Smoking & Substance Abuse

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Substance abuse is the harmful use of any substance for mood-altering purposes. This includes illicit drugs, alcohol, prescription and over-the-counter medications, nicotine, as well as inhalants and solvents – which can all be used to harmful excess.

If you’re worried about your own or a loved one’s smoking or drug use, it’s important to know that help is available. Learning about the nature of substance abuse and addiction—how it develops, what it’s symptoms are, and why it can have such a powerful hold—will give you a better understanding of the problem and how to best deal with it.

Substance abuse and addiction are serious, but treatable, medical problems. This section contains tips for overcoming smoking and substance abuse, as well as information about the treatments available. Because the best way to prevent an addiction to nicotine or drugs is to never start smoking or taking the drug in the first place, we’ve also included some steps you can take to tackle smoking and drug abuse in your children.

Effect of substance abuse on the brain

People experiment with drugs and other substances for many different reasons. While each substance produces different physical effects, all abused substances share one thing in common – repeated use can alter the way the brain looks and functions. This is especially the case with drugs.

Taking a recreational drug causes a surge in levels of dopamine in your brain, which trigger feelings of pleasure. Your brain remembers these feelings and wants them repeated. As you continue to use drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine, which reduces your ability to enjoy not only the drugs but also other events in life that previously brought pleasure. This decrease compels you to keep abusing drugs in an attempt to bring the dopamine function back to normal.  The brain changes that occur also challenge your self control and hinder your ability to exercise good judgment and resist the intense impulses to take drugs. If you become addicted, the substance takes on the same significance as other survival behaviours, such as eating and drinking.

Understanding substance abuse and addiction

Many people do not understand why or how other people become addicted to drugs. A frequent misconception is that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behaviour. In reality, drug addiction is a complex disease, and quitting takes more than good intentions or a strong will. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so.

The good news is that treatment and support is available to help you counteract the disruptive effects of substance abuse and regain control of your life. 

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It is important to recognise the signs of drug use and abuse early, as this can rapidly develop into drug dependence. Below are a list of physical, behavioural and psychological symptoms to look out for:

Physical symptoms

  • Bloodshot eyes, or pupils larger or smaller than usual
  • Changes in appetite, causing sudden weight gain or weight loss
  • Changes to sleep patterns
  • Deterioration in personal grooming or physical appearance
  • Frequent nose bleeds, if related to snorted drugs
  • Seizures without a history of epilepsy
  • Unusual smells on breath, body, or clothing
  • Tremors, shakes, slurred speech, or impaired coordination

Behavioural symptoms

  • Neglecting responsibilities at home, work or school, e.g. failing classes, neglecting care of children or skipping work
  • Decreased motivation and loss of interest in extracurricular activities, hobbies, sports or exercise
  • Unexplained financial problems or need for money – may borrow or steal to get it
  • Silent or withdrawn, engaging in secretive or suspicious behaviors
  • Sudden change in friends and hobbies
  • Frequently getting into trouble with authorities, such as arrests for disorderly conduct or driving under the influence

Psychological symptoms

  • Unexplained change in personality or attitude
  • Sudden mood swings, irritability, angry outbursts or laughing at nothing
  • Periods of unusual hyperactivity, agitation, or giddiness
  • Lack of motivation, appearing lethargic or “spaced out”
  • Appears fearful, anxious, or paranoid, with no apparent reason
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Diagnosing a smoking or drug addiction often starts by seeing a general practitioner who will ask a series of questions, including how often the substance is consumed, whether the substance use has been criticised by the people around you, and whether you personally feel you may have a problem.

In cases of smoking, establishing whether or not there is an addiction is done at the doctor-patient level. The doctor may have you complete a questionnaire to get a sense of how dependent you are on nicotine. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are. Knowing your degree of dependence will help your doctor determine the best treatment plan for you.

With more powerful substances such as illicit drugs, the patient will usually be referred to a specialised addiction counsellor, psychologist or psychiatrist for an evaluation. A blood test might be ordered to see whether the substance is still in the blood, however this is not used to diagnose a drug addiction.

To be diagnosed with a drug addiction, you must meet the criteria specific to your country of residence. In the United States, a patient diagnosed with substance dependence must meet criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, a manual published by the American Psychiatric Association . A diagnosis of drug addiction involves a pattern of drug use that causes significant problems, and must include three of the following, occurring within a 12-month period:

  • Tolerance - the substance has less effect on the patient because their body has developed tolerance. They need more and more of it to get the same pleasure.
  • There are physical/psychological withdrawal symptoms, or the patient takes the substance to avoid experiencing withdrawal, or the patient takes a similar substance to avoid experiencing withdrawal.
  • The patient frequently takes higher-than-intended doses of the substance.
  • The patient often tries to quit or cut down.
  • More and more time is spent getting hold of the substance, using it, or recovering from its effects.
  • The patient’s drug use causes him/her to give up social, occupational or recreational activities.
  • Even though patients know it causes psychological/physical problems, they continue taking it.
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Recognising that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength. If you’re ready to make a change, learning new coping skills and knowing where to find help are essential in overcoming smoking and substance abuse. Here are some steps to consider:

  • Seek support: Support is essential to addiction recovery. Ask your family, friends and co-workers for support and encouragement, and let them know what specifically helps you most. Compassion, understanding and shared experiences can also help you break your addiction and stay cigarette or drug free. You may find support groups in your community, and there are also several available on the Internet.
  • Learn healthy ways to cope with stress: Smoking and substance abuse often stems from misguided attempts to manage stress. Feelings of stress, loneliness, frustration, anger, shame, anxiety, and hopelessness will remain in your life even when you’re no longer smoking to ease them or using drugs to cover them up. Learn healthier ways to keep your stress level in check, including exercising, meditating, practicing simple breathing exercises, and challenging self-defeating thoughts.
  • Identify your major triggers and challenges: Once you’re smoke-free or sober, the brain needs time to recover and rebuild connections that have changed while addicted. During this time, your cravings can be intense. Identifying your major triggers and challenges will help you solve problems and have a plan to deal with high-risk situations.
  • Don't get discouraged if you slip: Relapse is a common part of the recovery process. While relapse is understandably frustrating and discouraging, it is important to remember that relapse doesn’t mean treatment failure. Rather than giving up, get back on course as quickly as you can. See it as an opportunity to learn from your mistakes, correct your treatment course and strengthen your commitment.
  • See a therapist: Substance abuse, particularly when it comes to drug addiction, is linked to a number of problems that may be relieved with counselling. You may have relationship problems you need to work through or other underlying mental health concerns that need to be addressed.
  • Build a meaningful life outside of smoking and drugs: You can support your smoking or drug treatment and protect yourself from relapse by engaging in activities and interests that provide meaning to your life. When your life is filled with rewarding activities and a sense of purpose, your addiction will lose its appeal.
  • Regularly review the benefits you're getting from quitting: Make a list of the short-term and long-term benefits you are gaining from quitting and review them often to keep you feeling positive and motivated. This can include the money you are saving, the relationships you are rebuilding, and your improvements in health.
  • Avoid alcohol: Drinking is a high-risk situation. Avoid drinking situations until you're confident that you can remain smoke or drug free.
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Substance abuse and addiction are serious, but treatable, medical problems. Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual's life, effective treatment programs typically incorporate many components. They must help the individual stop using drugs, maintain a drug-free lifestyle, and improve everyday functioning in the family, at work, and in society.

There are many ways to treat substance abuse and addiction. Depending on the substance involved, treatment may include medications, behavioural treatments, or a combination of both. According to the National Institute on Drug Abuse (NIDA) , research shows that combining addiction treatment medications with behavioural therapy is the best way to ensure success for most patients.  A doctor, substance abuse counsellor, or other health professional can determine the right treatment for you.


Medications can be used to help with different aspects of the treatment process. This includes:

  • Withdrawal: Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically-assisted detoxification is not in itself treatment – it is only the first step in the treatment process.
  • Treatment: Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, medications are available to treat addiction to opiates, nicotine, and alcohol, but none have yet been approved for treating addiction to marijuana, stimulants, or depressants.

Behavioural Treatments

Most substance abusers believe they can stop using drugs on their own, but the majority who try do not succeed. Research shows that long-term drug use alters brain function and strengthens compulsions to use drugs. This craving continues even after your drug use stops.

Behavioural treatment provides you with strategies to cope with your drug cravings and ways to avoid relapse. They also help you to engage in the treatment process, modify your attitudes and behaviours related to substance abuse, and increase healthy life skills. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioural approaches. The four main types of behavioural treatments are cognitive behavioural therapy, motivational incentives, motivational interviewing and group therapy.

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The best way to prevent an addiction to nicotine or drugs is to never start smoking or taking the drug in the first place. Research funded by the National Institute on Drug Abuse (NIDA) has shown that prevention programs targeted at youths, and which involve families, schools, communities, and the media are effective in reducing drug abuse. The National Lung Association has come to a similar finding, with the majority of today's daily smokers having begun smoking before the age of 18. 

Here are some steps you can take to prevent smoking and drug abuse in your children:

  • Listen: Be a good listener when your children talk about peer pressure, and ensure that you are supportive of their efforts to resist it.
  • Communicate: Speak with your children about the risks and health detriments of smoking and drug use and abuse.
  • Set a good example: Set a positive example for your children by not smoking and abusing alcohol or addictive drugs yourself. Keep your home smoke and drug free. Children of parents who abuse drugs are at greater risk of drug addiction.
  • Strengthen your bond: Work on your relationship with your children. A strong, stable bond between you and your child will reduce your child's risk of using or abusing drugs.
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