Substance Abuse 101


I decided to begin the year with the topic that holds the greatest degree of passion for me–alcoholism and alcoholics; actually addiction from all types of substances. There are millions of addicts in North America and depending on the study you read, the ranges begin with a low of 5% and can go up to as high as 12%. I think part of this discrepancy is definitional in nature; researchers and those working within the field of addiction use differing terms to define alcoholism or drug addiction.

There are three differing classes of substance user; those that are non-dependent users—people who use substances but are not yet dependent upon them…substance abusers—people who use substances in a manner that they were either not intended for or the use of said substances is causing problems in at least one major life area (MLA)…and those that are substance dependent which is defined by those individuals that are using substances in a manner that causes problems in MLA’s and where they often experience tolerance, withdrawal, and significant loss of control.

Given these definitions, we have approximately 8% of the population that is substance dependent. John Bradshaw (Bradshaw on the Family) believes that for every one addict there are three to four other individuals impacted by their disorder; so when we do the math on these types of numbers it is easy to see how addiction and addiction issues are so prevalent in our society. North America consists of approximately 350,000,000 people—if 8% are addicted, we have 28,000,000 people suffering from addiction. In addition, if we add in those directly affected from the addiction we are now at approximately 84,000,000 either addicted or impacted by an addiction. This is a HUGE societal issue both in terms of financial cost and in terms of the cost in human suffering. We spend billions of dollars every year in health care, occupational productivity losses and accidents, and corrections/policing to deal with the consequences of addiction. It has always surprised me why we do not spend more on both prevention initiatives and relapse prevention skills development.


There are a number of questionnaires that exist that provide an answer to this question; the Michigan Alcohol Screening Test, the Drug Abuse Screening Test, the Addiction Severity Index, the Alcohol Use Disorders Identification Test, and many others.

The easiest test is the Cage Questionnaire– Have you ever felt or tried to cut down on usage? Have people annoyed you by being critical of your use? Do you feel bad or guilty about your usage? Do you use first thing in the morning (eye-opener)? If you answer yes to any one of these questions you would benefit from seeking a qualified assessment from someone who specializes in addictive disorders.


If you know you are suffering from an addictive disorder, the first thing to do is seek help from someone who is trained and certified in this area. Many people (professionals included) are well intentioned but not effectively trained to treat addiction and may end up further enabling this problem or recommending unsuccessful strategies at resolution. Given the sheer prevalence of addiction, it continues to amaze me that you can receive a PhD education in psychology without ever taking a course in addictive disorders! Successful treatment for addiction involves many and sometimes all of the following recommendations–abstinence from all mood-altering substances, detoxification, medical examination, inpatient or outpatient intensive therapy, regular and ongoing attendance at the appropriate 12-step meetings, and relapse prevention post treatment for up to two years.

It is important to highlight that addiction is a relapsing disease; more people will relapse in their first year of recovery than remain abstinent. The largest contributors to relapse include– not attending 12-step meetings, isolation, undiagnosed and untreated concurrent disorders (other psychological disorders like depression, bi-polar disorder, etc), and no access to relapse prevention counseling.




Case Example – Substance Disorders

Having been privileged to work with thousands of addicts over the course of my career, I have seen my share of successes and devastation. In presenting these cases, all identifying information has been removed and all names of people and places altered to assure anonymity. I present these cases not as a means to sensationalize this disorder but to show the extremes of impact that addiction can have and the joys that are experienced through recovery.

John came to see me post inpatient treatment for a problem with Percocet. When we first met, he was very angry with the medical profession and he was holding them, more specifically his family physician, solely accountable for his disorder. Upon meeting John he presented very positively from a physical aspect, was well spoken, and cooperative. John entered treatment after he was discharged from a local hospital for severe withdrawal treatment. Apparently, John had experienced a back trauma in his work and sought medical attention from his family MD. His MD placed him on a short-term disability immediately and prescribed a dose of Percocet (oxycodone and acetaminophen) to address his pain issues. Through diagnostic testing, it was determined that the back trauma was muscular and not structural. It was suggested that he seek a course of physiotherapy to remediate the problem. John attended the physiotherapy but continued to complain of back pain to his MD. He later admitted that he continued these complaints as a means to obtaining more Percocet as John discovered that taking Percocet also allowed him to ignore other issues within his life. Over time, John’s MD had increased his intake levels to 70 Percocet per day or 350mg of oxycodone—this is a significant amount of narcotic but clearly shows the bodies ability for the development of tolerance levels. Of additional concern was the amount of acetaminophen being ingested and thus processed by the liver. Percocet is a highly addictive narcotic with an elevated tolerance cycle. It is a medication to be used with caution and constant monitoring…in John’s case neither of these conditions existed. John might have continued this addictive cycle had it not been for a business trip. Somehow, John did not fully think through the amount of prescription he would require while away and as a consequence ended up running out of his Percocet! Percocet is not a medication you want to run out of especially at the levels that John was taking. This drug has a short life within the body, which means withdrawal effects will begin soon after the last dose. Within six hours of not having his Percocet John began to experience higher levels of pain, was sweating profusely, and was very agitated. Within the first 24 hours after his last dose, John experienced a cardiac event as a result of his withdrawal–it was this event that placed him in the hospital and later into inpatient treatment.

As I stated, by the time John came to me he was very angry with his doctor and blamed him for the addiction. Not that the doctor wasn’t at fault for part of this occurrence, however it needed to become clear to John that it was his lying and deceit that led to the elevated prescribing. His doctor was simply responding to someone with pain management issues…however, upon further exploration the doctor might not have taken this route with John. As therapy evolved John was able to see his part in developing and maintaining this disorder, had accepted the need to remain abstinent, and was active in Narcotics Anonymous. Nevertheless, I jump ahead…how did he get here in the first place?

John came from a dysfunctional family system (like all of us) that was scattered with alcoholics. Because of this, he had sworn to himself that this would never happen to him; albeit that he would drink now and then, his use was not in a dependent class when we met. He was abusing alcohol now and then and also found that it became a precursor to his elevated Percocet usage. Upon taking Percocet for the first time, he felt an overwhelming sense of relaxation and release from his stresses, which he enjoyed. Over time and due to tolerance rationales he had to continue to increase the dosage to chase that same effect. On a few occasions, he feared of overdose but was afraid to seek medical attention because he knew he would lose his prescription. He began to lie to his physician about his pain levels and make claims that the physiotherapy was causing more pain to justify the increased prescription amounts. As his Percocet intake increased, he also began to isolate from others for fear they would discover what he was doing. John began to discover what every addict finds out—you can chase that original high forever but you‘d never find it again. It was only by “mistake” that John ended up stopping, had he not had a cardiac event he might still be using today or worse…he may have eventually overdosed. In a strange way, he remains forever grateful for that trip that sent him into withdrawals.