Understanding the Complexities of Substance Use Disorder


The use of drug as abusive substance has trigger a number of health issues affecting lives from different stages of the society. This is also described as substance use. Addiction to a particular substance is described as behavioural disorder, which may include drugs, gambling or many other type of external factors that makes a short term pleasurable outcome upon their practice. The reason behind increasing problem of substance use disorder is their addictiveness severely harm physical, social and psychological wellbeing of the person. Wilnes et al. have connected the attention deficit and hyperactivity disorder with substance used disorder (Wilnes, et al, 2011). The reason behind use of illicit drugs or prescribed medicines is not a straight forward topic and it is hard to present the reason within a small or fragmented scenario. In current world of complexity and competitive attitude based society the social contexts contributing towards drug abuse are many fold. Hanson et al. have correlated the social and relationship contexts and abusive use of prescribed drug using a social media based case study. In most cases it has been found that popular belief about drug abuse is synonymous with mental illness, economic backwardness and educational deficiency. However, this kind of simplistic view and stigmatization is not correct. Barry et al. have discussed about the public beliefs regarding drug abuse and mental illness (Barry et al, 2014). In this essay the reasons behind the drug abuse shall be discussed from a critical view point with brief discussions on the physical, psychological, social as well as legal context. In addition a brief discussions shall be presented on preventive strategies.


Reasons behind drug abuse

The common substances encountered by the drug abuser are of many type, they can be illicit in nature or can be prescribed drug used to treat a particular disease. The illegal use of drugs include abuse of marijuana, alcohol, cocaine, Valium, heroin etc and opioid prescribed by doctors for pain relief. The use of prescribed drug for abusive purpose is a more recent phenomenon and triggers high risk among younger adults (Lankenau, et al, 2012). The abuse of drug can have physical, psychological, social as well as emotional backgrounds.

Physical factors behind drug abuse: The main physical reason behind drug abuse is addiction related feel good nature of the drug. In most cases the physical effects are high or low, which pushes person towards periodical consumption of drug. It is also important to notice that with time the physical factors grow tolerance towards the drug and the addicted person needs higher dose to similar kind of physical effects. Wise et al. discussed the role of positive and negative reinforcement mechanism on drug seeking habit. They stressed on the period of addiction and the degree of reinforcement and also on physical pain (Wise, et al, 2014). Physical pain is an important factor which contributes to the drug dependency. Prescribed drugs in most cases have feel good outcomes, which contributes in pain relief. Non-steroidal anti-inflammatory drugs are relatively safe however, sometimes excessive pain needs low does treatment with opioids. Tetsunaga et al. have reviewed this strained using a case study model and concluded the location of pain has a huge dependency on prolonged drug dependency (Tetsunaga, et al, 2018). The prescribed drugs which also have sedative effect are frequently abuse and this kind of misuse is a big contributor to physical drug abuse. They can have prolonged effect like recurrent use physical hazard and substance related legal problem. (Hernandez, et al, 2010) Laxmaiah Manchikanti et al. have discussed the role of therapeutic opioids used for chronic pain, on prolonged drug abuse practice within a scenario of ten years perspective (Laxmaiah Manchikanti, et al, 2010). Grattan et al. found that patients with no substance abuse history have a enhanced tendency after opioid therapy (Grattan, et al, 2012). In UK the misuse of prescribed opioids have become serious phenomenon and it has increased the number of drug related death (Giraudon, et al, 2013).

Psychological factors behind drug abuse: Psychological reasons are important contributor in drug abuse. The negative feeling associated with personal or social perspective can trigger psychological stress, which are relieved by the use of substances with ecstatic and euphoric factors. With time this psychological dependence lead to addiction and the patient becomes mentally dependent on the drug. Any kind of hindrance about getting the drug can lead to volatile emotions and withdrawal symptoms as the body need to compensate the deficiency of the chemical substance. The psychological signals related to addiction are relaxing attitude by usage of drug, psychological distancing from family, loss of interest, changes in friendship, anxiety, anger or mood swing. Adolescence is a turning point in terms of psychological construction of a person. The stigma of getting differentiated from family, friends and school is a common problem among teenagers. They feel different treatment as a illusive psychological outcome which affects their mental health (Moses, 2010). This behaviour sometimes leads to depressive and anxious outcome, which leads to substance abuse. In an UK based cohort study Edwards et al. analysed the role of depression and anxiety among boys and girls on their frequency of abusive behaviour (Edwards, et al, 2014). At the same time involvement in illegal and criminal activities, antisocial drug using friends, poor family relations also triggers the problems in developmental psychology and ultimately leads to substance abuse (Liddle, 2010). For women on the other hand sexual abuse during childhood or adolescence have prolonged effect which lead to addictive behaviour (Taplin, et al, 2014). Young adults go through several psychological transition, which can lead to psychological and emotional stress. The problems are many fold and can have their social economic roots as described by Redonnet et al. (Redonnent, et al, 2012).On the other hand Lev-Ran et al. have put stress on depression and the abuse of cannabis (Lev-Ran, et al, 2014). During mid life also psychological stress due to problems related to mis life crisis can trigger drug abusive nature. Glei et al. have discussed the role of economic insecurity in this context (Glei, et al, 2019). On the other hand Cavaglino has stressed on sexual addiction in this context (Cavaglino, 2010). In this context it is worth to mention that mid life comes with a large number of psychological changes which originates from the change in social, economic, personal as well as relationship sphere, however, it’s demographic variables are yet not known. However, it is also dependent on stress, as well as personality traits (Turiano, et al, 2012). For women as the pattern of mid life crisis is big different from men, the psychology behind addiction can be different (Tuchman, 2010).

Social factors behind drug abuse: As a social animal human being constantly feel pressure and support from their social circle. They may not be direct in nature and can affect positively or negatively through the circuit of psychology. In other words it is sometimes difficult to distinguish between social and psychological context of drug abuse (Knowles, et al, 2015). Relationship problem and/or bereavement can trigger severe grief which can lead to addictive behaviour (Jentsch, et al, 2014; Lisha, et al, 2010). Environmental factors like poverty, household instance like drug addiction, social or sexual abuse, crime can lead to drug abuse to a considerable level. The role of macro level social forces can influence the microlevel, economic safety and opportunity factor which can ultimately lead to the negative end of drug abuse. It is not even related to the personal traits (Dunlop, et al, 2010). The sudden attack of economic crisis can lead to, extreme social ailments like homelessness and this can have serious behavioural problems like drug abuse (Thompson Jr, et al, 2013). With increasing social pressure from parenting, financial obligation, severe imbalance can happen leading to overwhelming problem of mismanage. For younger women this problems are much more prominent, Grant et al. have discussed this problems within a demographic context (Grant, et al, 2011). Among younger adults and adolescence peer pressure is an important factor behind drug abuse, the friend circles have an profound effect on the behavioural trait of adolescence and younger adults. Iwamoto et al. have discussed the role of masculine norms exerted by friend circles of boys and girls on alcohol abuse (Iwamoto, et al, 2013). On the other hand Dumas et al. have stressed on identity development issue in the context of peer pressure (Dumas, et al, 2012).

Emotional factors behind drug abuse: The emotional stress can come from different reason in a person specific manner which can trigger drug abuse. The reasons can be many fold like stressful relationship, negative childhood experience, victimization, natural distress and many others. In most cases illicit substance keep the emotional pain numb, which makes them attractive. However, this attraction, illusion or recreation make change in a chemical pattern and balance in central and peripheral nervous system and neuronic receptors to make permanent addiction by triggering anxiety upon withdrawal. The addicted persons feel a second kind of emotional stress due to their abusive behaviour, which include guilt due to addiction, fear from the stigma of exposure, helplessness as they are unable to quit the drug, depression out of inability to meet personal responsibilities, anger out of the sense of loneliness and resignation after a point of time from all positive ends of life. (Ekkekakis, 2013) Schreiber et al. have discussed the role of impulsive in substance addiction among young adults they hypothesised the role of emotional dysregulation can lead to higher cognitive impulse which incorporates high risk of addiction (Schreiber, et al, 2012). On the other hand Phelps et al. have discussed the role of neural circuits in decision making out of emotional reason and its connection to abusive behaviour (Phelps, et al, 2014). Childhood trauma another kind of emotional stress can trigger substance abuse and these early life stressors have profound relationship with change in neural circuit (Mustafa, et al, 2018). Moreover, these childhood trauma can have lasting effect up to adulthood as depression and anxiety in which alcohol and drug abuse acts as comorbid factors (Wolff, et al, 2012).

Other factors: As discussed in the previous sections on factors that detects drug abuse include physical, social and psychological as well as emotional are the major reason of drug abuse but there are certain factors those do not fit exactly in any section as mentioned. They are like, pharmacological factors where unawareness about a particular drug can lead to addictive behaviour, increased availability of drugs with an increase in modern communication, curiosity about euphoric sensation, urge for temporary enhancement of cognitive function can lead to drug abuse susceptibility.

Prevalence rate of drug abuse

To understand the demographic view of drug abuse it is necessary to know the prevalence of drug abuse with respect to region, gender, age and many other factors. According to WHO the global prevalence rate is from zero to 3 % and highest prevalence was found in Eastern Mediterranean region. The prevalence is greater than or equal to 1.6 %, for men, whereas 0.7 % for women in Americas. However, in Africa Eastern Mediterranean Europe and Western Pacific this rate is higher. When considered for alcohol abuse the prevalence is 0-16 percent in Eastern Europe. (WHO, 2010) For United Kingdom the scenario is like, one out of ten adults were found to be using illicit drug in England and in Wales. For Scotland there is a lowering of drug abuse from 2008 to 2015. Initially the cannabis use was highest in England and Wales among other European countries, however in now a days this has lowered. New psychoactive substances are generally less prevalent. Mephedrone is the only stimulant that has been found to be used. The high risk drugs like opioids was once highly prevalent in England and Wales for a long time even at 2017 it was found to be very high for the usage of crack cocaine.(European monitoring centre for drugs and drug addiction, 2019)

Theories of addiction

To understand the nature and remedy of addiction certain theorical modulation is necessary. The addiction theory deals with two major area of alcohol and narcotic use. Sometimes they can have similar kind of traits, Emmelkamp et al. have discussed the usefulness of the theories in treatment of patient suffering from drug addicts (Emmelkamp, et al, 2012). Many theoretical backgrounds are available in this context and everyday new social theories are coming to cover the huge area of addiction. A few of them are discussed which have deep rooted relation with previous social, physical, psychological and emotional factors contributed towards addictive behaviour.

Genetic and biological theories: It is pretty difficult to predict how addictiveness is inherited. However, cigarette smoking, alcoholism may have some genetic origin. Alcohol drinking in many case have cultural contribution and therefore may have genetic origin. Spanagel, et al. have systematically reviewed this matter with molecular networks related to aetiology (Spanagel, et al, 2010).

Endorphin is an internal opioid which regulates pain in the body. A deficiency of Endorphin due to internal factors can increase level of pain in the body. The genetic evidence show that the Endorphin deficiency can trigger addictive behaviour (Reed, et al, 2017). However, Edwards et al. have denied to rename addiction with deficiency, even after considering all the aspects of genetic basis of deficiency (Edwards, et al, 2020)

Behavioural theory: Addiction is a behavioural pitfall in which the drug itself reinforced the abusive behaviour. This disorder is sometimes connected with lower level of dopamine which increases the consumption of alcohols and opioids (Nutt, et al, 2015).

Disease theory: Addiction is a psychological process and it is connected to the neural circuit. Therefore, like many other behavioural and cognitional ailment addiction is also a chronic disease. However, it is a contradictory theory still opposed by various group of experts (Heather, et al, 2018)

Moral and spiritual model: In this model as a combination of biological, psychological, social and spiritual factors people feel and try to leave the “bad habit” of addiction. To some extent they feel like addiction is a separation from God. However, this type of stigma may have positive end towards freedom from the addictiveness. (Alexander, 2010) However, Allen et al. have opposed this theory and concluded religiosity and spirituality can increase substance abuse rather than decreasing (Allen, et al, 2010).

Social learning theory: This theory put stress on the social environment of the addicted person, in which the addicted person learn the substance abuse from their social environment. They try to learn the cope up strategy with stress, which might involve increasing friendship with addicted person. Best et al. have connected this with the identity associated with social environment (Best, et al, 2016).

Attitude to drug taking: interventions and preventive measures

The popular view about drug abuse is sometimes complex and in most cases people think it is a corrupted behaviour. On the other hand the liberal view suggest that, self-control can be a key process of curing addiction (Foddy, et al, 2010). Recently, Baumeister et al. have put stress on willpower over the self-control (Baumeister, et al, 2015). Legislative steps have been taken by UK government to mitigate the drug abuse issue. Dargan et al. have discussed the role of mephedrone associated adverse effect and its remediation by legislative interventions (Dargan, et al, 2010). Media and newspaper coverage has shown a positive role in the change of drug abusive behaviour in UK. Hernandez et al. have discussed the role of media in UK within a ten years tenure concept (Hernandez, et al, 2012).


Abusive and addictive behaviour is a social problem. It has underlying reason within social, physical, emotional as well as psychological zones. Theories are constantly coming up to define addictive behaviour. However, with ever changing social needs more research is needed to prevent substance abuse. Many legal interventions are already there to combat the issues. However, more public awareness is needed.

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