What are the main contributors to substance abuse addiction relapse

and what are the best ways for close friends and family to support
substance abuse addicts through the rehabilitation process?

Kealey Meyer

Senior Project Advisor: Erin Skyles

Substance abuse and addiction is something that affects the majority of Americans today. Nearly
everyone in American knows someone who is struggling with this issue, whether it is obvious to
them or not. For this paper, the topic of study that I explored was what the most effective
methods of treatment to addiction are, as well as what the people closest to the addict can do to
best support them. In this, it is aimed at better understanding the addict’s point of view rather
than our own perceptions. It was found that the 12 step program was fairly effective, but
treatments varied between patients, and that connection and open conversation were the most
important things between addicts and those around them. The resources used were from people
who have studied the relationship between patients and their addiction, while also keeping a
close watch on how the relationships with their families and friends affected the tendency to turn
to drugs.

12th Grade Humanities

Animas High School

April 6, 2020
 Part 1: Introduction

“In 2017, an estimated 20.7 million people age 12 and older needed treatment for a

substance use disorder. Only 4 million people received treatment or about 19% of those who

needed it” (Thomas). The majority of Americans today have been inadvertently or directly

affected by substance abuse and addiction, whether that be themselves or someone who they

know is addicted. The epidemic we face today as Americans is ineffective rehabilitation

treatment, thus leading to relapse. Not only does addiction and relapse affect the addict

themselves, but it can also have monumental impacts on the people around them. It is like a

ripple effect, disrupting those closest the most and slowly flowing out to shake up the lives of

everyone within reach. We as humans tend to place blame on the addict when we are hurt by

their actions because it is the easiest and seems to be the most logical reason for all of the pain.

Americans have made it our focus to aggressively educate kids on the physical effects of

drugs using slideshows that show messed up brains and deteriorated skin on arms, yet we never

seem to talk about why people do drugs. The most effective approaches for substance abuse

rehabilitation include knowledge about the biology of addiction, eliminating isolation and

judgment, and recognizing the functions that people are using drugs in the first place for; then

building treatment around that. From this, the first step towards effective treatment for substance

addiction is to educate the general public on the root causes and internal effects of addiction.

Part 2: Historical Context/Background

To begin understanding addiction, we must first look at the biology of addiction.

Extensive research has been done over many years to gain an understanding of what different

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drugs do to your brain. Beginning around the 1960s and the 1970s, drug use and abuse became a

national concern, catching the attention of many. The public really took notice of the issue when

the War on Drugs began. It was starting to become a serious problem, and people were finally

getting the confidence to speak up about it. Thus began the research. Doctors and scientists all

over were opening up to the idea of the neurological aspects of drug addiction and dove in with

everything that they had, starting with how it works in the brain and then moving to treatments.

Misconceptions were formed, illustrating addiction as a choice. While the first time using the

drug can be a choice, one you are hooked it is unbelievably hard to get out of it.

As Koob said in his article ​Neuroscience of Addiction​ “Human addictions are chronically

relapsing disorders characterized by compulsive drug-taking, an inability to limit the intake of

drugs, and the emergence of withdrawal syndrome during cessation of drug-taking

(dependence).” As more and more research came to light about what is actually happening in the

brain while someone is addicted, it became clear that it is less of a choice and more like a need.

As people became aware of how little choice there was in it, the misinterpretation that the public

had was beginning to be wiped clean, but not all of the way. Society still encounters strife when

it comes to not being judgemental towards addicts.

Part 3: Research and Analysis

Although the biological side of addiction is important to know for understanding

addiction, it is also crucial to understand the psychology behind it. Not only is there a physical

dependency on drugs when it comes to addiction, but there is also the psychological reasoning

behind using drugs in the first place. Scientists have determined these reasons to be termed as

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“functions”. A study done in 2001 in the UK presented data resulting in multiple functions for

drugs, but as the study progressed, it was found that some functions were more prominent than

others. Not only that, but some functions were far more common within different subgroups

(such as age and gender) than in others. Take, for example, age, and that 50% of young people

between the ages of 16 and 24 years have used an illicit drug on at least one occasion in their

lives (Ramsay and Partridge, 1999). Considering this statistic, the researchers of this study began

to narrow down their focus on this age group, asking the initial daunting question of “Why?”.

This gave them the groundwork for their study, and they took off with the functions of

drug use, asking people of different ages and gender to begin to understand their big question. As

research and results began building and growing, they were finding more and more correlations.

There are common functions that pertain to the majority of people sans the factor of gender and

age. “The most popular functions for use were using to: relax (96.7%), become intoxicated

(96.4%), keep awake at night while socializing (95.9%), enhance an activity (88.5%), and

alleviate depressed mood (86.8%)” (Boys et al 1). While these can be applied to all people, some

are more specific in different subgroups. From this, we can begin to almost predict the reasons

specific people are using, began using, or why they ​will ​begin using.

Next, the study began to analyze the different subgroups. As the results started to pile up,

they started to see patterns. To begin, they looked at specific drugs. Some drugs showed more

function differences for age and some for gender. For cannabis, it seemed to be age. They found

that older users seemed to take it for the purposes of feeling elated/euphoric or to sleep and

younger users use it to increase confidence and to stop worrying. The older users seemed to use

cannabis for more recreational uses while the younger ones seemed to be using it from

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something that stems from social pressure and insecurities. For amphetamines, it was more

related to both gender and age. Women tended to use them to lose weight while men didn’t, and

older users answered that they used the drug to feel elated/euphoric while younger users reported

using it to stop worrying, decrease boredom and enhance activity. Just as with cannabis, we can

conclude from this that younger users are using amphetamines for reasons that pertain to

self-confidence and mental health while in contrast older users leaned more towards just feeling

good.

These kinds of results showed up throughout the whole study, more or less repeating

themselves within each drug. A few things that can be concluded from this study are really the

psychological aspects of the functions of drugs. It seems as though for women and younger

users, these reasons that they do the drugs stem from something that is happening inside them

with insecurities or confidence throughout life. Now, questions could be asked about where these

insecurities are coming from, but it will vary from person to person.

What can be taken from this information is how we as friends and family or anyone close

to them can support them. “According to the National Institute on Drug Abuse, between 40 and

60 percent of people recovering from drug addiction relapse.” Reasons for relapse can vary,

some of the most common (but not limited to) being depression, physical pain, fatigue,

unemployment, and self-pity (Gonzales). If an addict is near any of these circumstances or any

of their triggers, it can catapult them right back into the need for the drug. Taking that into

account, their triggers can be anything from a smell to a sound to a place, so they can certainly

easily be triggered. Yet, if you look at most of these, they are things that people cannot

necessarily get away from. Take depression for example. Just as addiction is, depression is a

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mental health disorder. Of course, people can take medication or go to therapy or any method

that they use to battle this disorder. An addict with depression, on the other hand, is fighting two

wars on the inside. Not only are they fighting the physical need that their body feels for that

drug, but they are also fighting the crippling feeling of depression that often interrupts everyday

tasks.

That then can lead to unemployment in a multitude of ways. For starters, there are a lot of

jobs nowadays that are drug testing, and some are even no-tolerance companies. It doesn’t stop

there though. Depression can debilitate people, rendering them unable to even get out of bed, and

if they happen to be victorious over that task, it’s nearly impossible to complete everything else

throughout the day. That is only two of the causes that can lead to relapse, and they are fairly

catastrophic to the addict themselves.

Considering these difficult factors, we then must turn to treatments. According to an

article written by Nora Volkow from the National Institute of Drug Abuse, there are 13 essential

principles that we need to take into consideration. First, understanding that addiction is a

treatable disease will allow us to explain the difficulty of staying sober since it is quite biological

once the brain is hooked. Then, we need to recognize that one treatment will not rehabilitate

everyone. Treatment options and plans will vary between people based on the drugs that they are

on and the characteristics of the people themselves. It can be quite a process to find the proper

treatment for each person, but patience is key. The next crucial step is to have treatment readily

available and affordable. Most addicts will not immediately agree to help, but once they do, it is

vital to get them in as soon as possible before they change their minds, and treatment will often

times be expensive.

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 The next principle that is pivotal is that the treatment that is decided on is not just

treatment for drug abuse. It is also focusing on the aspects of the person themselves and the

environment around them, as that can play a very major role in addiction. The next bit that is

important is the time that the addict remains in treatment. Again, the time that is appropriate for

each person will be different, but it is absolutely fundamental to recovery that they stay in

rehabilitation until they significantly reduce or altogether stop drug abuse and use. It will most

likely take quite a bit of time, but persistence and perseverance will help. Next, there needs to be

some form of behavioral therapy, whether that be individual, group counseling, or family

therapy, it allows room for support and skills in resisting the urge to use. The next piece to this

puzzle is the proper medication. This can be a tricky part, mainly due to the fact that it is a

current addict, and the goal is to stay away from drugs but prescribed accurately, they can be

quite effective for most patients.

The eighth principle mentioned is that the needs of the patient will constantly be

changing as the progress and digress, so it is important to keep a close watch and evaluate where

they are at. Next, as talked about before, many addicts have one or multiple other mental

disorders. Taking all of these into account while searching for treatment can be helpful in finding

the most beneficial one, and keeping a close watch on those disorders throughout recovery will

allow suitable evaluation. Another thing to realize is that when a patient is taking medications for

a form or part of treatment, it is only temporary and is not part of the long term plan. While the

medications can soothe the symptoms that plague the addicts within the first few months or years

of rehabilitation, they are not a permanent fix. They are there for the purpose of taking the edge

off so that they can then work towards better results.

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 The next part is that effectiveness is not based on whether it is voluntary or not. Knowing

that their actions and their drug use are being monitored can be a great way to get them to

withstand the urges that come with the symptoms. For the thirteenth principle, the NIDA says

that all patients should be tested for HIV/AIDS, hepatitis B and C, and other infectious diseases.

This is a very important one. The presence of infectious disease can be helped and treated when

found among the rehabilitation process and thus lessens the risk of further pain.

Considering all of these principles that were laid out, we as the ones closest to the addict

can begin to support them in the ways that we can. Effective treatment and catching the tell-tale

signs before addiction starts (i.e. romanticizing drug use, sudden changes in behavior, and if they

doubt the recovery process) (Ackermann) can mean the difference between rehabilitation and a

continuous loop of falling in and out of substance abuse. When different treatments are being

designed, their main goal is not only to get the addict off of the drug but also to guide and

support them back into life. They work on functioning within their families and workplaces and

society as a whole. (Volkow 13) Diving into what we as the closest to them can do, we have to

look at what our roles are within their lives.

“Family dynamics is the basis for all individuals to learn how to cope with the

challenges they might face in later life. Parental support and unconditional

positive regard strengthen self-esteem and self-confidence, and their absence

reduces them. Drug abuse is often referred to as a family issue because of the

serious negative consequences of addiction and because the importance of

recovery affects not only the substance abuser, but also all the members of the

family. Therefore a focus on the role of families is critical in understanding and

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 preventing the destructive intergenerational cycle of substance abuse and

addiction.” (Masood 2)

Family can play one of the biggest roles in rehabilitation. They are the ones that are

arguably the closest to the addict, and how the addict grew up can often play a major part in why

they began drugs in the first place. The environment that people are put in every day can affect

many things, and making sure that it is a safe and positive place to be can be vital to someone

recovering. Unconditional support is a big part of this. This means that no matter what slipups

may occur, or what thoughts and hardships come, there needs to be a constant feeling of support

coming from those around the addicts. As hard as it may be, any judgment must be cast aside.

What is also an important component is that the addict is spending time with family

members and feels included. In the study conducted by Masood, Sobia, and Sahar, they deduced

the results that 80% of the recovering participants in their study had frequent communication

with their parents on a regular basis or whenever they had time to do so. It was also found that

70% spend more time with their mothers than their fathers. (Masood 825) From this, we can

understand where a connection within a family is important. It is vital to our nature to feel

connected to other humans, and so from this, it is easier for addicts to feel like they have a

support system when there is open communication without fear of judgment.

Another thing that is vital for supporting an addict is to be sure that you are not enabling

the addict. When you are enabling an addict, you are allowing them to take advantage of your

kindness. An article outlining the factors of enabling gives us direct signs of it, including denial,

justification, allowing substance use, suppressing feelings, avoiding the problem, protecting the

family’s image, minimizing the situation, playing the blame game, assuming responsibilities, and

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controlling behavior. (Tagliareni) These are all things that people commonly find themselves

doing naturally in some cases when in reality it’s doing the exact opposite of helping.

Part 4: Conclusion

From all of this, it can be said that what the main focus of rehabilitation should be is the

functions of these drugs. If resources were focused on ​why​ people are using drugs, we could then

build programs to support users to steer clear of those reasons. Then, the threat of relapse can

decrease because the need to stifle whatever feeling comes up when those reasons appear will be

deluded. Some examples of this could be support groups that are implemented within the 12-step

procedure. In these groups, there would be a target audience that would be being addressed, and

using that audience the group could also be directed by the functions. Take the UK study for

example. You could look at the different age groups and take a sample of the younger

population.

From that, the study deduced that the functions revolved more around a need to fit in or

as an escape from the stress of life. Taking this into consideration, someone could arrange a

support group of young people focused on finding purpose and how to relieve stress. Then,

looking at the older population, they found that the more common functions gravitated towards

feeling euphoric and happy, or with women, it was to lose weight. From this, there could be a

support group that focused on things that made them happy other than the drugs, or maybe there

could be one for women and they could focus on how to feel okay in your body. Focusing on the

“why’s” of drugs could potentially bring about substantial change in the need for it.

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 Taking this into consideration, there is still the question of what can people who are close

to the addict do to support. It has been proven time and time again that the most important thing

someone can do to support an addict is to stay connected and open. That does not mean try to

connect by enabling and allowing them to use your kindness against you. In actuality, it means

keeping an open conversation in everything and holding them accountable for their actions. Do

not let them get away with something just because it means confrontation. It could quite possibly

be the difference between a step towards being clean or a step towards relapse. Another thing to

keep in mind is to not let slip-ups and difficult days or weeks discourage you. Rehabilitation is a

hard and likely long process for all sides. One of the most important parts is allowing there to be

honest communication.

Now, opening this up to be a discussion within further research is the next step. If we are

to have effective methods in rehabilitation, there is a demand for everchanging growth. We can

look at past methods and refine them to make them better. That being said, it can be difficult to

tailor the treatments to everyone’s needs, including the cost. That is precisely why there are

thousands of treatments out there. That is also why it is vital that conversation about treatment

methods stays open. There are more and more cases every day, and each one brings a new

obstacle to them. If we are to have any growth in this epidemic, we have got to be open-minded

to new ways.

With that in mind, we can then turn our research into asking how effective focusing on

the functions can be. We can ask a whole new leud of questions pertaining to the “why’s” and

begin to focus our attention on what is really the root of the problem. We have an abundance of

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research on the biological aspects of addiction, as I’m sure we will never run out of new things to

learn. Now, it is time to turn our attention elsewhere.

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