No single factor determines whether a person becomes addicted to drugs, and like other disorders, the risk increases in some individuals (NIDA, 2020b). Biological factors which influence risk include epigenetics, development stage, gender, weight, and ethnicity. Risk factors are an important consideration in the development of substance use disorders and include factors such as (1) aggressive childhood behavior, (2) lack of parental supervision, (3) drug availability at school, (4) drug experimentation, (5) decreased peer refusal skills, and (6) community poverty (NIDA, 2020b). Comorbidities such as mental illness increase substance use, and account for 40-60% of addiction risk. Protective factors are just as important and may decrease risk behaviors. These include (1) self-efficacy,
(2) parental monitoring and support, (3) positive relationships, family, and friends, (4) good grades, (5) school anti-drug policies, and (6) neighborhood resources (NIDA, 2020b). Self-Assessment Quiz Question #1 Which of the following is NOT a risk factor for developing substance use disorders?
a. Aggressive childhood behavior. b. Lack of parental supervision. c. Positive relationships with family and friends. d. Drug availability at school.
STIGMA AND IMPLICIT BIAS IN SUBSTANCE USE DISORDERS
Implicit bias exists in all of us, both positive and negative. Science has identified that the brain recognizes patterns and creates shortcuts to process overwhelming sensory information. A bias is one shortcut to process external information and exists even in those who pledge to be fair, including physicians, nurses, teachers, and judges. Words used by clinicians such as addicts can stigmatize individuals with substance use disorders reflecting misconceptions that these behaviors are choices rather than compulsions (NIDA, 2018). To this end, the word addiction has been eliminated from the DSM-5 ® (Diagnostic and Statistical Manual of Mental Disorders , 5th ed.) in favor of the more neutral substance use disorder (APA, 2013). Fortunately, the brain can also unlearn bias, which is accomplished by becoming self-aware and engaging in deliberate practice. Using appropriate terms, such as opioid use disorder , establishes a culture of respect. Negative biases can dehumanize individuals, affect the therapeutic alliance, and, ultimately, the course of recovery (NIDA, 2018). Stereotyping leads to healthcare disparities. Clinicians who stereotype drug use as a criminal activity marginalize disadvantaged groups and negatively influence treatment plans, which may increase drug use (NIDA, 2018). Stigma and implicit biases impact fear in disclosing substance use, decreased quality of care, or reduced access to care (NIDA, 2018). Transgender individuals are those whose gender identity differs from the sex assigned at birth and face disproportionately
higher rates of discrimination, violence, and other forms of stigma (Wolfe et al., 2021). Adverse mental and behavioral health outcomes, including post-traumatic stress disorder, depression, suicide attempts, and substance use are evident in the transgender community (Wolfe et al., 2021). Substance use is shown to provide a coping mechanism to deal with the discrimination that a majority of transgender individuals experience. Additionally, transgender individuals experience higher risks of developing substance use disorders than the general population (Wolfe et al., 2021). Unfortunately, this population may not receive an appropriate diagnosis because of decreased healthcare access or the avoidance of care because of the fear of stigma. Healthcare Considerations: Every member of our community may help to lessen stigma and prejudice against those who suffer from drug use disorders by: ● Understanding substance use disorders are chronic, treatable medical conditions. ● Changing stigmatizing language with more empowering, preferred language that does not equate people with their condition or have negative connotations. ● Addressing systemic racism, sexism, and other forms of discrimination leads to multiple layers of stigma for many people with addiction (NIDA, 2018).
RISK FACTORS FOR SUBSTANCE USE DISORDERS
Substance use is common worldwide, but use is not always indicative of a disorder. Research findings suggest variability in the speed at which a disorder develops (Marel et al., 2019). Progression for heroin is the quickest (0 months), followed by cocaine (0-4 years), cannabis (1-6 years), tobacco (1-27 years), and alcohol (3-15 years). This information is critical for implementing health promotion and early initiatives (Marel et al., 2019). Several risk factors also influence the likelihood and speed with which this occurs, including younger age of first use, biological
male gender, ethnicity, geographical place of birth, marital status, lower income, unemployment, and substance use history (Marel et al., 2019). A developmental perspective may suggest a gradual shift from late adolescence into adulthood when examining both patterns and predictors of use (Allen et al., 2021). The link between self-esteem and substance use is uncertain but can lead to greater contact with risk-taking behaviors among peers (Allen et al., 2021). However, poor adolescent self-esteem has been linked to many adult problems.
SUBSTANCE USE INTOXICATION
Substance intoxication is associated with and without substance use disorders. The most common changes with intoxication include disturbances in wakefulness, attention, thinking, judgment, psychomotor skills, and interpersonal behaviors (APA, 2013). Specific routes of administration produce rapid absorption into the bloodstream, escalating intoxication effects and the likelihood of patterns of use. Intoxication often begins
in teens and is the first substance-related disorder. Withdrawal is usually, but not always, associated with substance use disorders but can occur at any age. Short-acting substances have a higher potential for withdrawal than longer-acting substances. The substance’s half-life largely parallels withdrawal aspects (APA, 2013).
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