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Chapter 3. Physiological Factors: Part 4

Florida Drug and Alcohol Test (TLSAE) Course:  Chapter 3. Physiological Factors: Part 4

3.4. Aspects of Use, Abuse, Dependence and Addiction

What is the difference between use and abuse?

Some people who drink or use drugs moderately experience relatively few problems in any area of their lives. Abuse happens when people cross that line and drink or use drugs at a level that causes problems in one or more areas of their lives. This includes physical health problems, mental health/emotional problems, family problems, relationship problems, financial problems, work or school problems, social problems, and legal problems.

Some factors that lead to use and abuse of alcohol and/or drugs include:

Family
It is important to consider the significant impact substance abuse has on the individuals within a family system and the family system as a whole. Families with a history of drug and alcohol abuse can lead their children to view this behavior as normal. The children cannot relate to the downside of abuse and addiction. They see their parents drinking and taking drugs, so they think this is all part of being a grown-up. They begin the same process of use and abuse.

Others are ashamed and never speak about what goes on in their families. They keep these secrets to themselves. The emotional stress of physical and mental abuse usually associated with dysfunctional families begins to build up. They develop fears, are insecure, have low self-esteem and begin to think the only way out is to escape by drinking or taking drugs. Low self-esteem can be a factor for individuals who are dependent on alcohol or other drugs.

Moving

Moving to a new neighborhood, having to make new friends and trying to fit into a new environment can be an emotional strain. The fear of not being accepted can cause depression and isolation leading to alcohol and drug abuse. The use of alcohol or drugs gives the person a reduced sense of isolation, more confidence and a sense of being part of the crowd.
Drinking group

Wanting to be Part of the Crowd (PEER PRESSURE)

Trying to find out which piece you are in a social puzzle can be a very difficult task. Being part of the clique is very important. Being part of the "in crowd" brings social recognition. Cliques can influence the way people think. A person may think that if their friends are using alcohol and drugs it must be okay: "If I start to use, I'll fit in and become more popular."

Lack of Confidence

Low self-esteem, insecurity and lack of social skills can lead to alcohol and/or drug abuse. Alcohol and drugs are often used to gain confidence, be more outgoing or feel more secure. Before they can face other people or be social, some people feel a need to have a drink or take drugs.

Any of these factors, or a combination of factors, can lead to alcohol or drug use or abuse. Alcohol or drugs can give a person a false sense of security - making it appear that the person is in control of her or his life, when in fact they're not! The same problems and issues will be there when the person comes down from that high. In many cases, continual use and abuse will make the problems worse.

(Teen Drug Abuse: http://www.teendrugabuse.us/teensandalcohol.html)
(National Institute on Alcohol Abuse and Alcoholism: http://pubs.niaaa.nih.gov/publications/aa37.htm)
(Centers for Disease Control and Prevention: http://www.cdc.gov/alcohol/faqs.htm#alcoholismAbuse)

What does dependence mean?


Dependence refers to a physical state where when a person stops using a drug or alcohol, withdrawal occurs. If a person experiences withdrawal symptoms after discontinuing use of drugs or alcohol, then they're dependent on that drug or alcohol. After repeated use of a drug, the user's body becomes so accustomed to a particular drug that it can only function normally if the drug is present.

What is tolerance?

TOLERANCE MEANS THAT TO GET THE SAME HIGH, THE PERSON NEEDS TO DRINK MORE ALCOHOL OR TAKE MORE DRUGS


Over time, with regular use, a user needs more and more of the drug to get the desired effect. Tolerance requires that you use more and more of the alcohol/drug to achieve the same “high” or medical effect. Increased tolerance means an increased risk for overdose, for two reasons. First, every drug has a main effect (the effect the user wants) and side effects (effects that the user does not want). Tolerance does not develop evenly to all effects of a drug.

For example, barbiturate users develop tolerance to the desired mood-altering effect of the drug faster than they do to the side effect of depressing breathing. When the user increases the dose to get the desired effect, they risk taking enough to cause them to stop breathing, which of course would cause death. Second, if a user has not used the drug for a while, tolerance will decrease. Tolerance to any drug decreases with non-use. After a period of not using a drug, the dose the user had previously used may now be enough to cause a fatal overdose. Heroin is a good example of a drug for which tolerance can drop very quickly, and many people die every year from heroin overdose.

You cannot overdose on alcohol or alcohol in combination with other substances.

Many people who abuse the drug take it in combination with other drugs or alcohol to enhance its effects. Mixing drugs or alcohol with any other substances is a very risky thing to do. Many deaths can be attributed to overdoses of these drugs or deadly combinations of the drugs or drugs and alcohol.

What is withdrawal?

Withdrawal is related to physical dependence and tolerance. After repeated use of a drug over a period of time, the body adjusts itself to enable it to function normally with the presence of the drug. When use of the drug stops, the body fails to function normally because it has adjusted to compensate for the presence of the drug, and this abnormal functioning is felt as withdrawal.

Withdrawal from different drugs varies in unpleasantness, severity and risk of death. Withdrawal from heroin is one of the most unpleasant withdrawals. Withdrawal from heavy barbiturate or alcohol use after a very long period of use has a high risk of death. Withdrawal symptoms are usually the opposite of the effects and side effects of the drug. For example, one of the side effects of heroin is constipation, and one of the withdrawal effects from heroin is diarrhea.

(Help guide.org: http://helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm)

What do the terms cross-addiction and cross-dependence mean?

Drugs can be grouped into different classes according to their effect on the central nervous system (your brain and its connections to the various organs and other parts of your body). If a person is using a drug repeatedly over a period of time, she or he will develop dependence on that drug. The person will also develop dependence on other drugs that she or he has not used that are in the same class as the drug she or he is using. This means that when they stop using one drug and begin to experience withdrawal, prescribed use of another drug in the same class might stop or decrease the severity of withdrawal.

An example is the use of methadone (a narcotic) to help heroin (a narcotic) users avoid withdrawal. Cross-addiction is also used to describe addiction to more than one drug, whether or not it is in the same class.

What does cross-tolerance mean?

Continued use of a drug will build tolerance to that drug, but tolerance might also increase to other drugs in the same class.

For example, use of an opiate drug will cause tolerance to other opiate drugs. Heroin is a narcotic drug, and so are morphine and Demerol. If a user develops tolerance to heroin, he or she will also show a tolerance for morphine and Demerol without using those drugs regularly.

It is possible for a person to develop tolerance to general anesthetic by using drugs in the depressant class. In rare cases, people have awakened in the middle of surgery and become conscious of pain, but they remained unable to move or speak to let the surgeon know that they were conscious and feeling pain. If a person uses drugs regularly and needs medical treatment, it is important to let the doctor know what drugs they use and how often.

(Recovery Today: http://www.recoverytoday.net/articles/142-cross-addiction)

Why People Abuse Alcohol/Drugs:

Chemical dependency typically evolves from abusing alcohol and/or drugs in an illusive attempt to meet one’s emotional needs for comfort and esteem.  The “quick fix” brought on by alcohol and/or drug consumption is often a way to self-medicate, thereby temporarily masking emotional pain.  Getting drunk or high begins as a mood altering experiment that progresses as a repetitious coping mechanism for “getting along” with life. 

Chemical substances produce real feelings of euphoria or relief, especially in the early stages of use.  As the pleasure centers of the brain “learn” this effect, impulses to use or drink, even when consumption causes negative consequences, gradually exceed the rationale for appropriate restraint.  Defensive mechanisms such as denial and repression sabotage decisions to quit.  Finally, addiction takes over when the substance actually alters brain chemistry so that the drug becomes vital to the brain’s normal functioning.

EFFECTIVE WAYS TO DEAL WITH STRESS AND FATIGUE AND HOW TO HAVE A POSITIVE DRIVER ATTITUDE

Your attitude, or state-of-mind, affects your behavior when you drive. Have you ever been on the highway and seen a vehicle in front of you weaving in and out of traffic? That person may not realize that their behavior and attitude is probably triggering angry and aggressive reactions from other drivers. The driver who is weaving is "impaired" by a poor driver attitude, which is causing the driver to be discourteous to others and drive aggressively.

YOUR DRIVING ABILITIES CAN BE AFFECTED BY THINGS OTHER THAN ALCOHOL AND OTHER DRUGS

Driving when impaired is a deadly choice; denial is an impairment because it eliminates choices. When drivers are in denial, they don't realize how their actions are affecting the driving community. Other drivers are aware that they are driving impaired, but simply don't care.

No drink and drive



What kinds of things are driving impairments? You learned about alcohol and how even small amounts can affect a person's ability to react and respond while driving. You learned about illegal drugs that can alter the chemistry of the brain and slow a person's reaction and response time.You also learned about prescription and over-the-counter medications and how some medications can impair a person's ability to drive. Now let's review other impairments that can affect people's driving abilities and learn how denial, if you let it, could reduce your ability to drive safely. The reason that denial is an impairment is because it is a thinking process that says, "This doesn't apply to me."

Other things that can impair a person's driving include:

Stress


Everyday life can have a negative effect on driving abilities due to stress: School, an argument with a friend, work, traffic - all these cause stress at times. When you're in a state of mind where you can't think clearly because you are STRESSED OUT, it's dangerous to drive. It could be as dangerous as getting behind the wheel while under the influence of alcohol or other drugs. When emotions are running high, think twice before getting behind the wheel of your vehicle.

When you're riding in your vehicle on the way home from school or work, observe the drivers of the vehicles nearby. What do you think their stress level is like? Should that person be driving?

It helps to talk to someone about your concerns and worries. Chances are that talking to someone like a friend, family member, teacher or counselor, is not going to solve your stressful situation, but sharing your stress with other person can help you see your problem in a different light and will definitely change you in your situation.

Emotional Stress

There may be times in your life when an unfortunate event or incident totally consumes you. Examples include the death of a family member or friend, the breakup of a romantic relationship, moving, and severe family problems. These traumatic events could have an adverse effect on your driving abilities.

Fatigue


People who are sleep-deprived could find their eyes closing, just for a second here and there, on the road. But all it takes is a second and they can't undo the crash once it happens. Sometimes, the only thing stronger than denial is regret!

Driving while tired is a dangerous impairment. Drivers who choose to stay on the road instead of pulling off for a rest need a wake-up call!
anger

Anger


Driving while angry, irritated or upset can negatively impact your driving abilities. Anger may lower your trigger for reacting poorly to stressful events; when mixed with other impairments, such as fatigue, it's a deadly combination. But if you're angry and you know it, you can take responsibility and control it!

Have you heard about how vehicles have blind spots - places where you can't see other vehicles, people, or objects? Well, denial can be a driver's attitudinal and behavioral blind spot. Observe other drivers on the road. Do they seem to have positive driver attitudes, putting safety first and treating other drivers with courtesy? Or do they seem to be driving under the influence of an impairment, such as anger?
selfish driver

Attitude


Attitude plays a big role in whether or not a driver gets into a collision. Many collisions are caused or exacerbated by a poor attitude on the part of one or more of the drivers involved in the crash. They may have driven aggressively, been speeding,or have behaved as if a right-of-way law didn't apply to them. They may only change their attitude if something terrible happens, such as a crash. Some people are selfish and drive while they are tired. For instance, they say, "I can make it to Montana today because I'm me. I have to get there. I can make it because it's so important to me."

Me me me...Let's face it, people can be self-centered and self-serving. Too often, people do only what's best for them. But it's important to make the safety of ourselves and others our primary concern when we're behind the wheel. If you don't allow enough time to get somewhere,will you:

  •  Speed
  •  Tailgate
  •  Weave in and out of traffic
  •  Speed up for yellow traffic lights
  •  Refuse to let anyone else merge into your lane
These actions put the driver and others on the road at risk. They are selfish acts because they consider only the driver's desire to reach her or his destination quickly.

Having a poor driving attitude can cause you to receive traffic tickets, have to pay fines, have to pay increased insurance rates, suffer or cause severe injuries, and even have criminal charges brought against you that result in jail time. Most drivers realize all these things can happen, but they don't believe it. Being realistic about the risk and being responsible for your behavior is an important part of being a safe driver.

Stress and anger can contribute to the worst form of aggressive driving, ROAD RAGE. This occurs when people behave violently towards other road users. Road rage incidents are often discussed on news reports. When you are driving, you don't know whether or not other drivers have weapons. You don't know what other drivers are like. If you notice someone driving aggressively, increase your distance from the other driver. Never challenge other drivers.

Coping with stress, fatigue, and anger and your emotional state of mind

Let's review some situations on the road that might make you angry.

  • Someone cuts you off
  • A driver turns without using a turn signal
  • Somebody cuts across several lanes of traffic
  • Other drivers won't allow you to merge into traffic

First of all, you must realize people on the road don't know you, so their actions aren't directed at you personally. If another driver pulls alongside you and starts flipping you off, she or he is probably angry at something else. Maybe they're angry with their spouse, their boss, a co-worker who refused to change shifts with them, or a person in another vehicle who cut them off.

IF AN AGGRESSIVE DRIVER IS FOLLOWING YOU:

Take the next exit. Go to a well-lit place with lots of people around or to a police station.

Secondly, breathe properly. When you get angry, breathe through your whole body. Put your hand on your diaphragm, near your stomach. Take such deep breaths that you blow it up like a balloon. If you breathe shallowly, the air will only go into your chest. As you take deep, slow breaths, hold each for five seconds. After several breaths, you will feel calmer because more oxygen reaches your brain when you breathe into your diaphragm. Try it now! You can use this relaxing technique at home, at school, or in your car.

Third, rank incidents in your life on a scale of one to ten. Each of us has ones and tens in our lives. A paper cut you get in class might be a one. Someone calling you out of class to tell you that a close family member had passed away might be a ten. When somebody cuts you off on the road, doesn't signal, or does something else that makes you angry, rank it on a scale of one to ten. Even if the other driver almost hit you, which might be worse than a paper cut, their action is unlikely to be a ten in your life. Psychologists say that if you put things in perspective, you'll get less angry. If you stop and think about it, you can probably forgive the other driver on the spot.
green car


Pretend you know the other driver. When someone cuts you off and you get angry, pretend it's your friend or your pastor or your second grade teacher that you liked so much. If you do this, and you make the decision to think of them in a good light, you will get less angry.

Listen to soft music; relax. Don't add more stress to a bad situation by listening to loud music. You will get more stressed-out and might even drive faster.

THESE COPING TECHNIQUES CAN BE USED IN ANY SITUATION - NOT ONLY WHEN YOU DRIVE, BUT IN EVERYDAY LIFE

REMEMBER
  • Realize they don't know you
  • Breathe
  • Rank the event from one to ten
  • Pretend you know them
  • Relax
  • Control your emotions
Any condition that interferes with your judgment or reasoning abilities makes you an unsafe driver. Emotional distress of any kind - anger, sadness, depression, anxiety - can affect your concentration and your ability to make good decisions. It's up to you to take responsibility for your behavior and judgment. You must recognize when you are not in the proper condition to be behind the wheel.

Anger is a very dangerous emotional state. As a safe driver, you cannot, let other drivers' mistakes provoke you into becoming hostile. You might be feeling angry before you even get into your vehicle, and that's when you have to take a good look at yourself and decide whether you can calm yourself down. Maybe you just had a fight with someone you love or something happened at school to upset you. Can you let go of those feelings before you start driving? If you can't, you will be driving while impaired. You might become impulsive, take unnecessary risks, and react irrationally to other drivers.

Control your emotions before getting behind the wheel. Take a walk or do breathing exercises until you calm yourself down.

Besides anger, other emotions that can impair your ability to drive include sadness, depression, and anxiety. They can make you less alert and unable to give your full concentration to driving safely. These emotions can last a long time, so it's important for you to recognize when you're not capable of driving your best. If you have to, find someone else to drive during the time that you are recovering from strong emotions. Don't risk being behind the wheel when you're preoccupied with other problems. Even happiness can be a dangerous emotional state. If you're daydreaming or too busy thinking about some good news you've received to focus on safe driving, you could be creating an unsafe situation.

Always be aware of your state of mind. Any kind of distress or strong emotion can interfere with your driving abilities, making you an impaired driver who is endangering others by being on the road. Look at yourself objectively and decide whether you really have the focus and alertness you need to safely use a motor vehicle. If you have any doubt, wait. Give yourself time to calm down and concentrate on safe driving.

Coping with Fatigue

If you're driving and you get sleepy, the best thing you can do for everybody is to get off the road. Go to a well-lit parking lot or rest area and rest for a while. It's amazing how a few minutes of rest can help when you're fatigued. Before you get behind the wheel again, get some exercise. Jump up and down, do jumping jacks, or jog down the block and back. Get your blood circulating and your heart pumping; you will feel and see so much better. Drink coffee or soda and eat a snack.

Other Suggestions for Staying Awake and Alert Behind the Wheel Include:
  • Turn on the air conditioning
  • Roll down the window
  • Turn the radio on and sing along

Before Taking a Long Road Trip:
  • Plan rest stops before you leave - at least once every two hours or 100 miles
  • When you stop, eat a small snack
  • Take a short, brisk walk before getting back into your vehicle
  • Continuously move your eyes while driving; it will keep you more alert


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