Substance Use Disorder and Mental Health

Substance misuse has become a great cause for concern for society in recent years. More people are getting addicted to or misusing psychoactive substances (including alcohol and nicotine) every day. According to the WHO, these substances have a huge influence on mental processes such as consciousness, cognition, perception, mood, and emotions. Due to more research around this topic being conducted in Western countries, statistics tend to show more people adversely affected by substance misuse in the United States and European countries. That being said, the mortality rate has been shown to be the greatest in low- and middle-income countries with larger populations and limited data (Peacock et al, 2018). Tobacco and alcohol use are highly prevalent in contemporary society and precipitate a large majority of the harm from their misuse (Gowing et al, 2015). It has been estimated that there are around seven million people in Pakistan who suffer from substance use disorder, with around 700 people dying daily due to succumbing to drug-related complications. This makes the number of drug-related deaths greater than those because of terrorism (Ahmed et al, 2020). To explore the zeitgeist of drug use in modern society, this write-up will appraise the prevalence of substance use disorder, substance misuse and mental health, as well as the stigma towards people with this condition and its treatment.   Multiple government regimes have struggled to curb or contain the issue of substance misuse in Pakistan. According to research conducted by The Lancet, the use of cannabis, opiates, heroin, and prescription painkillers are the most widespread in Pakistan. An astonishing 73% of individuals who inject drugs have reported sharing a syringe, contributing to the high prevalence of HIV (Yaqub, 2013). A study done on the rising trend of substance misuse in Pakistan discovered that heroin is the most abused substance along with cannabis, with the average duration of substance use disorder being 1 and 5 years (Ghazal, 2019). In Pakistan, there are more than three million people between the ages of 15 and 64 who regularly use heroin and around five million who use cannabis (Ahmed et al, 2020). Almost half of the participants of a study conducted by Ghazal (2019) reported suffering from comorbid depression along with their substance misuse issues. Family conflicts and peer pressure were extrapolated as being some of the reasons for the misuse of drugs. Other factors that contribute to misusing substances include marital issues, socioeconomic problems, bad social influences, or using substances as an escape from stress or feelings of failure (Ali et al, 2022). Drug use has been gravely ignored in Pakistan due to the strong stigma surrounding it, as well as a lack of empathy from the government and society in general. While public opinion has shifted to being more empathetic and viewing people afflicted by substance misuse issues as victims of society, the relapse rate for this condition remains 90%. This could be due to the lack of support from families and the community to treat people plagued by this condition (Yaqub, 2013).

Substance use disorder (SUD), or drug addiction, is defined as a disorder with chronic relapse rates, along with behaviors that result in a difficulty to self-regulate drug use despite its negative impact on life. The term “addiction” has a negative and derogatory connotation, which is why scientific literature tends to use the term “substance use disorder” (Singh and Gupta, 2017). While the misconception around SUD tends to be around addiction to illegal drugs, people can get addicted to legal drugs (such as alcohol, nicotine, painkillers, and tranquilizers) as well. Stimulants like cocaine and methamphetamine are extremely addictive and the risk of overdose is especially high for individuals using depressants like opioids, benzodiazepines, and alcohol. While hallucinogens seem to be the least harmful of the drug categories, they pose a risk to a person’s life by exponentially increasing the risk of accidents (Benedetto, 2022). There are a multitude of theories elucidating SUD. One theory, as mentioned above is the absence of self-regulatory behaviors. Another more recent theory dictates that SUD could be goal-directed and is influenced by an inordinate valuation of drugs. This theory explains drug addicts’ behaviors as initially being for the sake of pleasure, but later using drugs as a reward and means of escaping negative emotions, stress, and withdrawal symptoms (Loganathan and Ho, 2021). While the myriad theories about SUD give us an insight into the motivations for the behavior of people with this issue, it is imperative to also take into account the factors that may trigger the condition.

While research has shown that there is a strong relationship between genetic contributions and the vulnerability of addiction, an individual’s social environment and life experiences could alter their genetic composition, making them more susceptible to SUD. The increased reactivity due to exposure of stress-related hormones in an individual’s life can make them more vulnerable to develop SUD and even increases their chances of relapse. This stress can entail any type of physical, psychological, or sexual abuse, including neglect and poverty (Ruisoto and Contador, 2019). Stress in early stages of life can instigate issues with substance misuse in young people as well. SUD is not an uncommon occurrence for high school students, causing multifarious behavioral issues such as violence towards peers or teachers (Raffee et al, 2021). Issues with substance misuse may also increase student involvement in criminal activity, along with causing detriment to their academic progress. Young people are also oblivious to the pernicious effects of misusing substances and tend to increase substance use to better deal with negative feelings or life events, to feel grown-up, numb pain, and even increase low self-esteem (Ahmed et al, 2020). Gender distribution for SUD tend to show more men than women who report more problems substance misuse. That being said, there is evidence of telescoping in alcohol, cannabis, cocaine, and opioid disorders. Telescoping is the phenomenon where, in this case, women engage in drugs later in life but progress to addiction at a quicker rate than men. While men are more likely to suffer from SUD, women are more likely to seek help for their condition while facing a harsher stigma and less social support than men (Zakiniaeiz and Potenza, 2018).

There is a strong stigma towards people suffering from SUD and mental illnesses in general in contemporary society. The stigma can include enacted stigma (discrimination towards a certain subset of people), perceived stigma (fear of enacted stigma), or self-stigma (internalizing the social stigma and feeling ashamed of one’s condition).  Research done in Pakistan has shed light on how deleterious stigmas can be for the treatment process of someone with SUD as it lowers self-esteem and induces a mild form of depression (Khalid et al, 2020). The stigma surrounding SUD has been seen to be greater than that of other mental illnesses as the common perception of the condition tends to be that of a moral shortcoming or an absence of willpower (Rey et al, 2019). One way to combat this stigma and improve public perception is to portray the treatment for these conditions as effective, which has shown to decrease stigma as well as discrimination towards people with these issues (McGinty et al, 2015). Studies done have shown that women are more likely to be afraid of people suffering from SUD, with younger people generally having the perception that people with this condition are more dangerous, hence increasing their social distance towards them (Topkaya et al, 2021). Despite working with people who have a range of psychological and emotional issues, child protection social workers also tend to view mental illness and SUD as chronically relapsing illnesses, which adversely affects the chances of parents with these conditions keeping their children (Scott et al, 2018). Equitable treatment for SUD should address the individual’s multiple needs, be readily available and for an appropriate duration, as well as include medication if required (Jordan et al, 2020).

One reason for the barriers to effective treatment for SUD is the disregard for social determinants of the condition. The lack of integration between the primary and mental health services could also pose as a reason for the lack of effective treatment (Jordan et al, 2020). Other barriers could also encompass limited access to care organizations, financial reasons, lack of self-awareness of the seriousness of the disorder, along with perceived shame in getting help (Benedetto, 2022). The ability to fully comprehend and address the maladaptive schemas people with SUD have, along with their psychological flexibility, are necessary to effectively treat the condition, as they tend to contribute to the severity of the disorder (Albal and Buzlu, 2021). To address the issue of SUD, the individual needs to suspend any substance consumption and manage withdrawal symptoms through detoxification. While this is the first step to being treated, it should be coupled with other treatment approaches as well (Benedetto, 2022). The most common forms of treatment include pharmacological treatment, behavioral therapy, as well as social support. Pharmacological treatment is used for people with opioid and alcohol addictions and nicotine preparations (such as patches, gum, or nasal sprays) are used to help people suffering from tobacco addictions. The psychological treatment approach includes Motivational Enhancement Therapy (MET) or Behavioral Therapies, which aim to modify certain substance use behaviors. Other psychological treatments include Cognitive-Behavioral Therapies and Family Therapies. While focus on treatment is crucial to curb the issue of substance misuse in society, prevention interventions should be aimed to adolescents to work on alleviating the risk of more people developing SUD (Singh and Gupta, 2017).

Substance use disorder is an affliction most societies turn a blind eye to. With heroin being the most misused substance in Pakistan and the high prevalence of HIV due to this, society needs to work towards mitigating the stigma surrounding seeking help for this condition, as well as make treatment centers more accessible. A major obstacle when seeking help tends to be the strong stigmas surrounding people with SUD as being an absence of willpower or a moral shortcoming, which dissuades people from making their issue known and consequently getting treatment. While there are many theories that explicate the motivations behind substance misuse issues, many of them fail to consider the social determinants and their effect on behavior. Negative life events induce stress and may lead to an elevated risk of SUD. Other reasons for people misusing substances, especially for young people, include increasing low self-esteem or developing the habit as a form of escapism. Research has indicated that a mix of treatment approaches, improving accessibility to these resources, along with prevention and awareness campaigns for people suffering from substance misuse issues may prove to be the panacea for this global epidemic.  

References:

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