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Substance use / addiction



Substance-related problems refer to excessive use of alcohol or other drugs to the extent that it negatively affects life. Addiction refer to intense focus on using a certain substance, such as alcohol or drugs, to the point that it takes over their life. If you or someone you know is struggling with substance use problems or addiction there are ways to get help. 

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In this article you can learn about substance abuse and addiction, and some of the options to get help.



What are substance-related problems?

There will be differing views on when the use of drugs and addictive drugs is a problem. From a child and family perspective, it is a problem "when the use of drugs has a disruptive effect on the tasks and functions that are to be taken care of in the family when the emotional ties between people are strained and disturbed by a party's use of drugs".

The medical definition of substance abuse is that at least three of the following descriptions are true [ICD-10][1] :


  1. Strong desire or feeling of compulsion to take the drug
  2. Problems with controlling intake with respect to to start, to stop and how much to take
  3. Physiological abstinence, ie when the drug intake ceases or decreases, the person gets bodily withdrawal symptoms which are relieved by continued intake.
  4. Development of tolerance, so that increased amounts are needed to have the same effect.
  5. Increasing indifference to other joys or interests.
  6. Drug use continues despite obvious signs of harmful consequences for health and relationships

The medical definition of harmful drug use is as follows (ICD-10): 

A pattern of use that causes physical or mental damage, and that the damage is clearly demonstrable. Duration at least 1 month or repeatedly within 1 year.


What is drug addiction?

The term drug addiction covers both an addiction to legal drugs, illegal drugs and alcohol. An addiction to a drug is characterized by, among other things, a lack of control, a strong or compulsive desire to take the drug, abstinence and continued use of the drug despite the fact that it clearly has major negative effects on one's own life and health.

Drug addiction can be both physical and mental, or a combination of the two. When the drug addiction is physical, the addict will experience physical pain in the form of abstinence when he or she stays away from the drug. If the addiction is mental, the addict may feel that intoxication is more important than anything else and that it is impossible to stay away from the drug because it is the only thing he or she wants to do. As a rule, a drug addiction will be both physical and mental. When the body is no longer physically dependent on the substance in question, the mental dependence will probably last much longer. 

  • Source: [Mestringshusene Bolkesjø][2]


Addiction is a complex problem

Addiciton is a highly complex problem:

Drug addiction is a complex problem that can consist of both physical and mental factors. The physical addiction may be that an addict feels sick if he stops taking a certain drug (abstinence), and the mental addiction may be that the addict is so eager to intoxicate that it overshadows everything else.

When someone develops drug addiction, they may feel that they are losing control of their choices. Intoxication can be perceived as more important than anything else, therefore addiction can be understood as a type of "coercion" where the user is unable to reduce the abuse, even though they know that it harms them both physically and mentally. 

Source: [Rustelefonen][3]


Addiction is not an absence of free will

It has been common to think of a drug addict as a person without free will. It is not true. Substance abuse does not deprive the individual of the ability to think and act of his own free will, but makes it more difficult to choose other alternatives over intoxication.


Psychological vulnerability to drug addiction

The following is written in Utposten, a Norwegian publication for GPs [Rognli, 2013][4] :

To understand why vulnerable individuals choose to seek relief through intoxication, it may be helpful to gain some knowledge from developmental psychology and cognitive psychology. The individual develops through interaction with the environment, especially with close caregivers. After repeated interactions on the same topic, understanding and expectations of oneself, others, and the world in general are developed.

In the group of patients who are addicted to heavier drugs, there are many people with negative basic assumptions. These basic assumptions have often emerged as a psychologically rational and appropriate adaptation to a dysfunctional environment.

A common emotional consequence of such basic assumptions is shame. In many cases, it can be helpful to understand irritability, frustration, and anger as the patient's defense against feeling ashamed. Often, drug patients - as a result of difficult upbringing conditions and brutal drug environments - have an activated and powerful defense. This can arouse negative feelings in the helpers, who may become exhausted and tired. We often describe these patients as "difficult" and "relationship damaged".

 In a TED talk video Nina Volwkow tells the following about addiction [TEDMED, 2014][5] :

Both obesity and substance abuse problems have been stigmatized as a moral failure associated with a lack of self-control in people with such problems, according to Nora Volkow. It's problematic the way she sees it.

- I have never met an addicted person who wanted to be addicted. And I have never met an overweight person who wanted to be overweight.

- Can you imagine what it is like to want to stop something, and not be able to? You try and you fail, and you try again and you fail again, and again. And you begin to hate yourself for not being able to keep track of yourself.

- Simply put, it's like driving a car without brakes. No matter how much you want to stop, you will not be able to, Nora Volklow explains.


Drugs may hijack the brain's motivational system

A slightly different and more social perspective on addiction is given in a great post at the ErLik magazine [Erlik, 2014][6] :

The problem is not that you like intoxication. Everyone can do that. The description of the heroin's effect sounds great to me. The equation does not increase with dependence. On the contrary, the good feeling becomes less and less. What is increasing is the unconscious urge: "Just have to have it!"

He emphasizes that drug addiction is about much more than the purely physical urge to take a drug:

What characterizes the addict is a lock in very few subject positions. That is, few ways to define themselves, few roles they can play in society. In the end, there may be only one: "I'm a drug addict."

It also happens that the drugs hijack the brain's motivational system. Intoxication becomes not only a problem, but also a solution - in fact the solution to most things. "Intoxication is the answer to all questions."



How common is substance-related problems?

Substance-related disorders are among the most common mental disorders among adults, and is experienced by 6% of adults each year [Jacobi et al., 2014][7] . The only mental disorders that are more common arer anxiety disorders (experienced by 15% of the population each year), and mood disorders (i.e., depression and bipolar disorders; experienced by 9% of adults each year).



Prevention and treatment of substance abuse problems and addiction

Prevention and treatment of substance abuse problems is a large and comprehensive field. It includes a wide range of initiatives both at the societal level, in various growth arenas, and in relation to access to and the quality of relevant assistance services. In this article, this topic will only be outlined very briefly.

Nina Volkow recommends that we emphasize the prevention of both drug-related problems and obesity by offering real alternatives and opportunities to people who are vulnerable to either drug or overeating problems. 

- Our challenge is not to know how to prevent, but to put it into action. It's about offering real alternatives and opportunities. For example, why can we not offer healthy food? Why can we not establish environments that stimulate - instead of hinder - physical activity?

An important message is that one must stop looking at drug addiction as a physical illness, and to bring out perspectives that can help explain the meaning behind the addiction.

It is important to prevent loneliness and exclusion among young people. A number of measures can also be useful in preventive work, and the measures in Iceland are a good example.



What helps with mental health problems?

The most important thing to know about recovery from mental health problems and disorders is that it is possible to get better

A variety of measures can contribute to alleviate or completely remove a mental disorder, or to increase quality of life despite the symptoms of the disorder. This list is examples of what might be helpful in relation to mental health problems:


  1. Psychotherapy




    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][8] .


  2. Online therapy




    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][9] .


  3. Support / self-help groups




    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][10] .


  4. Helplines and chats




    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][11] .


  5. Online communities and forums




    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][12] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.



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References & Footnotes
  1. ICD-10: World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research (Vol. 2). World Health Organization.
  2. Mestringshusene Bolkesjø: Hva er rusavhengighet? [What is drug addiction] Retrieved 9th of February 2020 from:
  3. Rustelefonen: Hva er rusavhengighet? [What is drug addiction]? Retrieved 9th of February 2020 from:
  4. Rognli, 2013: Rognli, E. B. (2013). Et psykologisk perspektiv på rusavhengighet [A psychological perspective on drug addiction]. Utposten. Retrieved 9th of February 2020 from:
  5. TEDMED, 2014: Nora Volkow. Why do our brains get addicted? TEDMED. Retrieved 9th of February 2020 from:
  6. Erlik, 2014: Du blir ikke avhengig fordi du liker det [You do not get addicted because you like it]. Retrieved 9th of February 2020 from:
  7. Jacobi et al., 2014: Jacobi, F., Höfler, M., Siegert, J., Mack, S., Gerschler, A., Scholl, L., ... & Wittchen, H. U. (2014). Twelve‐month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1‐MH). International journal of methods in psychiatric research23(3), 304-319.
  8. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from:
  9. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  10. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  11. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  12. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.