1.8 Why People Continue to Use Substances

What is physical dependence? Physical dependence is “a physiological state of cellular adaptation occurring when the body becomes so accustomed to a drug that it can only function normally when the drug is present” (Csiernik, 2015, p. 19).  This means without the substance in the body, the body simply does not function “normally”.  When someone experiences these symptoms, it is called withdrawal.  This can include shaking or trembling, nausea, cramping, muscle spasms and more.  People who have a substance use disorder may experience withdrawal, “the development of physical disturbances or physical illness when drug use is suddenly discontinued in the opposite direction to the original effects of the drug” (p. 31).  This is the body’s physical response to the absence of the drug.  Withdrawal can range from discomfort to death, depending on the physical dependence (how long a person was using a substance, how often) and the type of substance a person is using.  All these factors will impact their withdrawal, for example, withdrawal from opioids is different than withdrawal from alcohol.  When working with people in withdrawal, it is important to remember it is painful, for both physical and psychological reasons.

With physical dependence also comes tolerance.  Tolerance is the “body’s adaption to the presence of the drug requiring increased amounts to produce the same outcome as originally experienced (Csiernik, 2015, p. 29).   This means that over time it takes more of the substance or drug to produce the same feeling.  This has been known as “chasing the dragon”.

What is psychological dependence?

What is psychological dependence?  Individuals who have a substance use disorder may also develop a psychological dependence.  When you reviewed the activity exploring your habits, perhaps you determined a habit you engage in makes you feel happy.  A psychological dependence is the “mind need” for a substance, “a drug becomes so important to a person’s thoughts or activities that the person believes that he or she cannot manage without the substance” (Csiernik, 2015, p. 20).  There is also the belief that persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. (Khantzian, 1997, p. 231)

In this case, a person simply wants to numb their emotional pain and knows that by using and continuing to use a substance their pain can be numbed.  Psychological dependence is just as intense as physical dependence, if not more so.  If you believe you need a particular substance to manage your daily life, the withdrawal from that substance can be difficult.

Both physical and psychological withdrawal may be reasons why a person continues to use substances, and /or experiences a substance use disorder.  According to the American Psychiatric Association (2013), to diagnose a substance use disorder a person must have dependence and have experienced withdrawal.  This would include substances like alcohol, heroin, cocaine, and even cannabis, which was a recent addition to the DSM-V. Withdrawal, both physical and psychological can be quite painful, particularly for people who are using opiates. Let’s watch the John Lenec discuss his experiences with opioid use and withdrawal. Note the language used by the Canadian Press. How might you change this language to reduce stigma?

What did you notice?  What were the physical symptoms of withdrawal John discussed?  What were the psychological symptoms of withdrawal John mentioned?  The symptoms of withdrawal may prevent some people from reducing or stopping their substance use.  The table below indicates a number of substances.  Please review the types of dependence for the most commonly used substances.

Table 1.8.1 Psychoactive Drugs by Class: Stimulants

Stimulants block the re-uptake of dopamine, norepinephrine, and serotonin in the synapses of the CNS.

Symptoms: Enhanced mood and increased energy.

Table 1.8.1 – Adapted from:  Schwab, J.E. (2018). Drugs, Health & Behavior. OER Pressbook. Penn State. https://psu.pb.unizin.org/bbh143/           (Updated with Canadian Content)

Table 1.8.2 Psychoactive Drugs by Class: Depressants

Depressants change consciousness by increasing the production of the neurotransmitter GABA and decreasing the production of the neurotransmitter acetylcholine, usually at the level of the thalamus and the reticular formation.

Symptoms: Calming effects, sleep, pain relief, slowed heart rate and respiration

Table 1.8.2 – Adapted from:  Schwab, J.E. (2018). Drugs, Health & Behavior. OER Pressbook. Penn State. https://psu.pb.unizin.org/bbh143/           (Updated with Canadian Content)

Table 1.8.3 Psychoactive Drugs by Class: Opioids

The chemical makeup of opioids is similar to the endorphins, the neurotransmitters that serve as the body’s “natural pain reducers.”

Symptoms: Slowing of many body functions, constipation, respiratory and cardiac depression, and the rapid development of tolerance.

Table 1.8.3 – Adapted from:  Schwab, J.E. (2018). Drugs, Health & Behavior. OER Pressbook. Penn State. https://psu.pb.unizin.org/bbh143/           (Updated with Canadian Content)

Table 1.8.4 Psychoactive Drugs by Class: Hallucinogens

The chemical compositions of the hallucinogens are similar to the neurotransmitters serotonin and epinephrine, and they act primarily by mimicking them.    Symptoms: Altered consciousness; hallucinations

Table 1.8.4 – Adapted from:  Schwab, J.E. (2018). Drugs, Health & Behavior. OER Pressbook. Penn State. https://psu.pb.unizin.org/bbh143/           (Updated with Canadian Content)

It is important to note cannabis is not indicated above; however, in the DSM-V it is included as a substance with psychological dependence as people can experience withdrawal.  Were you surprised by any of the states of dependence on any of the substances? The dependence on a substance is one factor that can keep people in a cycle of use.  Uncomfortable withdrawal may make it difficult to go to school, work, or take care of a family.  In some cases, it is extreme, as mentioned in the video.

Are you a regular coffee drinker?  Have you ever tried to give up coffee?  Did you experience any symptoms?  Do you smoke tobacco?  Have you tried quitting?  What was that like?  When we think about substance use and withdrawal, we may immediately go to substances we see in the media, like heroin and cocaine.  It is important to note, based on the chart above, every substance is different, and psychological and physical dependence will be experienced differently depending on the substance and the person who uses it.

All substances have some risk, as they impact our body and brain in different ways.