SUBSTANCE USE, ABUSE, AND DEPENDENCY
Addiction begins with a person drinking alcohol or using drugs occasionally (substance use). The substance use progresses to a compulsion and an obsession, where, even if the substance doesn’t have the desired effect, the person fears being without it and even substitutes it with other substances in case it is unavailable (substance abuse).
Compulsion further progresses to loss of control, where the person is unable to limit the amount of use and develops binge patterns of substance use. The person is also unable to stop using the substance, despite knowing the adverse consequences of the substance (substance dependence). This results in medical and psychiatric complications ranging from mood swings and anxiety to depression, panic disorders, and paranoid schizophrenic reactions or other psychoses (Fields, 2004).
The modality of treatment, duration, and intensity of sessions depend on the addiction behavior of an individual. Therefore, distinguishing whether a client’s addiction behavior falls under the category of use, abuse, dependency, or loss of control helps professionals tailor their treatment to the individual needs of each client. Let’s have a look at the examples of use, abuse, and dependent.
• Example of substance use: Let’s consider the case of Susie, a single, White female aged thirty-two. Susie has no prior history of mental illness, no family history of alcohol or drug, and no family history of any medication. Susie attends a bridal party on Sunday night, drinks more than her usual amount and oversleep on Monday. Susie reports feeling hung over, despite which, she goes to work instead of calling in sick. Her employer smells alcohol and subjects her to a breath test. The breathalyzer indicates a reading of 0.08. When you assess Susie, there is no indication of prior substance misuse or drug use. Susie reports having many sober leisure interests such as yoga, jogging, photography, and spinning classes. She describes most of her friends as healthy and nondrinkers. However, she presents with some insight in reports that due to her recent breakup with her boyfriend, she is upset and sometimes overindulges in consumption. She reports the use of alcohol two to three times per month, with one to two glasses of wine at each sitting.
• Example of substance abuse: Let’s consider the case of Johnny, a single, Hispanic male aged twenty-seven. Johnny has been sent to an assessment due to his recent offense of driving under the influence of alcohol. Johnny reports drinking three-times a week, primarily Friday to Sunday. Johnny reports usually consuming four to six cans of beer during these days. He does not have any history of health or legal issues. However, upon further probe, he admits that he feels stressed and sometimes drinks beer at night in excessive quantities to relax.
• Example of substance dependency: Let’s consider the case of Paul, man aged forty. Paul had a well established career as a meat cutter and is currently on disability leave from his job, where he has been employed for four years. He reports that his use of cocaine and alcohol has affected his financial condition in “disastrous” way. He reports homelessness and his income is limited to disability insurance at the present time. His addiction has resulted in the loss of his children, his home, and his job. He has a record of being arrested for domestic violence, which he states was related to his use of cocaine and alcohol. He reports having attended numerous parenting education classes and clearly identifies his substance abuse as being the factor that inhibits his ability to maintain a stable lifestyle for himself and his children. Paul reports two prior inpatient treatment program histories, which were not effective for him to get rid of his addiction. Each time after the treatment, he would again be seen under the influence of alcohol and cocaine.
