There are three fundamental problems associated with substance abuse. The first is the behavior itself of addiction, whether that is excessive drinking of alcohol or drug abuse. The second is the set of attitudes which is ‘underneath’ the excessive consumption. And finally, a high percentage of substance abusers have long-standing mental health problems usually involving affective (or mood) disorders such as anxiety or one of the many depressive disorders. Successful treatment of substance abuse needs to address all three issues in order to help someone attain true sobriety (as opposed to mere abstinence – the so-called ‘dry drunk’).

The problem of excessive consumption

One of the myths associated with substance abuse is that in order to be an alcoholic or drug addict, one must use many times per week, and always to excess. Neither is true. Bona fide alcoholics can drink most of the time in moderation, but still be considered an alcoholic. This is because they don’t have control over the drinking. Sooner or later, an alcoholic will drink to excess when they weren’t planning on it. A high percentage of people convicted of a DUI have a substance abuse problem. Think about it; who in their right mind would plan to intentionally drink excessively, knowing that they would need to later operate a motor vehicle in order to get home? Such individuals drove somewhere, never intending to drink to excess, but did so because they cannot control how much they drink. Even though they might drink in moderation nine out of ten times, sooner or later the alcoholic will drink far more than they intended, and have a problem being able to stop once they start drinking.

Over time, the alcohol or drug addicted person, will use substances more often during different times of the day. He or she will develop elaborate means of hiding their substance usage from even the most keen of observing loved ones. Any substance abuser can hide their addiction from anyone until the problem gets to be really out of hand.

The problematic, underlying attitudes

Behind every substance abuser is entitlement. It’s the “I deserve a break today” mentality. “Because I worked so hard today, I deserve a drink.’” Or “because the kids were so demanding and I made it through the day, I deserve to get high.” Usually, there’s an underlying belief that has at least the two phrases of “because of __________” and “I deserve (insert the specific substance here).” It is often discussed in Alcoholics Anonymous (AA) that alcoholism is first and foremost, a thinking disease. That is, the alcoholic has thoughts that are distorted or just plain wrong. Over time, these thoughts take on a life of their own in the person’s mind. Add to this changes in the brain that occur with sustained substance abuse, and the afflicted individual has become severely handicapped in being able to get out of the addiction on their own.

The presence of other conditions that increase the risk for substance abuse

There are many conditions, that if left undiagnosed and untreated, can lead to substance abuse. About half of all adults with untreated ADHD become addicted to substances (ususally alcohol and/or marijuana). Many also have anxiety disorders or one of the many depressive disorders (major depression, low grade depression [called dysthymia], or bipolar disorder). Effective treatment for substance abuse involves assessing someone for these conditions. There is often a family history of these conditions as well as substance abuse in general in individuals who go on to develop substance abuse problems.

Treatment

The first step in treatment of substance abuse is to get a thorough evaluation by someone competent to treat addictions. In many states, there are certifications and / or licenses awarded by the state to people who have received specialized training in the treatment of addictions. A good evaluation often asks for input from family members, employers or other sources. This is because, most people with addictions will not accurately report their behaviors when evaluated.

Success rates for the treatment of substance abuse are not as high as they are for many other kinds of mental health issues. This is because of the powerful mechanism of denial. Denial is an unconscious process whereby the substance abuser truly is unable to see that they have a problem, even when it is painfully obvious to everyone else.

The continuum of denial:

(1) I don’t have a problem………(2) I have a problem but I can solve it myself……(3) I may need some help from someone else……(4) My life is unmanageable because of my addiction and I will lose everyone and everything unless I get help.

Often, people are coerced into treatment under the threat of a loss of a partner, a job, or some other opportunity. But, they enter treatment under duress when they’re in the first or second stage of denial. They go the treatment process never convinced that they had a problem to begin with. They went to appease someone, and then succeeded in abstinence for a time. Sooner or later, they relapse.

The more that more people can give the addicted person the message that they have a problem, and invite them back to the way they used to be, the more likely that the addicted person, slowly over time will move along to the third and fourth stages of denial where treatment is more likely to work.

One of the most effective treatments for addictions is AA for alcoholics or NA for drug addicts. These are based upon the 12 steps of recovery, and involve attending meetings and working with a sponsor. These groups are not run by professionals, but such programs have proven to be one of the most effective ways of managing addictions. Working with a mental health professional can supplement the work of these programs. A mental health professional can help with the other mental health issues than can be present. In the Chicago area, see a mental health professional at Heritage Professional Associates or ask someone whom you trust and respect for the name of a qualified mental health professional.