The Culture of Addiction
Posted: April 10, 2015
Introduction: The Community of Addiction
Culture in and of itself can be defined as any group of people that share some set of attitudes, beliefs, or values. Culture, contrary to popular thinking, is not limited to race or ethnicity but encompasses any group of people with similar thinking or behavior that is derived from that particular way of thinking. In this research blog I will take a look specifically at the culture of addiction, in particular, those suffering from alcohol and drug abuse or dependence. The addiction community is constantly on the rise, in part, due to the influx of new drugs introduced into the public on a daily basis.
Those abusing drugs or alcohol share a mindset that is consumed around using and abusing these substances. Subsequently addicts’ behaviors are driven by their need to use and receive their next “high”. Often times an addict has to hit rock bottom in order to seek treatment but the reason’s that compel that initial use vary widely. Some users report boredom, emotional pain, peer pressure, and physical injuries as the start of their addiction. Among the research that looks into the addiction community as a whole, arises the notion that dependency may be influenced genetically. The National Institute on Alcohol Abuse and Alcoholism (2012) published a report that stated genes are responsible for about half of the risk for alcoholism. Although genes are not the sole determining factor of substance abuse, it has been proven to hold some weight. Another risk factor traditionally affecting the culture of addiction is high rates of poverty and broken homes (Stimmel, 2002). Oftentimes, individuals come to begin abusing alcohol or drugs as a way to cope with stressors such as low socioeconomic status or lack of social support. These two examples of this culture’s traditions provide the key theme of nature vs nurture and how both work intermittently to influence the onset of this disease.
Among other connections seen among this culture is mental illness including but not limited to depression, anxiety, and schizophrenia. As noted above users are often trying to find a way to release unpleasant feelings they are having and turn to drugs to do so. Research by Baker and Velleman (2007) supports that between 25 and 45 percent of people seeking treatment for alcohol use disorders have a current or past anxiety disorder. Similarly, estimates of lifetime prevalence of drug misuse among those with psychosis are around 50 percent. As a whole, those suffering from mental illness as well as substance abuse have more difficulty leaving the alcohol and drugs behind. It is for these reasons that often times rehabilitation facilities include dual-diagnosis as a program to treat ailments that coincide with the user’s addiction. Dual diagnosis simply means the individual meets requirements for both a psychological disorder as well as an addiction to drugs or alcohol.
Another epidemic that affects the addiction community substantially is homelessness. In one study performed in the UK researchers found that rates of alcohol dependence were three to four times higher among homeless individuals and drug use was more than five times higher among the homeless (Baker et al. 2007). The similarities between the co-existence of mental health, socioeconomic status, support, and homelessness with drug and alcohol addiction may be an area that requires further study in order to help treat this culture of drug and alcohol abuse. Paying particular attention to the cultures that correspond with addiction could lead to better treatment and the prevention altogether of alcohol and drug use.
Another major correlation that has been found among the addiction culture is that of drug users and criminality. Often times those submerged in this culture find themselves exhibiting deviant behavior that may or may not land them in jail. Due to the criminal nature of drugs and alcohol, whether it be obtaining or consuming them illegally, the user is faced with the decision to break the law leading them down another dangerous path. Today addiction is seen as an increasingly serious problem and many in the criminal justice system agree. Often times the first time an individual has a run in with the law due to their drug problem, as a substitute to jail time, the judge will offer a stay at a residential rehab instead. Rather than throwing the abuser in jail, they can receive the treatment they need to successfully re-emerge themselves into the community with the hopes of sobriety and positive change. Alcohol is illegal for those under 21 years of age and it is prohibited for a person of any age to operate a vehicle under its influence. Prescription drugs are illegal unless directly supervised and monitored by a physician, and street drugs such as cocaine are illegal all together. For these reasons it is apparent why consuming drugs and alcohol are directly linked to criminal behavior. Along with the scandalous nature of these substances, it is often observed that those stuck in this culture will engage in unlawful behavior to obtain these substances. The addiction culture is infamous for doing almost anything to get their hands on the source of their addiction. Many users report lying, cheating, and stealing in order to obtain their drug of choice. It is for this reason that many users loose important relationships which leads me into my next point.
The families and loved ones of drug and alcohol abusers suffer almost as much as the addict themselves. Due to the addiction, counselors see all too often, the abuser has ruined many significant relationships and support they had prior to this disease. The loved ones get sick of dealing with the lies and excuses of the abusers which creates a whole other culture in itself- families of addicts. Most rehab facilities offer counseling and support groups for family members of drug and alcohol abusers to deal with the psychological suffering endured by these individuals. Most family members will attest to the destructive power drugs have describing it as “the end of relationships” (Barnard, 2007). The problems that families suffer from brought on by the drug abuse of a loved one is often recurrent and places enormous burdens on all aspects of their lives including socially, mentally, and physically. Once an individual becomes addicted to these mind altering substances the families find it particularly hard to cope with the fact that the abuser is acting like someone they have never met. Personalities are affected, decision-making is affected, and common sense is thrown out the window as far as addicts are concerned, so reasoning with their loved ones is almost nonexistent. Family members eventually separate themselves from the addict until they are ready and willing to receive help. This in and of itself is a problem within the addiction community because social support from family members is instrumental in seeking treatment and maintaining a life of sobriety. Family therapy has gained substantial support among this culture in that rebuilding these lost relationships can offer hope by undoing some of the damage the addict has caused. Counselors are seeing the importance in bringing the family into therapy and in these sessions strive to engage, join, stabilize, educate, and develop coping and relapse prevention strategies (Margolis & Zweben, 2011). When the family is involved in therapy and can provide a system of support the likelihood of success is much higher than those without the influence of family. It remains important that if there is any hope that the family will be involved in treatment to get them on board as soon as possible and into a treatment program that will fit the family as well as the individual’s needs.
Treatment of Addiction
The treatment for addiction is constantly being evaluated and new forms are always on the rise. Most all treatments include some form of education, counseling, and cognitive or behavioral approaches. Frequently healthcare providers play a key role in intervening and helping their patient understand that treatment is necessary. It is normally the health professional’s job to help their patient decide to enter care (Schuckit, 2006). The first form of treatment I would like to discuss is the traditional 12-step model that has been around for decades and is still the guide put in place by many rehabilitation facilities today. The 12-step program is rooted in spirituality as it began with a focus on religion and God as being the driving force to lead a life of sobriety. Over the years the 12-step model has been altered in various ways depending on each individual’s religious views. It serves as a plan one can implement to get and remain sober. The major steps involved in this program include admitting the problem, understanding that it is possible to lead a life free of addiction, making amends with those who have wronged you, and continually admitting when one falls short. Meditation or prayer is also key in this approach, as it allows for a weight to be lifted off of the addict’s shoulders. Groups such as Alcoholics Anonymous were formed based on this model and show just how much of a culture those suffering from addiction really are. Alcoholics Anonymous have regular meetings where this culture all come together to share stories and seek support from like-minded individuals.
Another form of treatment that is widely used in the treatment of alcohol and drug addiction is motivational interviewing (MI). Motivational interviewing was originally written about by Dr. William R. Miller as an intervention for alcohol use disorders, but as its popularity grew, transitioned to treat many other behavioral disorders (Schumacher & Madson, 2014). This is done through professional counseling where the counselor works with the addict to show them they have control over their own lives. Often time’s abusers feel as though they have lost control or that their addiction has taken over their life; this is when the counselor steps in to work on self-assessment and self-motivation techniques. MI encompasses expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy (Miller & Rollnick, 2002). Ultimately, therapist’s help clients commit to change and assist them in implementing a change plan. This form of therapy has shown effectiveness with individuals both as a single treatment, and as a pretreatment of cognitive behavioral therapy. For alcohol use in particular, motivational interviewing has been found to be more effective than directive confrontational counseling (Emmelkamp & Vedel, 2006). Overall motivational interviewing is a strategy that prepares the individual for change and helps the individual develop intrinsic motivation.
Along with the 12-step model and motivational interviewing there are many randomized controlled trials that have demonstrated overall support for cognitive behavioral therapy (CBT) as an effective psychotherapy for those suffering from addiction. CBT is a “time-limited psychotherapy that is rooted in social learning theory” (O’Connor & Stewart, 2010). Through this approach vicarious learning and reinforcement are critical to substance use behaviors. Normally, the addict continues to use due to the positive reinforcement he/she receives; for example reduced stress, reduced pain, or reduced social inhibition. CBT asserts negative reinforcement for these behaviors and is accompanied with self-efficacy training in an effort to show the patient that they can cope with outside stressors without the use of dangerous substances. Another component of CBT that is used and shows empirical evidence of success is cue exposure. Similar to positive and negative reinforcement cue exposure works on the notion of classical conditioning. Rather than associating a pleasant experience with drug use, cue exposure involves repeated exposures to relevant cues and teaches the addict how to cope with the urges associated with that cue. These types of conditioning are meant to help teach the addict, through repetition, how the avoidance of relapse is possible.
Relapse prevention is the last method of treatment I will discuss that is instrumental in not only treating the addict but preventing them from entering back into this culture of abuse. Relapse defined is “the process of returning to symptomatic behavior after a period of symptom remission, and is the most widely noted outcome following treatment for substance abuse disorders” (Witkiewitz & Marlatt, 2011). Relapse prevention is based on cognitive-behavioral strategies used to help the client identify their personal high-risk situations and provide coping skills to increase their chance of refraining from use when put in these situations. This form of treatment includes group therapy where the counselor provides direct instructions of modeling, behavioral rehearsal and coaching, along with discussing situations where relapse is most common. Role play is widely used in this prevention as a tool to help recovering addicts play out scenarios they may encounter upon returning to their normal environments. This type of therapy addresses both the behavioral responses (such as anger) along with the cognitive processes that select which mode of action is best. Preventing relapse is the biggest issue once an individual completes treatment and is something the addict will always have to be aware and cautious of. Addiction is considered a disease among the community at large and it is a lifelong battle to remain free from its influence; this is why relapse prevention strategies are a necessary step in the treatment of substance abuse.
Baker, A., & Velleman, R. (2007). Clinical Handbook of Co-existing Mental Health and Drug and Alcohol Problems. New York: Routledge.
Barnard, A. (2007). Drug Addiction and Families. London and Philadelphia: Jessica Kingsley Publishers.
Emmelkamp, P., & Vedel, E. (2006). Evidence-based Treatment for Alcohol and Drug Abuse: A practitioner’s guide to theory, methods, and practice. New York: Routledge.
Margolis, R., & Zweben, J. (2011). Treating patients with alcohol and other drug problems: An integrated approach. American Psychological Association.
Miller, William R.; Rollnick, Stephen. (2002). Motivational Interviewing: Preparing People for Change. Guilford Publications.
O’Connor, R., & Stewart, S. (2010). In Cognitive-behavioral Therapy for Refractory Cases: Turning failure into success. American Psychological Association.
Schuckit, M. (2006). Drug and Alcohol Abuse: A clinical guide to diagnosis and treatment. Springer US.
Schumacher, J., & Madson, M. (2014). Fundamentals of Motivational Interviewing: Tips and strategies for addressing common clinical challenges. USA: Oxford University Press.
Stimmel, B. (2002). Alcoholism, Drug Addiction, and the Road to Recovery: Life on the edge. New York: The Haworth Press, Inc.
U.S. Department of Health and Human Services-National Institute on Alcohol Abuse and Alcoholism. (2012). A family history of alcoholism: Are you at risk? Retrieved from http://pubs.niaaa.nih.gov/publications/FamilyHistory/Family%20History.pdf
Witkiewitz K., & Marlatt, A. (2011). Therapist’s Guide to Evidence-based Relapse Prevention. Academic Press.