Early recognition of substance use disorders and needed actions
It was a damp and cold day with a slight overcast that fit the funeral’s somber mood. My father had died, leaving many stories untold. I was the youngest son, to whom he had often confided. I often thought he might not have revealed to my brothers the personal stuff he shared with me. After my father’s solemn burial at the cemetery, my uncle took my hand. I gladly followed him away from my father’s burial site and the family members there. We reached the furthest and less-visited part of the cemetery, filled with older gravestones.
My uncle pointed to a headstone with hard-to-read engravings that had tilted to the left, sunk partway into the ground. He said, “This is the tombstone of my father, your grandfather; he was a drunk with the worst alcoholism imaginable. Your grandmother took over the family grocery store business and divorced our father after he disappeared for some years. She had to save all of us kids from being out on the streets. Our father continued to drink after he left us. When he reappeared, he was extremely ill. After receiving medical care at a local hospital, he lived with a close relative. He finally had to go to a nursing home where he spent his last days.”
My father’s sister, my aunt, had a much more romantic tale. Her story about my grandfather was of his migration from a European country with the challenge of fitting into U.S. society—a situation made worse by his poor command of the language. He found some comrades in a local community religious group and would often stay out late with them, drinking at the expense of his struggling family. Even though he was a well-educated man in his country of origin, life was hard for him, and he didn’t adapt well. Also, he reportedly had great disappointment when his sister, with whom he had been very close, left their home and married a man of another background and religion, which the family did not accept. My aunt reported my grandfather became increasingly discouraged and depressed, from which he never recovered.
For my father and his siblings, the neglect and abandonment by their alcoholic father was a painful experience during their growing-up years. The unfortunate loss affected them for the rest of their lives.
This personal remembrance reflects how the tragedy of a substance use disorder affected our family as it has for many others—each with different stories to tell. Current statistics show the immensity and seriousness of unrecognized substance abuse disorders and addictions. An integrative psychiatry perspective looks beyond labels, symptoms, or characteristics to find understanding and positive treatment options for substance use problems.
How Serious Is the Problem?
Since 2000, over 700,000 drug overdose deaths have occurred in the U.S. The federal budget for drug control in 2020 was $34.6 billion. The total economic cost of addictions and substance abuse disorders would be much higher when including:
The expense of treatment and preventive programs
Additional related health care costs
Reduced job productivity and loss of earnings
Increased crime with resulting personal and public costs
Social welfare needs In 2017, 67.8% of the 70,237 drug overdose deaths were opioid-related (heroin, fentanyl morphine, and other prescription opioid pain relievers). 19.4% of people in the U.S. used illicit drugs in 2018. In 2018, 20.3 million people in the U.S. aged 12 or older had a substance abuse disorder, 14.8 million with alcohol, and 8.1 million with illegal drugs. Two million had an opioid use disorder which included prescription pain relievers and heroin abuse. In 2018, accidental drug overdose was the leading cause of death among persons less than 45 years old. [i] Given these alarming statistics, recognition, and treatment of any condition that can potentiate or put one at risk for a substance use disorder, addiction, severe health compromise, and death need attention as soon as possible.
According to statistics, the opioid epidemic is a public health crisis, with 136 deaths per day and climbing between 1999 and 2019. The statistics are much higher today, in 2022, the pandemic crisis and economic hardships.
According to the National Center for Drug Abuse Statistics:
Almost 50,000 people die every year from an opioid overdose.
Over 10 million people misuse opioids in a year.
Opioids are a factor in at least seven out of every ten overdose deaths
Forty-eight thousand six people overdosed on opioids in 2020.
3.8% of American adults abuse opioids each year.
At least 71.8% and 80% of overdose deaths involve opioids.
68.0% of all overdose deaths occur from synthetic opioids.
Fentanyl and fentanyl analogs are a factor in 19.8% of all overdose deaths.
Problem with Legal Narcotic Prescriptions
Healthcare practitioners learned to treat pain with opioid drugs, which are now known to cause addiction. As their prescribers, patients taking the pain pills accepted the prevailing belief that there is a low risk of addiction. Since then, prescriptions for pain medicine, such as opiates, have soared. Unfortunately, people prescribed opioids for pain can develop opioid use disorders (addiction) and risk dying from an overdose. Opioid overdose deaths since have multiplied, and yet opioid prescriptions have increased. Receiving long-term opioid therapy creates a high risk of opioid addiction. [ii]
Is Sugar Addictive?
I saw the addiction to sugar and refined carbohydrates in my family. One of my older brothers struggled with severe health issues. He had to work twice as hard as anyone because of his autism spectrum disadvantages in the workplace. It was when poorly understood autism spectrum traits had few available accommodations. His go-to place for gratification and sanctuary for anxiety and worry was sugar and refined carbohydrates. He rapidly gained weight, became obese, developed diabetes and heart disease. It was a miracle that he lived to 69 years of age with the help of excellent medical care. My dear brother was one of my significant influences in my pursuit of integrative and holistic medicine. [iii]
Overused refined carbohydrates, aka sugar, contributes to obesity, diabetes, heart disease, and other health issues; thus, it resembles the abuse or addiction to other substances. Though an addiction-like problem, it is often overlooked, especially with the massive marketing of sweetened products and their ready availability at many food outlets and restaurants. The results are an alarming rate of obesity and related medical diseases. Some characteristics of sugar addiction even resemble the symptoms of cocaine addiction.
The American Society of Addiction Medicine (ASAM, 2020) defines addiction as a “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.” Substance use disorders present characteristically in multiple ways: [iv]
Pathologically pursuing reward and relief by substance use and other behaviors
Consistent inability to abstain
Impairment in behavioral control
Diminished recognition of significant problems with one’s actions and interpersonal relationships
Dysfunctional emotional response
Cycles of relapse and remission
The Diagnostic and Statistical Manual of Mental Disorders 5th Edition—DSM-5 from the American Psychiatric Association replaced the term “addiction” with “substance use disorder.” The replacement occurred because the word “addiction” had an uncertain definition and possible negative connotations. “Substance use disorder” became a more neutral term and implied a more extensive range of dysfunction, from mild to the severe state of “chronic relapsing and compulsive drug-taking and alcohol use.” The DSM-5 describes alcohol and opioids as “use disorders with problematic patterns of use, leading to clinically significant impairment or distress.” [v]
The word “addiction” still commonly appears in the U.S. and other countries when:
There is the persistence of severe substance abuse problems, as when there are at least two significant occurrences within 12 months
A substance usage is more significant over a more extended period than intended
There is a persistent desire or unsuccessful effort to cut down or control the substance use
Spending more time in activities necessary to get the substance, to use a drug, or to recover from its effects
Craving or a strong desire to use the substance
Continued use, despite persistent or recurrent social or interpersonal problems that are caused or exacerbated by effects of the substance
Important social, occupational, or recreational activities diminish because of the substance use
Recurrent substance use occurs in situations in which it is physically hazardous
Continued use of the substance, despite knowledge of having a persistent or current physical or psychological problem that is likely caused or exacerbated by the substance
Tolerance is a need for markedly increased amounts of the substance to achieve the desired effect
Withdrawal shows the characteristics of withdrawal syndrome for the particular substance
Related substances are used to relieve or to avoid withdrawal symptoms
Many factors can increase the risk of developing a substance use disorder:
A family history of addiction can increase the likelihood of substance use disorders in relatives.
One national co-morbidity survey showed that individuals with a mood disorder are 2.3 times more likely to have a substance use disorder than those without a mood disorder.
For bipolar disorder, there is a 9.7 times greater chance of having alcohol dependence and an 8.4 times higher chance of having another type of drug dependence.
Trauma-related conditions, such as the experience of a traumatic childhood or adult life events, are common underpinnings of addiction.
Attention deficit hyperactivity disorder (ADHD), anxiety, obsessive-compulsive disorder, and schizophrenic disorders have higher associated substance abuse rates.
Early Warning Signs of a Substance Use Disorder
The early warning signs of drug and alcohol abuse include:
Increased drinking or use of other drugs
Changes in a job or school performance
Changes in attitude and mood, such as depression, irritability, suicidal threats, or actions
Unexplained changes in eating, sleeping habits, physical appearance, physical complaints, blackouts, or temporary memory loss
Behavioral problems such as dishonesty, sexual promiscuity, and stealing
Change in relationships, especially with new friends known to drink or use drugs
Alcohol on one’s breath, slurred speech, staggering, appearing “spaced out”
Missing alcohol, medications, or money from around the house
The presence of drug paraphernalia, such as pipes, pillboxes, etc.
Noticing these signs is critical, as recognition, early interventions, and treatment are vital to improved health.
The goal of any treatment would be to reduce pain and suffering and the staggering cost to society. Because addictions can switch, symptoms need early recognition and intervention. Changes in one’s addiction occur between behavioral or substance use problems such as compulsive eating, gambling, the internet, computer use, and sexual or pornography addictions. There are valuable screening tools and questionnaires available to identify many addictions. The AUDIT for alcohol and the SBIRT for alcohol and substance abuse are helpful for early identification.
New Research on Brain Function
It is also helpful to learn how the brain develops, perpetuates addictions, and can heal itself. Robust mechanisms in our nervous systems and brain serve positive purposes. These critical brain operations are for survival, food, shelter, reward, gratification, and reproduction. The same processes are also the miraculous pathway for the achievement of success and accomplishments. However, misdirection can occur, diverging into debilitating addiction and substance use disorders. [vi] As we’ve seen, the brain can adapt, change, and lay down new neurocircuitry (nerve pathways). “Neuroplasticity” is the descriptive name for this ability of the brain to change. Less-used neurocircuitry will wither away in a healing and regenerative process. Information is growing about the brain’s operations, functioning, and influencers.
The neuroplasticity process underpins the changes that can occur with training and positive addiction treatment programs. Changes in neurotransmitter patterns can cause new positive habits and behaviors. Training and positive experience in supportive social settings support these brain changes. Applying gained knowledge in neurological research can lead to prevention, restoration of health, and addiction recovery. [vii]
Integrative Medicine for Substance Use Disorders
Integrative and comprehensive approaches to substance use disorders and treatment are essential. Techniques such as trauma-oriented therapies, such as EMDR and Spiritual Emergence, are potentially valuable additions to treatment programs. A transpersonal, systems-oriented, body-centered, and trauma-integrated process fosters healing and spiritual emergence from mental health issues and substance use disorders. Addressing the physical, emotional, mental, social, and spiritual aspects becomes the pathway to wholeness and wellness. [viii]
A thorough addiction treatment approach looks at factors such as the environment, child-to-adulthood influences, psychosocial factors, trauma, and medical and neurodevelopmental issues. Investigating how other factors affect brain processes and human behavior is essential. An intervention or treatment program often depends on a qualified individual for an addiction assessment. Adding an integrative psychiatrist and an addiction specialist to the treatment team can bring complete focus to co-existing problems. Co-existing medical or other issues may need attention before addiction treatment is successful or sustained.
Integrative psychiatry and substance use disorder programs may include:
Mutual help/support groups
Mind-body-spiritual and sensory-based therapies
Natural complementary therapies and medications when felt to be safe and essential for treatment
Medication augmentation helps, especially when other interventions are unsuccessful. Drugs that help reduce cravings and relapses are most effective for opioids and tobacco. The medications available are only moderately effective for alcohol and minimally useful for stimulants, cannabis, inhalants, and other substances.
With the dramatic rise in death from opioid overdoses and the devastating effects of drugs and alcohol on individuals, families, and children, addiction is a problem that always needs attention. If you, or a significant other, such as a spouse, friend, or employer, see early signs of a substance use disorder, do not ignore them, as you may inadvertently contribute to the problem’s severity. Instead, seek immediate help and information to prevent severe consequences for recognizing and treating substance abuse. Seek or consult with:
Health care providers or your primary care physician
Addiction specialists, treatment centers, or programs
Integrative psychiatrists or holistic health practitioners
Twelve-step programs, such as Alcoholics Anonymous or Narcotics Anonymous
Thank you for reading Mind Wise by Ron Parks. The newsletter, about Mental Health and Wellness from an integrative perspective, is for your information and to share!
[i] National Center for Drug Abuse Statistics (2019). Drug abuse statistics, drugabusestatistics.org; NIH: https://nida.nih.gov/drug-topics/trends-statistics
[ii] National Institute on Drug Abuse (May 27, 2020). Opioid overdose crisis, drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis North Carolina Department of Health and Human Services (July 2020). Opioid-involved overdoses, 2018, injuryfreenc.ncdhhs.gov/DataSurveillance/poisoning/OpioidFactsheet-2018-FINAL.pdf
[iv] American Society of Addiction Medicine (ASAM) (2020). Definition of addiction, asam.org/quality-practice/definition-of-addiction
[v] Psychiatry Online (2020). DSM Library, dsm.psychiatryonline.org
[vi] Substance Abuse and Mental Health Services Administration (April 30, 2020). Mental health and substance use disorders, samhsa.gov/find-help/disorders TTTrx Opioid Recovery Resources. (turnthetiderx.org National Institute on Drug Abuse). Alcohol Use Disorders Identification Test (AUDIT), drugabuse.gov/sites/default/files/audit.pdf
[vii] Lawlis and Martinez, 2015.
[viii] Center for Spiritual Emergence, 2017.
[ix] Parks, R., MD (2020). Addiction resources, parksmd.com/addiction-references-resources; https://www.inmindwise.com/p/addiction-resources?s=w
Substance Abuse Mental Health Service Administration (SAMHSA), 2020.
Mercola, J., M.D. (April 15, 2017). Chasing the dragon—America’s struggle with opioid addiction, articles.mercola.com/sites/articles/archive/2017/04/15/documentary-chasing-the dragon- opioid-addiction. aspx;
McCance-Katz, E.F., MD, Ph.D. (2018). The national survey on drug use and health: Substance Abuse and Mental Health Services Administration. samhsa.gov/data/sites/default/files/nsduh-ppt-09-2018.pdf