What Causes Substance Use Disorders? A Look at Psychological Factors

In the last blog, I discussed the physiological factors leading to Substance Use Disorders (SUDs). This time, I will focus on psychological factors that influence the abuse of and dependence on mood-altering chemicals.  There are two main psychological factors that I wish to focus on: self- medicating for mental health disturbances, and relying on maladaptive coping mechanisms.

Many individuals suffer from mental health disorders, including mood disorders (e.g., depression or bipolar disorder), anxiety disorders (e.g., panic disorder, post-traumatic stress disorder, generalized anxiety disorder), psychotic disorders (e.g., schizophrenia), and personality disorders (e.g., borderline, histrionic, dependent, etc.).  Many times these disorders go undiagnosed.  When people have one of these disorders, all they know is that taking a particular substance or substances makes them feel better.  As discussed in the last blog, many drugs of abuse affect naturally occurring chemicals in our brains and often alleviate distressful feeling states.  We often see individuals with specific mental health disorders choose to abuse particular classes of substances.

For example, people who are depressed or who have anxiety disorders often choose substances classified as depressants (e.g., alcohol, sedatives, sleep aids), whereas those with hyperactivity and attention-deficit disorders often choose drugs from the stimulant classification (e.g., cocaine, methamphetamine, Adderall).   We are also discovering that individuals who have been through severe trauma with suppressed rage commonly abuse pain killers, such as medications in the opioid family (e.g., heroin, hydrocodone, Oxycontin). Obviously, these mood-altering substances are helping people feel better. Unfortunately, use of these substances can quickly and easily turn into abuse and dependence.

Another psychological factor that can lead to the development of an SUD is associated with maladaptive coping mechanisms.  For example, if a child is growing up in a family system that is full of neglect or violence, the child may experience significant fear or anger and have no means of handling these feelings in an effective way.  In other words, the child has not developed adequate coping mechanisms to handle the feelings.  The child is then introduced to alcohol by friends and realizes that he doesn’t feel as upset when he drinks alcohol.  He quickly learns to deal with feelings by consuming alcohol, a pattern that continues well into his adult years.  Many individuals learn to cope with negative emotional states (e.g., depression, anxiety, boredom, anger) by getting high.  This becomes the only way they have of dealing with these distressing emotional states.  Oftentimes, treatment is a process of teaching more appropriate means of coping than the potentially dangerous strategy of medicating negative emotional states.

Let us know your thoughts—please comment.


Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City.  He has been in the field of substance abuse treatment for over 30 years.  He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.

What Causes Substance Use Disorders? A Look at Physiological Factors

 In previous blogs, I’ve defined Substance Use Disorders (SUD’s) and addiction. In this blog, we‘ll begin to explore the factors leading to SUD’s. Our most current understanding of SUD’s is that they develop from a variety of factors often with one or more factors being predominant. The factors commonly fall into 4 primary categories: physiological, psychological, social/environmental, and spiritual. In today’s blog, I‘ll primarily focus on the first category; physiological factors.

We‘ve developed an understanding that, for some individuals and families, SUD’s seems to be more common in some families than in others. Is it because substance abuse is learned within a family system or is it because something genetic is inherited? A few important studies seemed to suggest the latter. In one study, children adopted out of an addicted family system early in life and raised by non-substance abusing families still had higher rates of SUD’s compared to children who were born to non-abusing parents. In another important study, identical twins of the same genetic make-up were compared to fraternal twins who were born at the same time, but who did not share identical genetic material. This study attempted to remove differences often associated with learned behavior within a family system. The study reported that identical twins had higher rates of substance abuse as they matured than their fraternal twin counterparts providing more evidence of genetic traits being passed on from generation to generation.

The studies mentioned above seem to suggest that, for some individuals, something is being inherited or passed on genetically, that makes some more vulnerable to addiction than others. But, what is it that is inherited remains elusive. Scientists have not been able to simply locate a specific gene which leads to a susceptibility to addiction. This genetic susceptibility seems to involve an interplay of several genes. Individuals with this genetic vulnerability also seem to share other common psychological disorders such as antisocial personality and attention-deficit hyperactivity.

One of the most intriguing questions in treating SUD’s is why aren’t we all abusing the same substance or substances? In other words, why do some individuals abuse alcohol, while yet others prefer cocaine, or marijuana, or heroin, or any other particular substance? Why are there individual preferences for mood-altering chemicals? The answer to this may lead to our understanding of what is being genetically inherited. A theory as to what is being inherited is often termed the “Self-Medication Hypothesis”.

The Self-Medication Hypothesis suggests that some of us choose particular, mood-altering substances because they compensate for deficiencies in chemicals that are naturally found in our brains. For example, dopamine is a naturally occurring chemical in our brains that give us the feeling of pleasure when released. Dopamine is released when we have sex, eat a nice meal, gamble, exercise or get high. We also know that cocaine, for instance, releases very high levels of dopamine in the brain. The theory suggests that when a person with abnormally low levels of naturally activated dopamine uses a substance such as cocaine, that person will have a greater activation of dopamine than they have experienced before. This may actually make the person feel more “normal” than ever before setting up a pattern of continued use and possible abuse of cocaine. Other chemicals in the brain handle other psychological states. For instance the neurochemical, GABA , when released, is associated with decreases in anxiety; serotonin is associated with mood; endorphins are associated with managing pain (emotional as well as physical pain). Different drugs of abuse work on different neurochemicals. Thus, the Self-Medication Hypothesis suggests that we seek out specific drugs of abuse in order to compensate for deficiencies in naturally produced neurochemicals.

Why is the Self-Medication Hypothesis only a hypothesis? The answer is because our current technology is not yet sophisticated enough to accurately measure levels of neurochemicals in our naturally occurring brains. We cannot yet determine, for instance, how much dopamine is currently produced in our brains and what the normal levels should be. Our ability to accurately measure these neurochemicals has not yet occurred although significant progress is being made. It is believed that, one day in the near future, we’ll be able to measure these neurochemical levels , thus allowing for accurate forecasts as to who is likely to develop addictive potential for different drugs of abuse. One day, we may even be able to alter neurochemical deficiencies and significantly decrease the likelihood of SUD’s for many individuals and families. What are your thoughts and reactions to this blog? Let us know.

Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.

What is Chemical Addiction?

                      What is Chemical Addiction?

In the previous blog,   I defined the meaning of Substance Use Disorders.  However, the term “addiction” as it relates to substance use often connotes a subtle, but important difference. Whereas a Substance Use Disorder (SUD) is usually characterized by loss of control over a substance, addiction suggests more of a preoccupation to use.  That preoccupation to use can be associated with a psychological obsession to use or a physical compulsion to use.  Many times it can be both.

  Let’s first take a look at psychological addiction. Psychological addiction represents more of the obsessive qualities of substance use.  In other words, the incessant thoughts of using substances; the frequent and almost uncontrollable urges to use, distracting one from other activities of daily life. These preoccupations to use can be very powerful causing one to become irritable and psychologically unavailable to others until the obsession to use has been satiated with actual use.  Most individuals dependent on substances experience some degree of psychological addiction.   One of the best depictions of this psychological preoccupation was portrayed in the writing of J.R. Tolkien’s Lord of the Rings trilogy.  The power of the magic ring led to such mental preoccupation that the character Gollum would stare at it calling it “my precious.”   His life became completely obsessed with the ring.  Nothing mattered more than getting his hands on the ring.

Physical addiction is less common than psychological addiction.  That’s because not every substance is believed to lead to physical addiction.  This point is a matter of controversy. The substances that are currently associated with physical addiction fall into two categories:  depressants and opioids.  Depressants include alcohol, benzodiazepines (i.e., Valium, Xanax, Klonopin, and Ativan) and barbiturates (i.e., phenobarbital, Luminal).  Opioids include opium as a pure opiate, partially synthetic opioids such as heroin, codeine, and morphine and completely synthetic opioids like hydrocodone, oxycodone, and methadone.

Physical addiction is defined by two factors:  withdrawal and tolerance.  Withdrawal is defined as the body’s physiological response to the absence of ingesting the substance.  Withdrawal is usually associated with daily use of one of the substances mentioned above leading to characteristic, physiological symptoms for several days to several weeks when abstaining from the substance.  These symptoms can include sweating, nausea, shakes, agitation, even delusions and hallucinations.  In very heavy physical addiction to depressants like alcohol or benzodiazepines, there are even fatalities associated with withdrawal when going “cold turkey”.   Alternative medications are used to treat cases of physical withdrawal.  Tolerance is defined as needing more of the substance over time to achieve the same level of intoxication or desired effect.  For example, a person may initially find that six drinks would provide the adequate dosage of intoxication needed, but after months of daily use need two to three times that amount to obtain the same effect.  This same effect applies to many pills and opioid substances.  Many believe that even daily marijuana use can lead to withdrawal symptoms and tolerance.

In summary, chemical addiction can be exhibited through psychological addiction and/or physical addiction.  While every mood-altering substance can lead to psychological addiction, it is current belief that not every mood-altering substance leads to physical addiction.  Share your thoughts on this topic. I would love to hear.


Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City.  He has been in the field of substance abuse treatment for over 30 years.  He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.

Do I Have a Substance Use Disorder?

Do I Have a Substance Use Disorder?  It Begins with an Honest Self-Appraisal


In the last blog, I attempted to give you a simple description of Substance Use Disorders (SUDs).  In this blog, I will help guide you toward understanding whether you meet the criteria for one of these disorders.  The essential element here is self-honesty.  You will be completing some screening questions to ascertain your patterns of substance use.  You must be truthful with yourself in answering these questions and avoid minimizing the answers.  No one needs to know the answers to these questions besides you.  Your willingness to honestly take a look at your substance use patterns takes courage. It is often very painful for us to admit our shortcomings even to ourselves. Furthermore, your willingness to take an honest appraisal of your use patterns suggests some degree of personal concern over your behavior.  It is commendable that you’re willing to look at your behavior so honestly. This step alone may be one of the most significant you have ever taken towards self-improvement.

Among the screening instruments that we use at Chat2Recovery as part of our assessment process include the Alcohol Use Disorders Identification Test (AUDIT) for drinkers and the Drug Abuse Screening Test (DAST) for substances other than alcohol.  They are easy, short and scientifically validated tools for screening for SUDs.  While these instruments are the ones we prefer to use, there are many more available for you to consider, including the popular Michigan Alcoholism Screening Test (MAST),  the CAGE for alcohol, the Substance Dependence Severity Scale (SDSS), and the Severity of Dependence Scale (SDS) for substances other than alcohol.

If and when you’re ready, you can go to these instruments at the following e-mail addresses.  For the AUDIT, which will be automatically scored, go to http://lapbc.com/self-tests/alcohol-use-disorder-test. For the DAST, which also is automatically scored, go to http://counsellingresource.com/lib/quizzes/drug-testing/drug-abuse.  At this site, you can also get access to other alcohol screening instruments mentioned above, namely, the CAGE and the MAST.  These questionnaires can all be completed anonymously, so there is no concern for your privacy.  While the scores to these screening tools may or may not suggest problem use of substances, it is highly recommended that you seek an evaluation with a licensed professional who specializes in treating substance use disorders for a more accurate view of your substance use patterns.  But, before you begin, remember, it all begins with an honest appraisal of your behavior.

In the next blog, I will review the difference between physical and psychological dependence to substances.  Please keep your comments and questions coming!  Speak soon.


Stay well,

Nick Lessa

What is a Substance Use Disorder?

Have you ever blacked out at a bar? Lost control at a party? Popped too many pills?

If you relate to the above statements, you will find the Chat 2 Recovery blog helpful.


This will be the first of what I hope to be a regular series of blogs about substance use disorders and their effective treatment.  I hope to share my views with an interested community who are willing, in turn, to share their questions and comments.  I begin by sharing my understanding of what it means to have a substance use disorder (SUD).

 According to our current understanding, there are two types of SUDs; Substance Abuse and Substance Dependence.  Substance Abuse is considered to be less severe than Substance Dependence.  The predominant factor in both of these disorders is the degree to which one loses control over the use of a substance.  The greater one’s loss of control over a substance, the more severe the disorder is considered to be.  Substance Abuse is characterized by irregular loss of controlSubstance Dependence is characterized by regular loss of control.  Loss of control is defined here as either consuming more than one sets out to consume or using the substance for a longer duration than anticipated.  The frequency with which this loss of control occurs determines the type and degree of an SUD.

 Let’s look at an example of an individual with a Substance Abuse Disorder.  Joe typically goes to a bar after work on Fridays for a few drinks with co-workers.  Most Fridays, Joe has a few drinks and then goes home to his family without incident.  However, periodically and unexpectedly, Joe goes to the bar and overdrinks to the point of blacking out.  From this blacked-out state, Joe, one evening, drives his car and gets arrested for Driving While Intoxicated (DWI).  In another unexpected instance, Joe drinks so heavily that he has his wallet stolen losing a great deal of money.    While, yet, another time he over drinks and gets himself into a physical fight with injuries severe enough to be taken to the hospital emergency room.  While these negative consequences of overdrinking appear significant, they occur without much consistency and intermittently over the course of a year.  The irregular loss of control, as characterized in this example, would be an example of the SUD known as Substance Abuse.  The irregularity of this person’s loss of control is what makes it Substance Abuse. 

Substance Dependence is characterized by regular loss of control.  Generally speaking, the substance is controlling the person rather than the other way around.  The person shows little ability to control how much or how often to use the substance.  While it’s common for individuals with Substance Dependence to use daily or quite regularly, frequency of use doesn’t matter as much as quality of use.  In other words, what happens when the person uses is the primary factor.

You should now try to assess your own control or loss of control over your substance use.  Ask yourself:  Am I setting limits on consumption and frequently not following those limits?  Am I setting limits on how long I use or how much I spend and frequently not following those limits? Do I determine days when I will not use substances and frequently break those rules?  

 Ironically, it is often easier to treat a person with Substance Dependence than with Substance Abuse. Because of the intermittent nature of loss of control with Substance Abuse, a person can easily develop excuses and rationalizations for their episodes of using too much.  For example, “I didn’t eat that day” or “the drug was more potent than usual.”  On the other hand, the person with Substance Dependence has a hard time denying their regular loss of control and can more easily admit to problem use.

While loss of control is the essential symptom of an SUD, there are other symptoms which need to be mentioned.  Clearly, the substance use must bring some level of impairment to the individual’s life in such areas as social, occupational, legal, medical, or financial.  In addition to negative consequences of use, the individual may also exhibit signs of preoccupation to use (e.g., thinking obsessively about using).  For some with signs of Substance Dependence, the individual may exhibit signs of physical dependence on the substance.  (Physical Dependence will be explored in a future blog.)

In my next blog, I will review ways of determining if you are exhibiting symptoms of a Substance Use Disorder.  Let me know if this description of SUD’s makes sense to you.  Please feel free to comment and ask questions below, and I will respond as soon as I can.

Look forward to hearing from you.

Stay well,

Nick Lessa

Chat2Recovery.com Offers Innovative Online Substance Abuse Treatment in New York State


  Contact: Maria Gross                                                                  FOR IMMEDIATE RELEASE

Email: MGross@Chat2Recovery.com

Phone: 212-532-0303


Chat2Recovery.com Offers Innovative Online Substance Abuse Treatment in New York State

New York, NY (January 17, 2013) – The Internet has already revolutionized many industries, with other industries now beginning to fully adopt new telecommunications technologies. One such industry is addiction treatment. Conventional rehabilitation requires that a patient with a substance use disorder needs to attend sessions face-to-face. However, addiction specialists are now finding online treatment for substance use disorders to be an effective alternative.

One addiction treatment website that is getting a lot of attention recently is Chat2Recovery.com, a new company created to treat people with substance use disorders in New York State. Chat2Recovery, also known as C2R, takes the innovative approach of treating people for their substance abuse problems completely over the Internet through videoconferenced group and individual sessions. The management team, in the addiction treatment industry for over twenty years, has gained a substantial reputation for its high standards of care and successful recovery methods.

The C2R program generally lasts for six weeks, although it can be extended if the client feels that he or she needs to do more work. The program consists of twice weekly group therapy sessions conducted pseudonymously online, some individual sessions with a counselor, and emergency access to counseling staff.  Clients can choose whether they would prefer their individual sessions to be conducted on the phone, via video conferencing, or face-to-face.  The program also gives clients access to readings and written exercises designed to educate them about the recovery process.

A spokesperson for the site said: “Substance abuse counseling over the Internet may seem like an unusual idea, but it has been found to be incredibly effective. We find that the fact the entire program can be done anonymously really helps our clients. It gets people involved who might not otherwise be willing to go through treatment, and it also helps break down barriers. When people are anonymous they are much more likely to be honest about the extent of their drug use, and that helps us to help them. Of course we provide an option where our clients can meet counselors in person for a one on one session, but the entire program can be conducted completely online if the client chooses. Nick Lessa and Maria Gross, two highly trained, highly accomplished addiction rehabilitation specialists, founded Chat2Recovery. They have gained extensive experience in working with people with substance abuse problems at Inter-Care, a highly reputed outpatient rehab facility in NYC.”


About Chat2Recovery.com

Chat 2 Recovery (C2R) is an online, outpatient, substance abuse treatment center treating adults 21 years or older who wish to abstain from or reduce their use of mood-altering chemicals or alcohol.

For more information please visit http://www.Chat2Recovery.com

Welcome Note

It’s been a dream of mine for over 10 years to provide substance abuse treatment online. I have been operating my own outpatient treatment centers for substance use disorders for over 20 years. Back in 1991, when I saw a website for weight loss, I knew it would be something people would respond to for substance abuse treatment. In those days, the cost to get an online program off the ground was prohibitive. Today, with technology advancing so rapidly and the costs of providing this technology decreasing, the time has come.

To see this dream come true is astonishing. Over the past year, my business partner, Maria Gross, and I have been spending inordinate hours preparing for this opening. We believe to have developed a program that will provide effective, quality-oriented and affordable treatment for those who choose to obtain treatment services online as opposed to face-to-face treatment or in addition to traditional outpatient treatment. We strive to provide you with the best team of clinicians possible in an atmosphere of respect and genuine warmth. I am always available to hear your suggestions to improve our services. Please don’t hesitate to contact me.

I have developed Chat2Recovery to bring you all the experience and wisdom for effective treatment that I have accumulated over the years. My weekly blog will provide a forum to share these experiences, communicate interesting news from the industry, and to gain more inspiration from your comments. Please join me in this journey.


Nick Lessa, LCSW-R, CASAC, MA
President and Clinical Director