Substance Use Disorders: Controlling The
Uncontrollable Urges

Substance abuse is not a small concern. It costs the United States government over $700 billion each year. More than the national impact on the budget. It contributes to deaths and the loss of quality of life to many Americans and their loved ones. The Centers for Disease Control and Prevention (CDC) reports that in 2011, there were around 40,000 drug overdose cases, a dramatic 118 percent leap from previous statistics; most of these related to prescription drug abuse.

This happens because the urge to use addictive substances can become uncontrollable once a dependency has been developed with its frequent use. It has nothing to do with poor self-control or willpower. According to the Commission on Narcotic Drugs that operates under the United Nations Office on Drugs and Crime, substance abuse can change the chemistry of the brain. This is the reason why it must be considered a condition that needs to be treated and managed.

Understanding “Substance Use Disorder”

“Substance Use Disorder” is the technical term currently used instead of “substance dependence” and “substance abuse,” according to the updated fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the diagnostic manual used by mental health professionals that “contains descriptions and symptoms of all mental disorders classified by the American Psychiatric Association (APA).” Though the word “addiction” is still being used by the National Institute on Drug Abuse, it is not considered a specific diagnosis based on DSM-5.

In this updated DSM, substance abuse disorder is described as “clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:”

The substance is often taken in larger amounts or over a longer time period than was intended.
There is a persistent desire or unsuccessful effort to cut down or control the use of the substance.
A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
Cravings, a strong desire, or urge to use the substance.
Recurrent use of the substance resulting in a failure to fulfill major obligations at work, school, or home.
Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
Important social, occupational, or recreational activities are given up or reduced because of using the substance.
Recurrent use of the substance in situations in which it is physically hazardous.
Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
Tolerance, as defined by either of the following:
A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
A markedly diminished effect with continued use of the same amount of the substance.
Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance)
The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Neuroscience Behind Substance Abuse

If you think quitting substance abuse is just a matter of having a strong will, you’re not alone. At least a third of the populace also thinks so. Substance abuse, however, can change your brain in ways you didn’t know were possible. Now, scientific research increasingly supports that the root of dependency on a substance is more about maladaptive learning. As such, addiction cannot just be “undone or unlearned” once dependency has been developed, despite one’s interest to quit. This is the reason behind the shift in the philosophy concerning substance abuse and addiction.

Most addictive substances do alter the brain. They work by targeting the part of the brain where the reward circuit/system resides, directly or indirectly. This happens when the reward circuit is flooded with dopamine, resulting in over-stimulation. Dopamine is a brain chemical or neurotransmitter that regulates the feelings of pleasure and urges, as well as, emotions, motivation, and cognition. Once this brain center has been physiologically modified, it is virtually impossible to reverse the process. Brain images of substance abusers look physically different from a non-user, particularly the area controlling behavior, learning, decision-making, memory, and judgment.

Addiction is a Disorder: The Implications

Neuroscience supports that addiction is a disease that needs to be treated. This new insight is changing a lot of perspectives, even policies, related to addiction. For instance, short-term, medically-assisted detox isn’t enough to eliminate the addictive substance in the body. A patient must go through long-term treatment, just like any other chronic condition, to manage the erupting symptoms. To prevent relapse, which is a real possibility, in the course of the treatment, an “Aftercare Program” with a mental health professional can make a significant difference.

This insight also implies that addiction isn’t just a habit or behavior that can be modified at will. One’s failure to quit the abuse of a substance isn’t an indication of flawed character or weak willpower. While the first decision to use drugs could be voluntary, it gets beyond your control once the dependence takes over. With an altered brain center, the processes it controls can lead to erratic, destructive and compulsive behaviors.

Aftercare: Battling Relapse Intelligently

According to Alcohol Rehab, “Drug and alcohol statistics show that the percentage of people who will relapse after a period recovery ranges from 50 to 90 percent.” The National Institute on Drug Abuse says, “Relapsing isn’t only possible, but it is most likely to happen because of the chronic nature of the substance abuse disorder.” Studies reveal that “aftercare” can reduce the chance of relapse. Unfortunately, only about 50 percent of those who enter rehab facilities enroll in an aftercare program, and not everyone in aftercare completes it.

What is “aftercare?” It is the continuing therapy that follows the usually short, medically-assisted detox and withdrawal phase of treatment. Aftercare is important, because for one reason or another, it is usually during the post-treatment when people are vulnerable and they relapse. Aftercare may vary from patient to patient, and usually it is tailored to each patient’s needs and goals, but it usually includes relapse prevention strategy, counseling and monitoring. For aftercare to be successful in curbing your uncontrollable urges it is important to be wary of the roadblocks when seeking professional help.

Finding the Right Companion for a Lifelong Journey

Recovery from a substance abuse disorder could be a lifelong journey, and the road will never be easy. The critical stage is when you could be gripped by confusion, fear, and loneliness after rehab. It is not only wise, but crucial to find someone who can encourage and support you during this time. In this critical stage, a strong support system of counseling can help to control your urges and avoid relapse. Family and friends can make so much difference, but if they are the reason why you are in this state, it is better to stay away from them.

During post-rehab, the best companion you can find is someone who will not only support and encourage you, but will also provide you the tools to avoid relapse. This companion is nearby – a trustworthy and capable therapist independently contracted with Carolina Counseling Services — Cameron, NC – on Hwy 87, near Linden Oaks. Your therapist will not only listen to your despairs, they can also assist you in living a clean, sober life through a customized aftercare program tailored specifically to meet your needs and goals.

Substance Use Disorders: Controlling The Uncontrollable Urges