This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Misconceptions about People with Substance Use Disorders by Olivia Noland
Substance use and abuse are often tagged with a stigma that is misconstrued. For some, addicts are all categorized into one, single group of people. For others, addiction is a term that means lack of self-control or inability to make good decisions. The APA defines addiction as a condition by which the body must have a substance in order to avoid withdrawal symptoms. This condition is often followed with building a tolerance to that substance, at which point the user must increase intake. What the world today misunderstands, is that no two people struggling with a substance disorder look alike. Clinical cases vary and different patients present their disorder differently. The field of substance-use studies or psychologists working with patients that have substance disorders tend to get bad reputations because there are far fewer people who have sympathy for those with substance-related disorders than those that have other mental health issues. Whether it be lack of knowledge or a closed mind, misconceptions about substance-use disorders are prevalent among society today and must be addressed.
First, it is necessary to address what the population of substance users look like. This population includes a wide array of individuals. Many outsiders believe that if someone is struggling with using, then they must be lower-class, ethnic minorities. While being of lower socioeconomic status (SES) tends to be a risk factor in substance-use, it does not encompass this population as a whole. Many people with a substance-use disorder are of middle- or upper-class status. There are plenty of CEO’s, managers, and business owners that struggle with a substance-use disorder. This population also includes a growing prevalence among college students who seemingly have their life together and do well in school. While a diagnostic criteria of inability to fulfill major roles at work or school is included in the DSM-5 for substance-use disorders, it is possible for this criteria to not be met and a substance-use disorder still be present. Therefore, it is possible for those working in higher paid jobs to have a substance-use disorder.
While television today often depicts substance-users as ethnic minorities, this too is a misconception. Frequently, ethnic minorities are in the lower SES category and are therefore at greater risk for first time use, but minorities do not make up in any way the entire population of those with substance-use disorders. Contrary to popular belief, African-Americans are typically less prevalent among all substance-use disorders than whites, Native Americans and Hispanics. According to the DSM-5, whites frequently present with more substance-use disorders than do African-Americans and are often equally represented with the Hispanic population in the United States. These rates may differ when it comes to different areas in different states, but as a whole, whites tend to present equally among the nation in substance-use disorders.
Another misconception among addiction and substance-use is that male users are far more common than their female counterparts. DSM-5 prevalence rates are typically pretty equal amongst the genders for most substances. There are a few substances (such as sedatives, hypnotics, and opioids) where adult males have twice the rate of prevalence than adult females. This is not the case, however, in many adolescent prevalence rates. There are many substances such as stimulants, sedatives, and some hallucinogens where adolescent females present with 2-3 times higher prevalence rates than males. This, along with income and ethnicity, goes to show that these substance-use disorders can present in many different scenarios and that minorities are not the only ones struggling with such disorders.
Next, a common myth that people who are not struggling with substance-use disorders believe is that relapse happens far too frequently and that treatment, therefore, must not work. Relapse, which means to return to a former state (in the case of substance-use disorders, this would mean to use after being sober for a period of time), is a part of many disorders and many illnesses that, is not infrequent, but does not mean treatment cannot work. There are higher recidivism rates among those who try to quit cold turkey or by means of just joining a support group, but when research-based treatments are used, relapse is far less frequent. When relapse does occur, it does not mean that treatment is thrown out the window, it just means that that patient must start over and try again. If we all quit trying after doing something we regretted, no one would get anywhere. There are supported treatments that have shown high rates of positive outcomes. Even if the patient never stays completely abstinent from the substance, treatment can help to lower the number of relapses and related problems.
Another misconception is that “if you want to stop bad enough, you can control it yourself”. While maybe a few amount of people have recovered on their own, a substance-use disorder is not just something that can be stopped on a whim. One of the diagnostic criteria for a substance-use disorder is that use of the substance still occurs even when social or interpersonal problems occur. Most times, those struggling with a substance-use disorder are also struggling interpersonally, but the substance takes the win and the person continues to use despite knowing the severity of their impairment. Another criteria is that these users often have many unsuccessful efforts to cut down on their own. When struggling with a substance-use disorder, stopping use is what they often want most, but often cannot achieve on their own. These users do not want to impair their lives and would love to be able to stop on their own, but is not as easy as it sounds.
The final misconception addressed is that “if a person would quit using this substance, they would stop feeling so depressed and anxious all of the time”. This would maybe be true if the substance were the sole cause of the depression or anxiety or any other psychological effect. Many times, however, the feelings of anxiety or depression come as a precursor to the substance use. A lot of times, people begin to feel depressed and down about life and feel the only way to feel better is to start drinking alcohol or start using drugs. This leads to overuse of these substances and can then become a substance-use disorder. In these cases, the depression needs to be treated as a disorder in itself. If both the substance-use disorder and the other psychological disorder is treated, then yes, they will both ease up on effects. However, if substance treatment is the only treatment sought, then after discontinued use, the feelings of depression or anxiety will often still exist leading the patient to temptation of continued use of the substance.
There are many misconceptions that the outside world has on substance-use disorders. Struggling with a substance-use disorder does not make you weak, it does not mean there is a lack of control to stop use, and it does not mean that other psychological symptoms will always subside. Those struggling with substance-use disorders are not strictly low SES, ethnic minority males. It also does not mean that after seeking treatment, relapse will never occur. All of these misconceptions lead to misconstrued outlooks on this set of disorders and with a little information and a lot of open minds, substance-use disorders can be better understood.