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.
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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.