appointments either at work or at school, often social obligations are not met and relationships suffer. In some cases legal problems arise which can cause problems in a person’s life. In addition abuse can be diagnosed when substances are used continuously in situations that may cause physical harm; a typical example of this can be seen with driving under the influence of drink or drugs.

Abusers of alcohol or drugs are usually drawn to the mood altering properties of substances which can lead to expectation of the desired state. This can motivate people into using and subsequently facilitate continued use (DiClemente, 2003, pp 96). People often refer to their substance use as inhibiting stress; however Curtin, Lang, Patrick and Stritzke (1998) examined the effect of alcohol with the threat of electric shocks. If alcohol reduced stress then the threat of shocks would have little effect on the intoxicated participants. Curtin et al, (1998) found little variation between intoxicated and non intoxicated conditions as both conditions reacted to the shocks. The study suggests that alcohol alone does not reduce stress; other factors are present such as attenuated cognitive control, this implies that there is little capacity to control behaviour therefore there is increased distracter interference. Smoking and stress reduction is also a common assumption, conversely Cohen and Lichenstein (1990) found that people who had tried to stop smoking and failed still had the same perceived stress level six months later compared to the perceived stress level of people who had abstained from smoking for six months. Substance abuse and dependence appears to increase stressful situations because of the maladaptive patterns of behaviour the addiction provokes. These behaviours could be partly explained by cognitive dissonance whereby a person will continue their way of life even when it is causing negative consequences (Festinger, 1962). Abuse disorders can affect both the abuser and the people around them and is often a precursor of dependence.

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The criterion for drug and alcohol dependence has a physiological, psychological and neurobiological basis which is characterised by tolerance and withdrawal. Tolerance is defined as the need to increase the amount of a substance in order to reach the effect previously reached. The physical need to have more of the substance to reach the desired affect can have a psychological basis with regard to a conditioned compensatory response. Evidence for this is given by Sokolowska, Kim and Siegel, (2002) who investigated tolerance in rats. They administered morphine every other day to create intolerance to the opiate; this went on until the rats had had six amounts in total. They found that through the learning trials the rats reacted to the drug before the maximum effect was reached. The reaction was reported as a drug onset cue and that the rats had associated the administration of the morphine with the knowledge that a larger dose was on its way. In the days to follow the researchers gave the rats smaller doses of morphine, not enough to illicit any pain killing effects associated with the previous larger dose, and found that this drug onset cue had triggered increased pain sensitivity called conditional hyperalgesia. Sokolowska et al, (2002) concluded that the rat’s reaction to the administration of the small dose was the drug onset cue and in turn the rats expected a larger dose to follow. Drug onset cues could possibly explain the very high relapse rate of substance dependent users (O’Brian, Childress, Ehrman & Robbins. 1998). There can be many drug onset cues such as the sight of a needle or even just walking past a pub, this conditioned response study suggests how people could benefit from unlearning this association and enhance future drug and alcohol rehabilitation programmes.

The biggest indicator of substance dependence is withdrawal which can show itself in many different ways, one of which is the physical symptoms characteristic of the substance a person is trying to withdraw from. In order for these symptoms to be kept at bay more of the substance will be taken, this can take over the lives of people with this disorder who often find they are spending more and more time trying to obtain the substance. People suffering from this disorder will often try and stop only to be met with the debilitating symptoms of withdrawal.

It is hypothesized that a contributing factor is neurobiological which offers an explanation into the repeated pattern of tolerance and withdrawal (Angres& Bettinadi, 2008). It is natural for species survival to seek out much needed resources such as food, shelter and sexual arousal. Once the goal is achieved it acts as a reward, this naturally leads to a motivational state which continues to grow. The reward system in the brain includes the accumbens, pre-frontal cortex and the mesolimbic dopamine system. Dopamine is activated in the brain during pleasure and reward behaviours. The person’s first sensation of pleasure is overtaken by the abused substance overriding the brain’s neurotransmitters. After prolonged use the neurotransmitters are desensitised creating the need for more of the substance. This in turn leads to the destructive cycle of tolerance and withdrawal (Hyman, 2005) as the substance has taken over the individual’s capacity to choose.

A large amount of research has been carried out on genetic factors contributing to the aetiology of substance disorders. This suggests a complex connection between environmental and genetic influences (Arpana & Lynskey 2008). Classic twin studies allow researchers to compare monozygotic and dizygotic twins to illuminate predisposed tendencies. A study conducted by Tsuang and Meyer (1998) looked at the shared vulnerability of drug use in relation to specific drug groups. For example the researchers wanted to know if cocaine was the preferred drug then would other stimulants be the other drugs of choice. By using twin men inferences could be made about the genetic and environmental factors involved. They found that there is a shared vulnerability of drug use across all categories and suggested that there could be one characteristic that puts a person at risk of polydrug use. Interestingly marijuana was found to be influenced by genetic and environmental factors specifically, with no other drug category involved. This result was replicated in a study using female twins (Kendler & Prescott 1998). Tsuang, Micheal, Meyer and Doyle (1998) postulated that different drug usage could possibly be related to genetic and environmental factors as there was a high correlation between the monozygotic twins and their drug of choice.

Further evidence of a genetic factor was given by Chassin, Curran, Hussong and Colder, (1996); they found that paternal alcoholism not only predicted future substance use but in addition it rapidly increased the rate at which the substance was taken. The evidence denotes that substance disorders are multi-factorial suggesting that a sole genetic factor cannot possibly explain the individual differences in addictive behaviour. However the significant results would suggest a polygenic effect, adding to the unquestionable importance of genetic research.

Interpersonal and situational factors can also play a role in the initiation and maintenance of substance disorders (Cadoret 1992). There is a much evidence to suggest that early risk factors are precursors of later substance disorders (Hawkins & Catalano, 1992). Adolescents are inevitably in danger of such risk from the pressure of their peers. Alberts, Hecht, Miller- Rassulo and Krizek, (1992) examined peer pressure using high school students. Simple offers of drugs and alcohol were offered to the students. If the response was no then pressure was applied. They found a significant difference between alcohol and drugs, with alcohol not needing pressure compared with drug offers where pressure was needed. When pressure was applied then there was a significant increase of acceptances. The evidence suggests that peer pressure is a high risk factor and that adolescents may benefit from learning how to say no. Another contributing factor was situational (Alberts et al, 1992), adolescents were more likely to say no when offers were made in their own home compared to offers made outside the home. Social factors are an important contributing factor as they can be partly responsible for adoption and maintenance of drug and alcohol consumption.

Refusing to be pressured into certain activities requires a certain disposition whereby personality can contribute to initial substance use and possibly lead to substance disorders. It is suggested that temperaments and traits can be precursors of initial onset and future dependence. People with low self esteem, high curiosity and emotional problems are possibly at greater risk from social pressure (Kaplan & Johnson, 1992). They suggest psychosocial influences can play a large role in the individual differences of a person’s substance use; in particular sensation seeking peers had a direct affect on the substance use of adolescents.

Substance disorders can be seen as a moral failing on the part of the abuser so people with these disorders can often be stigmatized and rejected by society. The large area of research regarding substance disorders suggests that the physiological reward system in the brain can be hijacked leaving the individuals at the mercy of the substance. This would imply once the substance has taken hold the user is powerless and in need of help not criticised for a bad choice. Abuse and dependence of any substance from alcohol to heroin is a growing problem for society but often ignored by society as once a person is addicted help can seen in vain. Genetic causality cannot alone offer an explanation into why people become to rely on substances however the diathesis model puts forward a forceful argument. This model postulates that the genetic influence regarding personality such as pleasure seeking behaviours and low self esteem can predispose the initial onset of substance use. The manifestation of a genetic predisposition in conjunction with situational factors regarding family and social influence could and should play a pivotal role in the ongoing research and offer hope to the individuals and their families concerning treatment and rehabilitation. The physical and psychological effects of abuse and dependence are ostensibly indivisible, involving behavioural, sociological and neurobiological factors; this can make for a complicated aetiology. Coupled with these factors different substances involve many different behaviours, in addition individual differences are present so diagnosis of the disorder and where possible, treatment has to be individualised.

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