The Psychology Service
Drug & Alcohol Abuse

What is drug and alcohol abuse?

Most of us on a daily basis use perfectly legal substances for pleasure and relaxation. However, even seemingly innocuous substances, such a caffeine, alcohol and nicotine, are psychoactive in nature, which means that they alter our mental functioning by having a direct action on the brain. When taken in excess, they can cause social, medical and psychological problems. For example, heavy use of alcohol can lead to diseases such as liver cirrhosis and alcohol-related dementia (Korsakoff’s syndrome). Furthermore, over time, an individual develops tolerance and has to consume progressively greater quantities to obtain the original effects. Physical dependence can occur, whereby the body ceases to function normally without the alcohol, which can lead to unpleasant withdrawal symptoms occurring.

Abuse of drugs or alcohol can occur in the context of other conditions such as Depression, or PTSD. The person can use these substances in attempt to “self medicate” and reduce their symptoms.

Drugs may be obtained legally or illegally. Common legal drugs include alcohol, solvents and prescription drugs such as Valium, Mogadon and barbiturates. Drugs which may be illegally obtained include the opiates, such heroin, stimulants such as Ecstasy and amphetamine, and hallucinogens, such as LSD and “magic mushrooms”. Cannabis has mixed depressant and hallucinogenic properties, and whilst tolerance develops, there is no consensus as to whether it induces clear physical dependency. However, although widely accepted as a ‘soft’ drug, there is increasing evidence that it exerts strong psychoactive effects.

What are the symptoms?

Some people who abuse substances such as drugs and alcohol suffer physical or psychological dependency i.e. they cannot manage without it, have cravings for it, and, in the case of physical dependency suffer severe withdrawal symptoms if they do not take the substance. Typical symptoms of withdrawal include heightened anxiety, insomnia, agitation and shaking, and it may also be complicated by convulsions or delirium. Acute intoxication is a transient phenomenon that includes acute drunkenness and ‘bad trips’ due to hallucinogenic drugs.

Others are not actually dependent on the substance they abuse, but its use has a damaging effect on their daily life, such as on relationships, and work, or leads to criminal acts.

Some people suffer psychotic phenomena during or immediately after substance use, including vivid hallucinations, delusions, psychomotor disturbance (excitement or stupor), and an abnormal mood, which may range from intense fear to ecstasy. There can also be delayed psychotic symptoms some time after taking hallucinogenic drugs.

How long does it last?

Some people use drugs either at times of stress or particular periods of life e.g. in adolescence or young adulthood, in response to group norms and pressure. Others have a more long-term problem, which can persist indefinitely.

What is the treatment?

The approach taken varies with the nature and severity of the problem, including whether there is physical damage and whether the goal is abstinence, reduction in use of the substance, or harm reduction (eg stopping sharing needles). Also detoxification i.e. a phased withdrawal of the substance sometimes with replacement with other less harmful substances may be necessary, if there is physical dependency. Different approaches may be taken at different stages of treatment.

Where there are severe problems, a specialist, multi-disciplinary treatment service may be required, in the form of a community drug and alcohol team approach. For milder difficulties, CBT can be an effective treatment method. ‘Social learning theory’ has been applied to the understanding and treatment of addictive behaviours, in the form of a ‘Relapse Prevention’ model. This approach focuses particularly on the factors that will influence the success or failure of an addict who attempts to become abstinent.

Where the drug or alcohol use is symptomatic of a condition such as PTSD, Depression or chronic pain, it is important to treat the underlying condition.