Lens for Drivers of Substance Abuse

Everybody is talking a lot about causes and cures for substance abuse, but like the weather, so little of the talk ends up changing the situation much at all. This short, informal paper outlines a simple lens for viewing, thinking about, and talking about what is really causing substance abuse, whether it be drug abuse or alcoholism.

The main point is to avoid a one-size-fits-all characterization that does a disservice to most people.

From observation of reports over the years, I have concluded that the primary drivers of substance abuse are:

  1. Experimentation and thrill-seeking.
  2. Peer pressure.
  3. Chronic pain.
  4. Environmental distress.
  5. Mental illness.

Those drivers are in fact order by increasing level of severity, so that the primary driver is the highest level of severity that is in play for a given individual.

Another main point is that it can be very counterproductive to attempt to use a solution to one of those categories when the primary driver for an individual is another of the categories.

It is also important to realize that superficial symptoms of one of the drivers may mask a more significant underlying driver. In fact, in extreme cases, it is very possible for an individual to be the victim of all five categories, and not so uncommon for individuals to be victims of two or three of the drivers at the same time.

Motivation

The usual touted solution is merely to spend more money, without very much concern for effectiveness.

My point is that if you don’t have a good handle on the underlying problem (root cause for the substance abuse), then you are unlikely to offer a truly effective solution.

Hence, my focus here on identifying the primary driver of substance abuse for any given individual.

Drugs vs. alcohol

In addition, this paper makes no attempt to distinguish the abuse of prescription pharmaceuticals and illegal drugs.

They are all substances and all subject to abuse.

Escape

Not that this simple explanation points us to a solution, but simply that if drugs or alcohol are providing an escape that works for an individual, to some degree, then any real solution will need to provide a comparable escape or release from the anxiety that is necessitating the desire for escape in the first place.

Counseling

It’s just a phase, they’ll grow out of it

Simple, traditional, teenage experimentation and thrill-seeking, maybe simply as an act of rebellion against parental authority may indeed be no cause for alarm. Ditto for peer pressure where kids graduate from high school, graduate from college, and start families, with each stage having its own baggage that will tend to get left behind as the individual matures and moves on to new peer groups, each hopefully more mature than the last.

Again, the trick is to look past the superficial driver and sense whether some more powerful, darker, underlying driver may be in play. Maybe a normal teenager can skate on from a one-time thrill, but someone with mental illness or severe relationship problems may not be so lucky, even though the initial experience is the same for both.

Environmental distress

  1. Relationship problems — parents, children, spouse or significant other, other family members, romantic breakups, marriage problems.
  2. Unstable home environment — missing parent, dysfunctional parent, physically, sexually, or emotionally abusive parents, no parents, homeless, disruptive presence of non-parental adults.
  3. Parental substance abuse.
  4. Parental mental illness.
  5. Parental work, health, or financial issues.
  6. Work issues — conflicts with boss or coworkers, loss of job, chronic unemployment.
  7. School issues — problems with authority, academic performance, poor relationships with classmates, bullying, cognitive difficulties.
  8. Loss — death in the family, traumatic accident.
  9. Health problems — personal or in the family.
  10. Gender identity conflicts or anxiety.
  11. Financial difficulties — making ends meet, rising expenses, lost job, reduced income, medical expenses.

Many forms of environmental distress have practical solutions that don’t involve substance abuse, especially professional counseling, but it may also be true that some element of environmental distress may trigger an underlying primary driver of substance abuse such as mental illness. Not that environmental distress might cause mental illness per se, but simply that it could trigger an underlying mental instability that up to that point may have been dormant or at least unnoticed or unnoted.

Relationships

Counseling can be a big help.

Underlying mental illness can be a major, underlying driver, so just because the obvious problem is difficulty with a relationship, one needs to dig deep enough to see if the relationship difficulty is the real, source problem or simply the trigger for an underlying mental illness issue.

Severe substance abuse

Moderate medication for legitimate chronic pain may not rise to the level of severe substance abuse.

Bouts of experimentation or thrill-seeking by teenagers will tend not to be severe substance abuse problems.

Occasional substance use as a result of peer pressure will not tend to indicate a severe substance abuse problem. It could be a yellow flag and bear watching more closely, but unless occasional becomes frequent for an extended period of time, it may not be a true, severe problem.

Addiction

For the purposes of discussion here, I would define simple substance abuse as having a specific triggering condition, while addiction would be abuse that is initially triggered but then takes on a life of its own, long after the initial trigger has abated. The point is that simple substance abuse can be cured by removing the trigger (and dealing with any lingering, lagged effects), while a true addiction would typically have a more complex resolution even after the trigger is safely removed.

There is the hybrid condition where the trigger persists for an extended period or even indefinitely, such as chronic pain, a disruptive home environment, or an abusive relationship, such that the otherwise simple substance abuse superficially persists as if an addiction. The resolution would be to either address the underlying trigger or to provide the individual with coping mechanisms to mitigate the effect of the trigger even if the trigger itself cannot be cured.

Chronic pain vs. temporary pain

If the individual truly does have long-term chronic pain, or a terminal illness, then their drug use probably doesn’t constitute abuse per se. But, all to commonly, that is not the case — a short term issue ends up becoming a long-term substance abuse problem.

Even then, one must dive deeper to discern whether some more significant factor is at work that is driving the abuse more than any short-term or chronic pain, such as mental illness, relationship problems, or a dysfunctional home environment. Put simply, pain may simply be the excuse rather than the root cause of the substance abuse.

Physical addiction vs. psychological addiction

So commonly, an individual successfully completes a rehab program, but shortly thereafter relapses. Clearly there is something more at work than the mere physicality of the addictive power of a given substance being abused.

In any case, even once physical addiction is taken out of the picture, the question remains which of the various drivers is the primary cause of the psychological addiction.

Address the primary driver of the psychological addiction and the physical addiction will most likely be a non-problem.

Mental illness

Mental illness is a huge problem. This paper is not intended to suggest any cures, but simply to note and highlight how significant a primary driver for substance abuse it can be.

I’ll go out on a limb and suggest that mental illness is the primary driver for most substance abuse.

Rehab and counseling simply can’t make a dent on substance abuse that is primarily driven by mental illness.

Use the lens

  1. Experimentation and thrill-seeking.
  2. Peer pressure.
  3. Chronic pain.
  4. Environmental distress.
  5. Mental illness.

Start at the highest level, mental illness, and work downward to find the highest level of primary driver that applies to a given individual.

Even for severe physical addiction such as opioids and chronic alcoholism, my claim is that as a general proposition if you address the primary driver of the substance abuse, you will be tackling the psychological component of the addiction, rendering any physical addiction a non-problem. Sure, physical addiction does require its own treatment, but focus on the psychological component first, otherwise the physical addiction will quickly return.

Not that I am suggesting or recommending that any reader engage in diagnosing or treating a suspected substance abuse problem, but I am strongly suggesting the use of this lens or model for general discussion of substance abuse as a social problem that needs to be addressed by society in general, and to use this lens when discussing and evaluating proposed public policy decisions for solutions to substance abuse problems, such as the purported Opioid Epidemic.

So, when someone proposes a public policy or treatment program or even a prescription for treatment of a single individual, we can ask: Which primary driver of substance abuse is being addressed?

Freelance Consultant