Category: Understanding Addiction and Recovery

How does addiction start, and why do only a minority of people who start abusing drugs go on to develop full blown substance use disorder? This is an incredibly complicated question, and it’s one that we do not still don’t know the whole answer to.

However, what we do know is that certain risk factors can increase a person’s chance of illicit drug use and of ultimately developing drug addiction. We also know a fair bit about how addictive substances can change a person’s brain chemistry in a way that ultimately makes drug use more and more appealing, which can eventually result in drug dependence.

This article will explore both of these topics, hopefully giving concerned family members greater insight into the complex disease of drug addiction and a greater understanding of the path to a brighter future.

Risk Factors For Substance Abuse

Though some people may assume that only the drug involved is what caused addictive behavior in someone who abuses drugs, the truth is that addiction more accurately results from a complex interaction between a person, a drug, and that person’s environment.

While not everyone with drug addiction suffers from these risk factors and not everyone with these risk factors develops drug addiction, recent research suggests that, as a group, people who developed addictions are measurably different from those who did not in a number of meaningful ways.

For instance, a person’s risk of alcoholism and drug dependence is significantly higher if they also suffer from other mental health issues, such as depression, anxiety, or eating disorders. This is because people with mental disorders may use illicit drugs to help relieve their symptoms instead of visiting a qualified mental health professional for a more appropriate prescription medication.

This will only worsen symptoms and overall mental health in the long run as the person becomes more and more dependent on these harmful illegal drugs just to function. The National Institute on Drug Abuse suggests that about half of those with a substance use disorder also suffer from mental illness, and vice versa.

Another major risk factor for addictive behavior is a family history of drug addiction. This is thought to be partially because drug users who are parents may set a negative example as they suffer from addiction, abuse alcohol, and provide an unstable environment while their children are young. Children will “learn” that drug abuse is an acceptable way to deal with painful feelings, and will be at higher risk of experiencing trauma during their upbringing, another risk factor in and of itself.

However, family history is also thought to be such a powerful predictor of susceptibility to addiction because of genetic factors, especially in the case of specific drugs like alcohol, with the children of alcoholics being four times more likely to become alcoholics themselves. Family history could serve as a sign that a person will have a stronger reaction to an addictive substance, and may therefore be more motivated to keep using it even despite actual or potential negative consequences. To worsen matters, specific mental health issues that can trigger or exacerbate drug use may run in families as well.

Strong peer pressure to engage in psychoactive drug use is another major risk factor, as studies show that peer pressure is one of the most common reasons that teenagers report for using alcohol and other drugs. This is especially harmful when it creates the risk of early exposure, as people who start using alcohol and other drugs before age fifteen are three and a half times more likely than others to be dependent on drugs at age thirty-two.

There are also certain prescription drugs that come a particularly high risk of drug misuse, which can in turn progress to the use of other addictive substances. In particular, prescription drugs like opioid pain relievers exert such a powerful physical effect on brain chemistry that even some people who had no intent of abusing their prescription medication do eventually become addicted to it.

Because opiates work similarly on the brain’s chemistry to certain illegal drugs like heroin, which is basically a far more powerful version of the same drug, they can often serve as gateway drugs to these other substances, which are even more dangerous and addictive.

In particular, the National Institute on Drug Abuse suggests that more than twenty percent of people who use prescription opioids abuse them, and opioids serve as gateway drugs to heroin for four to six percent of those misusers.

The Science Of How Drug Addiction Begins

Drugs causing addiction basically all work on the brain’s system for reward related learning. The brain responds to substance abuse by releasing the neurotransmitter dopamine, particularly in the brain’s pleasure center, which is located in a collection of nerve cells lying underneath the cerebral cortex.

In a healthy brain, dopamine interacts with other brain chemicals to prompt someone to engage in behaviors that were associated with human survival and sustaining life during the early ages of human evolution. For instance, eating or a sexual encounter generally promotes dopamine release, as do secondary learned rewards like socializing, shopping, playing games, or listening to music.

Though these behaviors stimulate dopamine release, when someone consumes drugs, they exert a far stronger dopamine signal. This is what makes addictive drugs so pleasurable to use, but that’s not the only way that drugs affect the brain. Physical addiction can develop when, over time, if a person is habitually abusing drugs, drugs alter a person’s brain chemistry so that the brain comes to “expect” the drugs.

The brain will get “used” to having more dopamine around, so it will need more and more dopamine just to function. This will result in the person needing to use drugs just to feel normal, and needing to use more and more of the drug if they want to get high. This creates a vicious cycle as tolerance is pushed higher and higher, and creates cravings as the brain tries to maintain equilibrium.

A deeper look at addiction and the brain includes areas involved in withdrawal symptoms as well as those involved in the increasing desire for drugs. Another part of the brain called the amygdala will send signals indicating that not using drugs is dangerous, which is why a person will feel anxious and irritable if they do not satisfy their drug craving. The National Institute on Drug Abuse offers a more in depth exploration of these ideas here.

Using The Marchman Act On Someone Who Has Lost Control Of Their Drug Abuse

Though early approaches to drug abuse involved punishing miscreants for their “selfish” behavior, we now know that drug addiction is a disease that requires treatment rather than a moral crime that requires punishment. The Diagnostic and Statistical Manual of Mental Disorders recognizes addiction as a legitimate mental health disorder, and thinking of it that way allows us to maintain empathy for those who struggle with it rather than thinking of them as deliberately hurting themselves and those around them with their behavior.

Overcoming addiction is always possible, and therapy and support groups can help people with drug addiction start to make their way back toward a healthy life. The National Institute on Drug Abuse explains that addiction is a chronic but treatable disorder, and also explains how addiction treatment works to help patients stabilize and begin to change their mindset.

However, some people with drug addiction may be reluctant to begin treatment, as they may not be able to imagine life without drugs and may be fearful of experiencing emotionally and physically painful withdrawal symptoms, though these can often be managed by the appropriate use of medication in an appropriate treatment setting.

In these cases, and if trying to reason with the person is unsuccessful, it may sometimes be necessary to use the Marchman Act, a Florida law that allows for the involuntary commitment of a person who is so severely impaired by substance abuse that they are incapable of making a rational decision about their treatment.

If you would like to learn more about the Marchman Act, or about how one of our professional intervention counselors can guide you through the Marchman Act process, feel free to call us anytime at (833) 995-1007 or to contact us online anytime here.

Substance Use Disorders According To The Diagnostic And Statistical Manual Of Mental Disorders

Substance use disorders are defined by the Diagnostic And Statistical Manual Of Mental Disorders (DSM-V) as a problematic pattern of drug use that an individual continues to engage in despite experiencing negative consequences. Last updated by the American Psychiatric Association in 2013 and published by American Psychiatric publishing, the DSM–5 is the gold standard for professionals when it comes to diagnosing any mental health disorder, including substance use disorder, which is more colloquially referred to as drug addiction.

Someone who has or is developing substance use disorder may exhibit these signs and symptoms:

• Frequently getting high for longer periods than they intended to or taking more of a drug than they intended to
• Being unable to handle their usual responsibilities due to their drug use
• Spending a lot of time using the drug, obtaining the drug, or recovering from the drug’s effects
• Giving up social or recreational activities that one formerly enjoyed in order to spend more time using drugs
• Using drugs despite the fact that it is causing relationship problems, financial problems, or legal problems
• Using drugs even in circumstances where drug use is dangerous
• Needing to use more and more of the drug to achieve the high that they want (tolerance)
• Experiencing withdrawal when they are not using the drug
• Experiencing intense cravings to use the drug
• Having trouble staying drug free without outside help

For someone to meet the full criteria for substance use disorder, these symptoms of substance use also have to be causing clinically significant impairment to the person. The Diagnostic And Statistical Manual Of Mental Disorders also includes a separate category for substance induced disorders, which are a separate category of substance related disorders than substance use disorders.

Addictive disorders are also referred to more specifically by the specific type of drug misuse the person is struggling with, such as in opioid use disorder or alcohol use disorder. To learn more, you can check out this breakdown from the American Psychiatric Association.

Recognizing The Symptoms Of Substance Use Disorder

Along with the clinical behavioral symptoms of substance use disorder explored above, it is also possible to recognize a substance use disorder from more visible signs and symptoms present in someone who you suspect is suffering from drug addiction.

For instance, you can often recognize someone who is misusing drugs by the signs of intoxication, which can vary based on the type of drug use they are struggling with. For instance, someone who has been taking opioids may appear drowsy while someone who has been using cocaine or other stimulants may be more likely to present as unusually “wired” and energetic.

Then, other drugs like hallucinogens may result in someone who looks as if they are out of touch with reality entirely. To learn more about the signs and symptoms of intoxication from specific drugs, you can check out each’s dedicated topic page on the National Institute of Drug Abuse website.

However, some general signs and symptoms of intoxication include slurred speech, erratic behavior, impaired control of motor functions, trouble maintaining consciousness, and uncharacteristically risky behaviors. Additionally, other symptoms of substance use disorder can be recognized from the physical appearance of someone who has been engaging in illicit drug use.

These physical signs include sudden weight loss, dilated pupils, and “track marks” on one’s skin from injecting unknown substances. Since injecting illegal drugs carries the risk of transmitting pathogens that can cause serious health problems like hepatitis B and HIV, these specific disorder signs definitely should not be ignored.

Causes Of Substance Use Disorders

The causes of substance use disorder can be quite complex, and it is almost impossible to predict which of the many people who experiment with drug use will go on to develop full blown substance use disorder.

After all, in substance use disorder, substance is not actually the cause of the disorder; rather, it results from the interplay of that substance with the person’s underlying vulnerabilities and specific circumstances.

However, according to the National Institute on Drug Abuse, some factors do seem to predispose a person to developing problems with substance use. For instance, drug availability and peer pressure at school can be a significant factor in whether children are exposed to drugs. Then, children who yield to peer pressure and begin their drug use at an early age are at higher risk, while children who have more parental supervision are more protected.

Another major risk factor is family history: in other words, someone whose family members struggled with drug addiction is more likely to have trouble controlling their drug use as well. This may be partially due to social factors, as children may learn from family members that drug use is an “acceptable” way to deal with one’s problems.

However, a significant portion of the association may also be due to genetic predisposition. For instance, the person’s genes may lead them to find drug abuse more pleasurable, or may contribute to the development of a mental illness that predisposes them to resort to drug abuse to manage negative feelings caused by the disorder.

As explained by the National Institute on Drug Abuse, having an underlying mental health condition is another major risk factor for developing addiction. This is referred to as “comorbidity” or a dual diagnosis. Post traumatic stress disorder, depression, bipolar disorder, and anxiety disorders have all been shown to increase the risk of developing problems with substances.

Understanding Withdrawal Symptoms

One reason that substance use disorder can be so hard to overcome is because of the severe withdrawal symptoms that can be caused by drug abuse. Frequent drug use can change the brain’s chemistry and the brain’s structure in such a way that a person’s brain and body begins to “expect” them to take the drug and to “need” it to function normally.

This will result in intense cravings if the person does not take the amount of the drug that they are used to. It can also result in withdrawal symptoms, which can cause such severe emotional distress and physical symptoms that a person may be motivated to take drugs just to avoid them. Depending on the substance that someone is using, withdrawal may also be physically dangerous, so consulting a doctor before going cold turkey may be advisable.

Treatment Approaches for Substance Use Disorders

Drug addiction treatment can take many forms, but almost always incorporates behavioral therapies. In behavioral therapy, a licensed alcohol or drug counselor helps patients to learn healthier ways to cope with life’s troubles and with any underlying mental illness.

Most rehab centers also offer some form of group therapy, in which patients share experiences and feelings with one another or are educated together about addiction related topics. These support groups serve an important role in helping patients to realize that they are not alone in their struggles with substances, giving them a much needed sense of belonging and alleviating feelings of loneliness.

After a person completes addiction treatment, outside support groups like Alcoholics Anonymous and Narcotics Anonymous can have much the same effect, helping patients to maintain their sobriety long term as they work towards the shared goal of recovery with the help of a supportive community.

Using The Marchman Act To Help Someone With A Substance Use Disorder

If someone with a substance use disorder is unwilling to consider drug addiction treatment, but obviously meets the criteria for a severe substance use disorder to the extent that they are a danger to themselves or others, you may be able to use the Marchman Act require them to be involuntarily committed to addiction treatment.

While causing legal trouble for a family member to ensure that they get the help they need should obviously be a last resort, in some cases, it may be the only step you can take to save their life. To learn more about the Marchman Act and how one of our skilled intervention counselors can help you to confront your loved one or to guide your family through the Marchman Act process, feel free to call us anytime at 833-995-1007 or to contact us online here.

Reactive attachment disorder is a relatively rare condition that can present in early childhood, and one that is associated primarily with serious childhood trauma such as abuse or neglect that is suffered during the earliest period of their life, generally before they are 8 months old. It can also be associated with changes to a primary caregiver during the same period or the traumatic loss of a caregiver.  

These factors prevent the child from forming a healthy attachment with their caregiver as most children do, which can seriously disturb the internal model of relationships that normal children eventually form. Such a child will then become unusually withdrawn and less able to form bonds and relationships with others, as evidenced by the fact that they will not seek out comfort from others and may instead react negatively to attempts that are made to comfort them or to provide them with love and care. 

On the other hand, there also exists a “disinhibited” form of reactive attachment disorder, in which children, instead of becoming withdrawn, will instead not exhibit the appropriate discrimination when it comes to their attachment figures. 

Such children may be overeager to trust unfamiliar adults, which can pose a safety issue, and they may not show a preference for their caregiver over a stranger or the developmentally appropriate behavior of checking back in with their caregiver after venturing off. To complicate matters further, some children with reactive attachment disorder may also display behavior that has features of both inhibited and disinhibited attachment. 

Along with the attachment issues that are at the core of their disease, children with reactive attachment disorder will also typically display other signs of behavioral disturbance, such as a decreased ability to regulate their emotions, unexplained sadness, fearfulness, and irritability, or disproportionate responses to change or stress. 

These symptoms will often lead children with reactive attachment disorder to struggle socially in school as well as at home and should be apparent before a child is five years old. They also should not be better explained by a pervasive developmental disorder like autism, which can cause similar symptoms but is not related to a traumatic history. 

There is no standard treatment for reactive attachment disorder, but the child should obviously first and foremost be removed from the neglectful or abusive environment. Then, caregivers can work to establish a safe environment for the child and to establish a more secure attachment with them. Therapy and treatment can focus on improving children’s social and emotional regulation skills, and on providing them with the opportunity to establish meaningful and positive social relationships. 

However, if the child is not given adequate opportunity to form these relationships, or does not adequately resolve their original trauma, symptoms of reactive attachment disorder can persist into adulthood, which is where this diagnosis can potentially intersect with issues of substance abuse. 

Though the condition is rare enough that relatively few formal studies have been done on reactive attachment disorder outcomes, adults who displayed symptoms of reactive attachment disorder may still exhibit disturbed attachment, such as a reluctance to form relationships with others or a diminished ability to establish and maintain those relationships. 

They may also continue to struggle with symptoms like hyperactivity, anxiety, depression, and feelings of loneliness or emptiness, all of which have well-documented associations with the abuse of substances as an attempt to “self-medicate” emotional distress. 

If this behavior becomes sufficiently entrenched, treatment for the substance abuse disorder may be required in the form of a residential or outpatient treatment program. There, intensive therapy can help the person to tease out the roots of their addiction and address their traumatic past, as well as to learn new coping mechanisms and other emotional regulation skills that will help them to build the healthy relationships with others that will help them to maintain their sobriety.

In extreme cases, use of the Marchman Act may be required to force someone who is struggling with substance abuse due to the aftereffects of reactive attachment disorder or any other psychological condition to undergo this intensive treatment and turn their life back around, especially if their loved ones are perceiving clear signs that the person is becoming a danger to themselves or others. 

The Marchman Act is a Florida statute that allows for the involuntary commitment of someone who poses such a danger due to their substance abuse provided certain other conditions are met. Though this extreme measure should typically only be tried after lesser measures like talking to the person have failed, it is sometimes necessary for loved ones to take this painful step to ensure their safety. 

To learn more about the Marchman Act and how one of our skilled intervention counselors can guide you through the process of obtaining your loved one the appropriate treatment, you can call us anytime at 833-497-3808 or contact us online anytime here.

To those who have not experienced it, many aspects of an addict’s psychology can be baffling, including the tendency that some addicts have to react to the fact that their life has become unmanageable due to their substance abuse by packing up and leaving town to start fresh somewhere else entirely. 

This practice is known informally within recovery circles as “pulling a geographic,” and, like drug addiction itself,  it is a usually misguided way of seeking external changes as a solution to internal problems, a literal running away from one’s problems as opposed to the emotional running away from one’s problems represented by getting high. 

While an addict who is pulling a geographic may admit that they have a problem, they may declare that their surroundings are the problem, and thus that problem can be solved by simply changing where they live. If they can move somewhere else, escape their burnout and change their scenery, perhaps get a new job and then find a new circle of friends, then, they say, everything will be fine. 

This, of course, ignores what might be clear to outsiders what is the most pressing cause of the issues: their substance abuse. While someone who is struggling with an addiction may indeed have problems in many other areas of their life, addressing those problems can be a tempting way for them to avoid facing the hard and scary truth that they have a serious substance problem and that getting clean for good is likely the only lasting solution to the reasons that their lifestyle has become dysfunctional. 

In the worst case scenario, suddenly “pulling a geographic” while exhibiting many of the other signs that their addiction has escalated to a critically dangerous level may also be an indication of a person’s conscious or subconscious plan to go entirely off grid to continue abusing substances in a place where they may have less people looking over their shoulder, a dangerous indication of denial of or apathy to the seriousness of their circumstances. 

However, in other ways, the desire to move to a new place could actually be a good sign insofar as it indicates a willingness to start over, a symbolic new beginning that could actually help them cut ties with the people, places, and things that they associate with addiction. A new start, though, is not in itself a cure, for one important reason that is another common saying in the recovery world: “wherever you go, there you are.”

In other words, if someone simply packs up and runs from a wrecked life without addressing the underlying issues that caused it to collapse and learning better coping mechanisms that they can use to manage their emotions instead, those issues are wont to reappear somewhere else. 

So even if an addict is heading out with better intentions, maybe even intentions of getting clean, being away from one’s support system and any accountability might not be the best recipe for facilitating recovery, especially during their vulnerable early stages of it. 

Pulling a geographic could also be a cause for concern because it may make it harder for loved ones to intervene in the case of an emergency or to even be aware that that emergency is occuring.  For instance, they may not be able to contact emergency services in the case of an overdose, and the Marchman Act, a Florida law that allows for the involuntary commitment of someone whose substance abuse has made them a danger to themselves or others (provided that certain other conditions are met,) can generally only be served if the person is physically in the county that you are filing the Marchman Act petition in.

For these reasons, it might be worth trying to step in before an addict acts on plans to leave the area if you become aware of those plans in advance, perhaps by encouraging them to seek treatment rather than escape. Or, in what might be a good compromise, perhaps you could suggest that they can move in addition to committing to a more traditional treatment plan that will be in place in their new surroundings rather than instead of one. 

If they remain intent on leaving without committing to such a plan, though, it may be best to try to intervene before they do. To learn more about how one of our skilled intervention counselors can help you start a conversation with your loved one about their substance abuse, and, if such an effort is unsuccessful, guide you through the process of starting the Marchman Act proceedings, feel free to call us anytime at 833-497-3808 or to contact us online anytime here.