DRUG ADDICTION AND ABUSE - FIRST SIGNS, SYMPTOMS, HELP AND TREATMENT - Written by Dean Gustar, Relapse Prevention Specialist

Drug Addiction and Abuse - Definition

When defining drug addiction, we must first consider what we mean by the term drugs. In this context, a drug is a substance that will have a psychological impact when consumed. We can drill down further into sub-categories, for example, illicit drugs, prescription drugs and medication, or legal drugs. Although alcohol can be classed as a drug, alcohol addiction or alcoholism are often viewed separately from drugs, though some of the impacts and treatment options are similar.

Medical professionals generally use the term substance use disorder, to describe what is more commonly known as drug addiction and problematic drug use, as an alternative to drug abuse, substance abuse or drug misuse. However, drug addiction and drug abuse are terms that people are more familiar with using. Treatment professionals have worked to implement language that does not create additional stigma when speaking to, or about, clients and patients with alcohol or drug issues. Some people often describe addiction as a complex brain disease, the disease approach is often featured in articles and treatment literature; it can be liberating for some but can also create stigma. Language is an important issue when talking about addiction.

A very simple definition of alcohol and drug addiction is that a person develops tolerance to a drug, so they must take more of the drug to get the desired effect, that they suffer from withdrawal symptoms if they do not take the drug, and that they continue to use the drug despite a build-up of negative consequences. Negative consequences of substance abuse include an impact on physical health, an impact on mental health, and changes in behaviour. They also experience cravings and urges to use drugs.

The First Signs of Substance Abuse

Drug addiction or substance use disorders do not happen instantly or overnight. There is a build up with identifiable signposts and behavioural changes along the way that may indicate substance abuse. Family members will often become aware of the signs that something is not right with a loved one. These first signs help us to recognise when someone is using drugs.

First signs of drug addiction or drug abuse would include:

• Losing interest in things that used to be important or that the loved one enjoyed doing
• Poor self-care - not looking after their appearance, not attending medical appointments, not eating well, a disrupted sleep pattern
• A buildup of effects on physical health - weight loss, or weight gain, frequent colds and health issues, drowsiness
• Behavioural changes - becoming more isolated from friends and family, being secretive, keeping strange hours, becoming defensive or argumentative over relatively minor things or if being challenged about their behaviours
• Spending increasing amounts of money, this might include stealing money from family, or manipulating situations to get more funds
• Taking a prescription drug or medications outside of the prescribing guidelines of their doctor
• Distinct changes in mental health, including mood swings, periods of depression, anxiety

How to recognise when a loved one is abusing drugs

So what is it that people with drug addictions do? What are the actual experiences of the family and friends of a loved one who has a substance use disorder or addiction?

Behavioural changes and erratic moods

Often you may notice that a person with a substance use disorder begins to withdraw from their responsibilities and social events. They may lose interest in things which used to be important to them. You might notice a withdrawal from life in general. Sleep patterns may become disturbed - they may keep strange hours. We may witness shifts in mood. There might be increased anger and agitation. Existing mental health conditions may worsen and medication compliance can become disordered, either seeking extra medication or not taking essential medications. You may also notice an increase in the use of alcohol.

Secrecy, dishonesty and denial

Usually, people with a substance use disorder will not be open about their behaviour. Often they will use in secret. This might mean that they are often having unscheduled meetings, private phone calls, or last minute schedule changes. If challenged about secretive behaviours they might deflect the challenge with anger or become upset. Perhaps the person will often go missing without any notice, or take a huge amount of time to carry out an unnecessary task. For example, they go out for some cigarettes and come back three hours later looking worse for wear.

Attempts to challenge are responded to, perhaps with an outright lie, or with a strategy to deflect. Often a lie can be made and maintained despite all evidence pointing to drug abuse and addiction.

Promises to change

Often the loved one may make promises to change or to seek help. It may be that these promises are truly genuine. However, addiction is very difficult to change without the right support and access to drug addiction treatment. Their promises to get and stay drug free can quickly fail when they experience withdrawal symptoms or cravings and life becomes too difficult for them.

We have seen clients get help that keeps their drug use and addiction protected. Perhaps they seek out a doctor who might help them with medications but has limited knowledge of the real impact of the drug abuse and without an insight into the bigger picture. Often they may claim to be drug free, even though they are now being given a prescription drug similar to their favoured substance, for instance, a person with an opiate addiction may find a doctor who gives them an opioid prescription.

Justification & blaming

Even the most gentle of approaches to the loved one may result in a pattern of justification. All would be designed to keep further challenges at arms length. For example, perhaps they may tell you it's not so bad, it's only at parties, everyone does it, it's my life. The justification can also be amped up so that you may end up feeling that you are responsible for the addiction - an element of blame comes in - perhaps they tell you if you weren't so controlling they would not use so much, or perhaps you should look at how much alcohol you drink before you question their behaviours.

Do I have a drug problem?

If you are already asking yourself whether your drug use is a problem, it is highly likely that you may already be struggling with addiction or your drug behaviour is causing problems to your mental and physical health. The good news is, that even when you are considering this question, you are on the first step of preparation to seek professional help or attempt to gain some control over your drug use and addiction. There are many different questionnaires available online, but perhaps it is best to ask yourself the following questions:

• Has my drug use become out of control? Do I use more drugs than I intended or take drugs for longer than I meant to? Do I engage in high-risk behaviour related to substances?
• Have I attempted to cut down or control my drug use but failed each time?
• Do I spend a lot of my time seeking substances, using substances or recovering from my drug use?
• Do I experience cravings for drugs and frequent urges to use drugs?
• Do I neglect tasks in my life relating to work, family or school because of using drugs?
• Do I keep using drugs despite it causing relationship problems with family, friends or a loved one?
• Have I stopped important social, recreational or professional activities because they get in the way of my drug addiction?
• Do I abuse drugs again and again despite increased risk and danger?
• Do I continue to use drugs despite experiencing mental or physical health issues that may have been caused by my drug addiction or made worse by my use of the substance?
• Do I find myself needing more and more of the substance to get the desired effect (tolerance)?
• Do I experience withdrawal symptoms if I don't have access to the substance (withdrawal)?

Help, Support and Addiction Treatment

According to a recent United Nations research document, UNODC World Drug Report 2021 , there are over 36 million people worldwide who have a substance use disorder. These high numbers of people with addiction and substance abuse issues mean that there is a constant focus on how we can develop and deliver effective addiction treatment and therapy.

Many countries have services and treatment centres delivering a range of services to support people with alcohol and drug problems. These treatment programmes and centres support the person with alcohol and drug issues to find their pathway toward recovery and reduce the harm and risk related to addiction. It pays to do your research to find the best professional services to meet the needs of your loved one and of the family. Each treatment programme will have their own philosophy of best treatment and menu of treatment options. Understanding your goals and doing your own due diligence will help you to search for and find the right services.

Initial Challenges

One challenge you may face, is in approaching your loved one about their addiction and encouraging them to get help. How we approach and treat the person is key. The initial intervention can help sow the seeds for positive long-term change. Change can be scary. We should keep in mind that resistance to change can have its roots in fear. Our experience with some of the patients we treat is that they worry about letting go of their lifestyles because they have no self-belief that they will be able to cope with what comes next. In these initial conversations, it is important to have a gentle and open attitude. Here are a few suggestions and examples:

• Talk about your feelings - "I love you and I am worried about losing you"
• Treat the person with love and kindness
• Ask them about what they would like to do and how you can help them
• Listen to their responses and repeat them back so they know you have understood them
• Do some research before the conversation so you understand what options might be available
• Timing can be important, tell them you would like to talk and ask when would be the best time

Professional Intervention

If your attempts to talk to your loved one have been unsuccessful then you may want to consider using professional intervention services. An Intervention is a carefully planned therapy strategy to help families to talk openly and about their feelings regarding the impact of the misuse of drugs or alcohol on themselves, on the person of concern and on the family. Trained intervention professionals will coach the participants in how to treat the person of concern with care and respect, to talk openly and honestly, seeking only to encourage change, open up a pathway to treatment and recovery, and show love and kindness.

A menu of treatment programmes or options may be offered as part of the intervention. Although the intervention centres around the treatment of the addiction, family members may also need commitment to making changes, or negotiating and holding boundaries. An intervention can be a starting point for open communication and change.

Choosing the most effective treatment

Addiction is often viewed as a complex disease that affects the way the brain functions alongside a range of problematic behavioural consequences. There are many options and different treatments available to patients, and no single treatment approach is right for every person. You should research all the programmes available and discuss options with the person of concern. There is no quick fix and the road to recovery may have many ups and downs. Some of these ups and downs may include relapse. It is important we accept that sometimes relapse is part of the recovery journey. When choosing the right treatment programme, consider the recommendations the National Institute on Drug Abuse makes about the components of an effective treatment programme.

Early Access to treatment

When a client is motivated to make some changes, it is important to search for and consider the programmes available and act quickly. When the window of opportunity opens, fast access to treatments and treatment centres can be crucial.

Covering the complex needs

Most effective addiction treatment programmes and centres will address all the related needs of their patients, not just the addiction. Medical issues, family therapy, education, social skills, nutrition and underlying causes are also important. Long-term recovery is a systemic process that emcompasses many different areas of life.

Talking Therapies

Behavioural therapies, such as cognitive behavioural therapy (CBT), are often featured as part of treatment. Talking therapy has a focus on behaviour change and navigating the challenges ahead. Relapse prevention is an example of cognitive behavioural therapy and is an intervention used to educate patients and give them the right tools to understand addiction and the process of relapse, and helps to retrain the brain. Behavioural therapies can also be useful to educate the family.

Physical health

Taking care of physical health will support addiction recovery, and it is important that medications are reviewed. Patients should also be screened for potential diseases, such as hepatitis B and C, HIV and TB. The National institute on Drug Abuse also recommends education to help reduce future risk.

Detox is just part of the process

A detox may be featured as part of treatment. This would be medically supervised treatment. Certain clients, for example, alcohol users, may require special medications and close supervision, or opioid users may require a plan to reduce their opioid medication. A standalone detox with no other supported features in care is really a sticking plaster over a gunshot wound. It should be part of a wider set of treatment therapy interventions.

Drug and Alcohol Testing

During all phases of treatment it is important to test and monitor for drug and alcohol consumption.

Screening for potential underlying mental health disorders

It is possible that a person who uses drugs may be unconsciously self-medicating an underlying disorder. For example, it is not uncommon to find a cocaine user has ADHD and quiets their brain in a similar way to medications for ADHD. It is important to screen for any potential issues such as depression and anxiety, and measure cognitive ability and brain functioning. Effective screening and use of diagnostic tools to help identify any potential mental health or brain disorders. Suitable treatment can then be implemented which will support better outcomes.

Flexible treatment planning

A treatment plan should be built for and with the person of concern. This should include suitable goals and address the addiction alongside a range of presenting issues. As treatment progresses, the treatment plan should be reviewed and updated to reflect progress and help motivation.

Treatment duration is important

It is very important for the treatment duration to be long enough. The National institute on Drug Abuse states that good outcomes are contingent on treatment length. Continuing care should also be part of the long-term plan.

Very important for you

There is a cliche often used about the emergency oxygen masks in aircraft. We are instructed during the announcements that if the masks come down we should put our own masks on before helping out others. This also applies to family and friends of people with substance use disorders. You have to look after yourself. Make sure you are taking care of your own physical and emotional health. Get as much help for yourself as possible. Talk, share and allow yourself to be supported. Seek out professional help if required. You need to remain healthy, balanced and stable. The road ahead will have many bumps to negotiate. And remember, sometimes just engaging in your own self-care can be something that inspires the person of concern to notice and begin their own process of change.

In order to learn more about drug addiction treatment at The Kusnacht Practice contact our specialists.

Written by Dean Gustar