Substance abuse contributes to a variety of social problems, including social disorders, disease transmission, family disorders, and criminal behavior. A variety of biological, psychological, and social factors are potential causes of addictive behavior. Therefore, it is important to resolve the causes relevant to each individual in order to resolve addiction. Long-term success is achieved only when the causes of addiction are addressed, but treatments also need to consider short-term goals like preventing relapse during the withdrawal stage.
Biological influences can make individuals susceptible to substance abuse. Various studies identified chromosomal regions in the human genome that can cause physiological dependence on addictive substances (as cited in Yoo et al., 2012). Another possibility is that regulatory functions of the brain do not develop properly, which means individuals are unable to regulate their impulsive behavior (Ersche et al., 2012). In that condition, people will more likely engage in repeated substance abuse and become addicted to a substance.
However, biological factors alone cannot predict addictive behavior. Psychological influences, such as personality traits and mood disorders, are also significant predictors for dependence on addictive substances. Ersche et al. (2012) found that individuals with low self-efficacy and impulsive traits, such as sensation-seeking and risk-taking, are more susceptible to addiction than people with high self-efficacy and well-regulated behavior. Chakroun, Johnson, and Swedsen (2010) found that individuals who meet diagnostic criteria for lifetime mood disorders will more likely engage in illicit substance abuse than individuals who do not meet those criteria.
In addition to mood disorders and personality traits, social influences can also account for addictive behavior. For example, childhood trauma is associated with higher instances of impulsive behavior and substance addiction (Ersche et al., 2012). Other social influences that can contribute to substance addiction include socioeconomic status, age, peer pressure, and cultural background (Li & Burmeister, 2010).
When looking for a solution to addiction, it is important to remember that there is no single cause for addictive behavior. Physiological, social, and psychological factors can all influence addictive behavior, so different individuals will need to assess different causes to resolve it. For example, adults will more likely suffer from substance addiction if they are unemployed and single (Blazer & Wu, 2009) while adolescents will more likely engage in illicit substance if they give in to peer pressure (Li & Burmeister, 2010). The treatment choice will also depend on other mood disorders present and personality traits, but cognitive-behavioral therapy (CBT) is usually regarded as the best-rounded type of therapy that can address various disorders effectively.
According to Tolin (2010), CBT is recommended as the first-line of therapy for any disorder because it is not limited to treating specific symptoms and has long-term effects. Patients treated with CBT show better improvements in general functions, such as quality of life and self-perception, than patients involved in other types of treatments. A meta-analytic review of different treatments showed that CBT has an average success rate of 61% while other treatment types, such as supportive therapy and psychodynamic therapy, have a 39% success rate at 6-month follow-up (Tolin, 2010). However, there is no evidence that CBT is superior to other therapies in adolescents, so family therapy should also be considered for treating substance addiction in teenagers.
Another important consideration is that individuals who need to overcome their addiction require a short-term strategy to prevent relapse and lessen withdrawal symptoms. Pharmacotherapy is a potential short-term strategy for treating addiction because various substances proved effective in reducing relapse rates in addiction treatment patients. For example, a group of patients with a history of cocaine abuse took GABA-ergic medication and recorded a 20% rate of success, which is significant when compared to the 7.5% success rate in the placebo group (Brodie et al., 2009).
However, research that evaluates the effectiveness of drugs in addiction treatment is often contradictory, so the use of medication in treating substance abuse warrants further research. Pettinati, O’Brien, and Dundon, (2013) reviewed eight studies investigating the effects of antidepressant medication in patients with major depression and alcohol dependence, and only three studies (38%) found the medication effective in reducing alcohol abuse. Even though opioid antagonists were effective in treating substance addiction, it is important to note that all patients also received weekly cognitive-behavioral therapy (Pettinati et al., 2013). Therefore, medication can make addiction treatment easier by preventing relapse, but pharmacotherapy alone cannot be used to resolve the causes of addiction and achieve long-term results.
In terms of illness symptoms and improvements in general functioning, CBT has proven superior to other forms of therapy. Because individuals with addictive behavior most likely suffer from issues that impair their social functions, such as low self-concept or anti-social behavior, CBT can help them transform their behavioral patterns. The ability to address a wide range of disorders makes CBT suitable for substance abuse because it is often co-occurring with mood disorders. However, relapse prevention is critical in addicted individuals, so short-term strategies like pharmacotherapy and psychosocial support also need to be considered to solve addiction problems.
References
Blazer, D. G., & Wu, L. T. (2009). The epidemiology of substance use and disorders among middle aged and elderly community adults: National survey on drug use and health (NSDUH). American Journal of Geriatric Psychiatry, 17(3), 237-245. doi:10.1097/JGP.0b013e318190b8ef
Brodie, J., Case, B., Figueroa, E., Dewey, S., Robinson, J., Wanderling, J., & Laska, E. (2009). Randomized, double-blind, placebo-controlled trial of vigabatrin for the treatment of cocaine dependence in Mexican parolees. American Journal of Psychiatry, 166(11), 1269-1277.
Chakroun, N., Johnson, E. I., & Swedsen, J. (2010). Mood and personality-based models of substance use. Psychology of Addictive Behaviors, 24(1), 129-136. doi:10.1037/a0018184
Ersche, K. D., Turton, A. J., Chamberlain, S. R., Müller, U., Bullmore, E. T., & Robbins T. W. (2012). Cognitive dysfunction and anxious-impulsive personality traits are endophenotypes for drug dependence. American Journal of Psychiatry, 169, 926-936.
Li, M. D., & Burmeister, M. (2009). New insights into the genetics of addiction. Nature Reviews Genetics, 10(4), 225-231. doi:10.1038/nrg2536
Pettinati, H. M., O’Brien, C. P., & Dundon, W. D. (2013). Current status of co-occurring mood and substance use disorders: A new therapeutic target. The American Journal of Psychiatry, 170(1), 23-30.
Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710-720.
Yoo, B. K., Shim, J. C., Lee, B. D., Kim, C., Chung, Y. I., Park, J. M., Kwon, D. H. (2012). Association of the neuronal cell adhesion molecule (NrCAM) gene variants with personality traits and addictive symptoms in methamphetamine use disorder. Psychiatry Investigation, 9(4), n. pag. doi:10.4306/pi.2012.9.4.400
