Client, Family, and Community Education

This chapter will include information about the etiology of substance related disorders; how substance abuse/dependence are prevented; the treatment and recovery continuum; effects of alcohol/drugs on the family; physical health risks associated with alcohol/drug use; a description of several self-help groups; and pharmacology-specific effects of drugs on the body.
Etiology of Substance Related Disorders
The etiology or cause of substance related disorders has been identified as involving
several factors that may appear independently or in combination with other such factors.
There is evidence that genetic factors play a role in both dependence and abuse. Other
causal theories cite the use of drugs as a means to cover up or get relief from other
problems related to mental illness, stress, issues involving relationships, self-esteem and
work, and others. Thus the using behavior is also looked at as a possible symptom of
other issues or problems (Kinney, 2003).
Views of the etiology of substance related disorders encompass
sociocultural, behavioral,
and biological factors
The sociocultural view
The sociocultural view
The behavioral view
suggests the influence of both positive and negative
reinforcement as causal factors for continued drug use.
Positive reinforcement
is when the processes experienced become associated with
drug use and its pleasant effects. When the feelings produced by drugs are
pleasurable, it increases the likelihood of future use. Drugs of abuse stimulate the
"pleasure pathway" in the brain (mesolimbic dopamine system). This can be
direct stimulation by drugs such as cocaine and amphetamines, or indirect
stimulation by drugs such as heroin and alcohol—reinforcing pleasure is a result
of its effects on GABA neurotransmitters (Kinney 2003; Carroll, 2000).
The behavioral view also suggests that drug use is negatively reinforcing.
use is negatively reinforcing when it provides escape from negative feelings. The
process of use may be called tension reduction or self-medication. Some drugs
produce this effect by enhancing activity of the GABA neurotransmitters, which
reduce the anxiety/fear responses. Increased use or levels of use have been noted
among people who have experienced traumas such as physical or sexual abuse.
Another example of negative reinforcement is
using to avoid unpleasant
withdrawal symptoms (Kinney 2003; Carroll, 2000).
The biological view
states there is a difference between children of alcoholdependent
parents and those of non-dependent parents with respect to genetic
predisposition and/or biochemical factors.
Research has shown that male children of alcohol-dependent biological parents
are four times more likely than children of non-dependent parents to develop
substance dependence, regardless of whether they are raised by their biological or
adoptive parents. Female children of alcohol-dependent, biological parents are
more likely to develop other disorders, such as depression, but more research is
needed (Kinney 2003; Carroll, 2000).
Research has also shown that there is a genetic factor that, when present, indicates
an increased predisposition for some individuals to become
substance dependent
should they begin to use.
Some individuals are more likely to have the gene present that regulates the sensitivity of dopamine receptor sites in the reward
center of the brain (mesolimbic dopamine system).
This indicates that some may
have a biological vulnerability to substance dependence relating to an enhanced
sensitivity to rewarding effects of drugs. The presence of the gene does not mean
an individual will definitely become chemically dependent just like the absence of
the gene does not mean that an individual would not become dependent with
sufficient use over time (Kinney 2003; Carroll, 2000).
Biochemical factors noted state
that the brain adjusts after use, so it has less of
some key neurotransmitter in the system and the need for more influences
continued substance use. The differences in ones' ability to metabolize alcohol
may affect the individual's continued alcohol use. Some individuals are lacking
the enzyme, aldehyde dehydrogenase, which breaks down a by-product of alcohol
(acetaldehyde). Increased acetaldehyde may cause an individual to feel sick and
experience alcohol-flush syndrome, common among Asians, thus this would not
reinforce continued use (Kinney 2003; Carroll, 2000).
How Substance Abuse/Dependence Are Prevented
Prevention programs are usually designed to address several areas such as: prevent drug
use from ever starting; if it has started, stop it as soon as possible; where use has
advanced, work to stop and reverse the progression while assisting to restore people to
health; equip people with the powers of resistance, decision-making, problem-solving,
and conflict resolution skills aimed at instilling resiliency and alternatives to drug use
(Ray & Ksir, 2004).
Prevention methods include the following approaches:
• Reduce the supply of illegal drugs available in society, usually through
interdiction, legislation, and legal penalties.
• Reduce the demand for drugs through treatment of drug abuse, education,
emotional development, moral growth, and individual and community activities.
Primary prevention
is intended mainly for the young who have little or no experience with drugs, and this approach tries to anticipate and prevent initial drug use.
Primary prevention is intended mainly for the young who have little or no experience
with drugs, and this approach tries to anticipate and prevent initial drug use by:
Promoting abstinence
• Developing refusal skills
• Educating the young about the dangers of drugs
• Increasing the age of legal use (of alcohol and tobacco)
• Promoting viable alternatives, activities that do not include drug use (Ray &
Ksir, 2004)
Secondary prevention
seeks to stop the experimental, social/recreational, and habitual
use and abuse from turning into addiction by acting when the symptoms are first
recognized. Secondary prevention incorporates intervention, education, and skill building
to provide skills to avoid future use and promote abstinence. Instead of jail, drug
diversion programs direct first-time offenders into education and rehabilitation programs
(Kinney, 2003).
Tertiary prevention
focuses on stopping the progressive damage of drug use and assisting
drug abusers back to a healthier state. Tertiary prevention incorporates the following
strategies: group intervention as a means to get people into treatment that includes
detoxification, abstinence, and recovery; desensitize the drug user to the people, places,
or things that trigger use; use of family therapy, group therapy, and residential therapeutic
communities; use of pharmacological strategies such as methadone maintenance;
promotion of healthier life styles, and use of aftercare support systems, usually utilizing
12-step programs (Kinney, 2003).
Addtional Preventive efforts
have been defined by the group that is being targeted for
the prevention effort; universal, for the general population, selective, for identified at-risk
groups, and indicated, for identified high-risk individuals (Kinney, 2003).