Monday, August 24, 2009

Health Care and Chemical Dependency

Dependency on chemical substances is a problem faced by all adult age brackets and across all economic lines. There is no class distinction with those who are hooked on drugs or alcohol. The term "Chemical Dependency", according to Dual Recovery Anonymous (DRA), is often used in conjunction with and at times interchangeably with the terms: chemically dependent, chemical dependence, alcoholism, addiction, substance abuse, substance dependence, drug habit, and drug addiction. chemical dependency, refers to a primary illness or disease which is characterized by addiction to a mood-altering chemical. Chemical dependency includes both drug addiction and alcoholism (addiction to the drug alcohol). A chemically dependent person is unable to stop drinking or taking a particular mood-altering chemical despite serious health, economic, vocational, legal, spiritual, and social consequences. It is a disease that does not see age, sex, race, religion, or economic status. It is progressive and chronic and if left untreated can be fatal.

According to DRA, when a person is chemically dependent, they have lost the power of choice over using mood-altering chemicals. They may be able to stop for awhile, but they will return to its use again and again despite their best intentions and exertions of logic and willpower. For these reasons, chemical dependence (alcoholism and drug addiction) is said to be a cunning, baffling, and powerful disease. Chemical dependency is characterized by continuous or periodic: impaired control over drinking and/or drug use (prescribed or illegal), preoccupation with the mood-altering chemical, use of the addictive substance despite adverse consequences, and distortions in thinking--most notably denial.

According to MindDisorders.com, disease concept of chemical dependency is the concept that a disorder (such as chemical dependency) is like a disease and has a characteristic set of signs, symptoms, and natural history (clinical course, or outcome). The disease concept has long been accepted by the medical community. The concept proposes that a disease is characterized by a specific set of signs and symptoms and that the disease, if left untreated, will progress to some endpoint or outcome (clinical course). However, controversy arises when the medical community is faced with new abnormal conditions, owing mostly to the new technologies in genetic engineering. This controversy becomes especially apparent when examining psychological disorders. In the past, psychological disorders were thought in general to be due to both psychological and social abnormalities. Although these psychosocial problems are still of utmost importance, researchers have since discovered that many psychological disorders, such as alcoholism, also have genetic causes. Recent studies have identified a genetic area (locus) where a gene is located that can transmit alcoholism from affected father to son. Mental health professionals also know from clinical experience that alcoholics demonstrate a characteristic set of specific signs and symptoms. Additionally, it is well established that the ultimate clinical course for untreated alcoholism is death. Therefore alcoholism, once thought to be a disorder of those with a weak will, or "party people" can now be characterized as a disease.

The disease concept of chemical dependency, according to MindDisorders.com, is gaining worldwide acceptance, but does have some critics who argue instead that addiction must be understood as a general pattern of behavior, not as a medical problem. Advocates of the disease concept of chemical dependency model maintain that the identification of biological causes or correlations is crucially important for treatment. They argue that if clinicians can understand the intricate details concerning the mechanisms associated with drug effects, then measures to interrupt the effects can be devised. These interventions can be both medical (developing new drugs to chemical block effects of illicit drugs) and psychological. According to the disease concept model, psychological intervention includes a vital educational component that teaches people with chemical dependency the concept of understanding addiction as disease. As a result of this understanding, affected people then view their dependency as a disease, similar to other diseases with a biological cause (heart disease, cancer, high blood pressure), and with a specific set of signs and symptoms and an outcome in the future (clinical course). Proponents of this approach believe that this understanding can help affected people to follow treatment recommendations, and can reduce shame and guilt commonly associated with chemical dependence. Alcoholics Anonymous is a prominent example of an organization that embodies the disease concept of chemical dependency.

According to DRA, denial as a stage of chemical dependency is a defense mechanism that includes a range of psychological maneuvers designed to reduce awareness of the fact that alcohol and drug use is the cause of an individual's problems rather than a solution to those problems. Typically an alcoholic or addict is the last to admit that they may have a drinking or drug abuse problem. Denial becomes an integral part of the disease process of chemical dependency, a major obstacle to recovery, and a precipitous factor in relapse events. Denial, is the cunning, baffling, and powerful part of chemical dependency that tells the addicted person that they do not have a problem. If a chemically dependent individual is "in denial" about their alcoholism and addictions they cannot become engaged in a recovery process. One cannot work on a problem unless they accept that it exists. Though the disease can't be cured, it can be arrested and treated (kept in remission). The disease is far more complex than the mere use and abuse of mood-altering chemicals and recovery is far more complex then just becoming abstinent. Unfortunately, many addicts and alcoholics believe that if they can just get drug and alcohol free they will be o.k. and can turn their life around. Detox alone is rarely enough. In order to maintain abstinence one must make personal, interpersonal, and lifestyle changes. These take time-- in fact, most professionals and recovering addicts and alcoholics believe that recovery from the disease of chemical dependency is a life-long process.

According to the Ohio State University Medical Center (OSUMC), substances frequently abused include, but are not limited to, the following: alcohol, marijuana, hallucinogens, cocaine, amphetamines, opiates, anabolic steroids, inhalants, methamphetamine, tobacco. Cultural and societal norms influence acceptable standards of substance use. Public laws determine the legal use of substances. The question of whether there is a normative pattern of substance use remains controversial. Substance-related disorders are caused by multiple factors including genetic vulnerability, environmental stressors, social pressures, individual personality characteristics, and psychiatric problems. However, determining which of these factors are primary and which are secondary has not been determined, in all cases.

The following are the most common behaviors that indicate an individual is having a problem with substance abuse, according to the OSUMC. However, each individual may experience symptoms differently. Symptoms may include:
--Getting high on drugs or getting intoxicated (drunk) on a regular basis
--Lying, especially about how much they are using or drinking
--Avoiding friends and family members
--Giving up activities they used to enjoy such as sports or spending time with non-using friends
--Talking a lot about using drugs or alcohol
--Believing they need to use or drink in order to have fun
--Pressuring others to use or drink
--Getting in trouble with the law
--Taking risks, such as sexual risks or driving under the influence of a substance
--Work performance suffers due to substance abuse before, after, or during working or business hours
--Missing work due to substance use
--Depressed, hopeless, or suicidal feelings
The symptoms of substance abuse may resemble other medical problems or psychiatric conditions. Always consult your physician for a diagnosis.

According to the OSUMC, specific treatment for substance abuse/chemical dependence will be determined by your physician based on:
--Your age, overall health, and medical history
--Extent of the symptoms.
--Extent of the dependence.
--Type of substance abused.
--Your tolerance for specific medications, procedures, or therapies.
--Expectations for the course of the condition.
--Your opinion or preference.

A variety of treatment programs for substance abuse are available on an inpatient or outpatient basis according to the OSUMC. Programs considered are usually based on the type of substance abused. Detoxification (if needed, based on the substance abused) and long-term follow-up management are important features of successful treatment. Long-term follow-up management usually includes formalized group meetings and developmentally age-appropriate psychosocial support systems, as well as continued medical supervision. Individual and family psychotherapy are often recommended to address the developmental, psychosocial, and family issues that may have contributed to and resulted from the development of a substance abuse disorder.

Many have a hard time believing that their addiction has caused a permanent change in their brain chemistry, preventing them from being able to use normally again. According to eGetGoing.com, they have to test this for themselves many times before they prove to themselves that they cannot drink and/or use drugs in a non-addicted way. Until they are convinced that they cannot control their use, they rarely begin the road to recovery. Chemically dependent people can control their disease by learning better ways to address their problems and by learning ways to avoid returning to the use of alcohol and/or drugs. By achieving an ultimate goal of abstinence, the chemically dependent person can possibly control the disease.

Until next time. Let me know what you think.

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