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CHEMICAL DEPENDANCY: CRISIS OF ADDICTION

Abstract
The abuse of alcohol and other drugs (AOD) is undeniably linked with economic and personal
adversities for both individuals and society. It is estimated that the annual national cost of
substance abuse is more than $144 billion. This includes related health and mental health care,
social welfare, victim's losses, unemployment and lost productivity, and criminal justice system
costs. The immeasurable human suffering caused by chemical dependency is equally
disturbing. Family dysfunction and violence, children affected by alcohol or other drugs before
birth, homelessness and poverty, accidents, homicides, suicides, and crime are often rooted in
the abuse of alcohol and other drugs. Substance abuse is a chronic, progressive, relapsing
disorder resulting in physical and psychological dependence on chemical substances. Much
like other health disorders, it also can be treated successfully. Effective treatment of substance
abuse disorders is essential for decreasing drug use and many of its accompanying problems.
Alcohol and drug abuse treatment reduces chemical dependency and thus helps control both
the spread and the associated costs of substance abuse-related diseases. As part of the healthcare team, nurses deal with PDD on a 24-hour basis. Quality nursing care is essential for
improving quality of life, health status, and continued abuse-free status of PDD.
Keywords: nursing, drug addiction, nursing process, intervention, motivation, interview,
family therapy

Chemical dependency is, a primary disease in which a person becomes addicted to drugs or
alcohol. It is a condition where an individual’s feels compelled to take drugs or drink alcohol
even when they understand that this can harm their health, family and social life and finances
(Ross, 2019). An example is cancer victims who are on a regimen of opioid medications will
almost certainly become chemically dependent on that medication, because of its interaction
with the body’s central nervous system. Opioids bond to certain receptors in the brain, causing
the increased release of dopamine. According to the National Institute on Drug Abuse,
“Dependence develops when the neurons adapt to the repeated drug exposure and only function
normally in the presence of the drug.
The most commonly abused substances are: Alcohol (beer, wine, liquor and cordials). In 2018,
about 139.8 million Americans aged 12 or older were alcohol users, 67.1 million were binge
drinkers, and 16.6 million were heavy drinkers. About 2.2 million adolescents aged 12 to 17
drank alcohol, and 1.2 million of the adolescents’ binge drank. Although the percentage of
adolescents who drank alcohol decreased between 2002 and 2018, about 1 in 11 adolescents in
2018 were alcohol users (MacArthur et al., 2016).
Opioids (heroin, morphine, hydrocodone, oxycodone, fentanyl, codeine). Prescription pain
reliever misuse was the second most common form of illicit drug use in the United States in
2018, with 3.6 percent of the population misusing pain relievers (MacArthur et al., 2016). For
people aged 12 or older and for young adults aged 18 to 25, the percentages who misused
prescription pain relievers were lower in 2018 than in 2015 to 2017. Similar decreases in pain
reliever misuse were observed for adolescents aged 12 to 17 and adults aged 26 or older in
2018 compared with 2015 and 2016 but not when compared with 2017. Among people aged
12 or older in 2018 who misused pain relievers, the most common main reason for their misuse
of a pain reliever was to relieve physical pain (63.6 percent). More than half (51.3 percent) of

people who misused pain relievers obtained the pain reliever they misused from a friend or
relative (Peacock et al., 2018).
Tobacco Use. In 2018, an estimated 47.0 million people aged 12 or older were cigarette
smokers, including 27.3 million people who were daily cigarette smokers and 10.8 million
daily smokers who smoked approximately a pack or more of cigarettes per day. Fewer than 1
in 6 people aged 12 or older in 2018 were cigarette smokers. Cigarette use generally declined
between 2002 and 2018 across all age groups. Some of this decline may reflect the use of
electronic vaporizing devices (“vaping”), such as e-cigarettes, as a substitute for delivering
nicotine (MacArthur et al., 2016).
Stimulants (amphetamines, methamphetamines, cocaine, crack cocaine, Ecstasy, Adderall,
Ritalin). About 1.4 million people in the United States are regular hallucinogen users. About
143,000 of them are minors between the ages of 12 and 17. In 2017, 1.2 million Americans,
including 344,000 minors between the ages of 12 and 17, used a hallucinogen for the first time.
In 2018, 2% of 12th graders admitted to trying a hallucinogen at least once in their lives
(MacArthur et al., 2016).
Inhalant are a group of solvents, gases, and aerosol sprays which people inhale to get high.
More than 23 million Americans have tried an inhalant at least once in their lives (MacArthur
et al., 2016). About 556,000 Americans are regular inhalant users. Almost 9% of 12th graders
in 2018 reported using an inhalant. Inhalants contribute to about 15% of deaths by suffocation
every year.
Marijuana. The estimate of past year illicit drug use for 2018 was driven primarily by marijuana
use, with 43.5 million past year marijuana users. The percentage of people aged 12 or older in
2018 who used marijuana (15.9 percent) was higher than the percentages in 2002 to 2017. This
increase in marijuana uses for people aged 12 or older reflects increases in marijuana use

among both young adults aged 18 to 25 and adults aged 26 or older. In contrast, marijuana use
among adolescents aged 12 to 17 did not increase between 2014 and 2018 (MacArthur et al.,
2016).
Globally, United Nations Office on Drugs and Crime (UNODC) estimates that between 155
and 250 million people, or 3.5% to 5.7% of the population aged 15-64, had used illicit
substances at least once. Cannabis users comprise the largest number of illicit drug users (129190 million people). Amphetamine-type stimulants are the second most commonly used illicit
drugs, followed by opiates and cocaine. However, in terms of harm associated with use, opiates
ranked at the top. In 2018, an estimated 164.8 million people aged 12 or older in the United
States (60.2 percent) were substance users (i.e., tobacco, alcohol, or illicit drugs). About 2 out
of 5 people aged 12 or older (108.9 million, or 39.8 percent) did not use substances. The 164.8
million past month substance users in 2018 include 139.8 million people who drank alcohol,
58.8 million people who used a tobacco product, and 31.9 million people who used an illicit
drug.
Surveys on drug use among the general population show that the extent of drug use among
young people remains higher than that among older people, although there are some exceptions
associated with the traditional use of drugs such as opium or khat. Most research suggests that
early (12–14 years old) to late (15–17 years old) adolescence is a critical risk period for the
initiation of substance use and that substance use may peak among young people aged 18–25
years (Peacock et al., 2018).

Sociocultural determinants of substance abuse
Media exposure helps influence social norms about alcohol and substance abuse through
advertising, product placements, and stories in a wide range of sources, including movies,
television, social media, and other forms of entertainment. Although alcohol sales and

marketing are highly regulated, people are exposed to a wide variety of alcohol and liquor
advertisements, especially in the United States. Targeted alcohol marketing resulted in
individuals developing positive beliefs about alcohol and substance abuse, and creating and
expanding environments where alcohol and substance abuse use is socially acceptable and
encouraged.
Discrimination and stress. Discrimination is seen as a key social stressor that elicits a
physiological response, including elevated blood pressure and release of stress hormones,
which may have lifelong deleterious effects, including increased alcohol and substance abuse
use. Self-reported unfair treatment and racial discrimination has been linked to higher alcohol
and substance abuse use.
Immigration may influence alcohol consumption and substance abuse. The theory suggests that
immigrants encounter difficulties and hardships as they transition into a new society and
culture. Hardships include the stress of experiencing new environments and cultures; living in
poor neighborhoods; finding good, secure jobs in safe work environments; encountering few
opportunities to enhance income or wealth; and engaging with fewer and smaller social
networks that may otherwise offer instrumental and emotional support. It also is possible that
immigrants may not become fully integrated into American society because of experiences
with discrimination and obstacles in social mobility. Because these factors are associated with
alcohol consumption and problems, immigrants may consume more alcohol and substance
abuse use (Peacock et al., 2018).
Acculturation, the degree to which an individual identifies with his or her native culture, is
thought to be related to substance use and abuse. Native American elders believe that many
substance abuse problems are related to the loss of traditional culture. Higher rates of substance
use have been found in persons who closely identify with non-Native American values and the

lowest rates are found in bicultural individuals who are comfortable with both sets of cultural
values.
Religious affiliations often play a protective role against drug use. Religious involvement may
inhibit adolescent risk behavior by altering behavior-influencing values or by functioning as
an external control factor. Affiliation with religions that forbid alcohol consumption was also
associated with less use of alcohol. Studies of European school and college students reported
that first and second-generation immigrants from Muslim majority countries were less likely
to drink and that their low levels of drinking influenced drinking overall at the schools.
Lifestyle Appeal. Sometimes individuals find the lifestyle of the substance abuser to be
appealing, perhaps even glamorous. Observers will notice the way a community of substance
abusers dress, the music they listen to, what they do for fun, their attitude toward structure and
responsibility, and find this lifestyle appealing. But the casual onlooker who may be enticed
by the novelty of such a lifestyle may fail to see the negative aspects.

Models of addiction
The following models have been most influential in developing drug policies and drug
treatment historically and are still used in Australia. These models influence the way people
work with young people and other individuals who have drug problems. You may be able to
relate to some models better than others and identify models that underpin your agency's
approach to drug use.
Moral model. During the eighteenth and early nineteenth centuries addiction was viewed as a
sin. Drug-dependent people were considered morally weak, and addiction was seen as a fault
of one's character. Under the influence of this model, users were punished with whippings,
public beatings, stocks, fines, and public ridicule being relatively common. (In some British
towns people were made to walk around wearing nothing but beer barrels.) Spiritual direction

was also a common treatment. Jail sentences were another form of punishment and at the turn
of the century many more drug users were put in mental hospitals as the jails became full.
Disease model. The disease model assumes that the origins of addiction lie within the
individual him/herself. This model adopts a medical viewpoint and suggests that addiction is a
disease or an illness that a person has. It believes that: Addiction does not exist on a continuum,
Addicted people cannot control their intake of a given substance, The disease of addiction is
irreversible. Alcoholics Anonymous (AA) is based on the disease model.
Psycho-dynamic model. This theory originated with Sigmund Freud and is still used today as
a way of treating people with drug problems. The basic philosophy behind the psycho-dynamic
model is that we can link problems to our childhood and how we cope (or don't cope) as adults.
In other words, drug use or misuse may be an unconscious response to some of the difficulties
individuals may have experienced in childhood. This philosophy forms the basis of many
counselling approaches which aim to gain insight into an individual's unconscious motivations
and try to enhance their self-image.
Social learning model. Russell (1976) introduced the idea that dependence is not only chemical
but also behavioral and social in nature. It is based more on the user's thoughts about the
substance, and what it is like to be 'under the influence' of the drug itself.
Socio-cultural model. This model has become popular in the last 15 years. Unlike other models
it focuses on society as whole and not just on individuals. This model is based on the idea that
the type of society in which people live has an impact on their drug use. In particular, this
model makes links between inequality and drug use. It suggests that people who belong to
groups who are culturally and socially disadvantaged are more likely to experience substance
abuse problems. It also recognizes that society labels users of certain substances as deviant,
thereby creating further problems.

Dynamics of addiction
The destructive effects of addiction are not only significant in the life of the addict, they are
also painful to those close to him. One of the first steps to overcoming a controlling habit is to
understand what it is and how it has a hold on you.
Compulsion. The person feels compelled to use. Compulsive behavior has a driven quality, as
though one is pulled along by forces out of one's control. Simply making a rational decision to
not use is often not adequate to facilitate stopping a compulsive behavior. Compulsive use is
often evident in a user's unsuccessful attempts to control or regulate use of a substance.
Craving. Craving often occurs daily or, is experienced with regular binges. The user
experiences intense psychological preoccupation with getting or using the substance. Craving
is dysphoric and agitating. With the exception of recalling the euphoria of the substance,
craving feels very bad.
Denial. Denial involves a true distortion of perception caused by craving. The user, under the
intense pressure of acute craving, is temporarily blinded to the risks and consequences of using.
Continued use despite adverse consequences. Addiction involves continuing to use even
though one knows it is causing problems. Substance abuse adversely affects relationships, job
functioning, health, finances and the capacity to manage one's life on all levels. The activity of
using assumes priority over other needs, including personal and financial security, comfort,
relationships, health and employment.

Interventions / Treatments approaches (pharmacological and non-pharmacological)
The goals of treatment are to reduce key symptoms to non-problematic levels and improve
health and functiona...