The CAGE questions are a system of empirically validated questions which help medical and mental health professionals identify problem use of substances or may indicate that further assessment is needed to screen for substance abuse and use.
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Addiction defines that a person is using a substance, or repeating a behavior which causes harm in one or more area of life including physical wellness, emotional wellness, psychological wellness, or occupational wellness. There are many forms of addiction, such as addiction to food, drugs, porn video games, alcohol, and one can even become addicted to relationships. We should add that even if the substance or behavior has not caused harm or impairment in one of the above areas, addiction or abuse should still be classified if the behavior could cause harm. Often a person who is dependent upon the substance or behavior has continued their addictive behavior despite relentless prior efforts to stop. This can be due to chemical dependency, or dual diagnosis, meaning an underlying mental health disorder which causes the addicted person to seek the refuge of substance or related addiction. Some of the underlying mental health diagnosis that can be related to increased risk of substance abuse or dependency include, depression, anxiety, bi-polar disorder, post-traumatic stress disorder. All forms of addiction involve the same neuroanatomical pathways and reward circuitry. The psychological and biological mechanisms of addiction activate a complex interplay of the dopamine, serotonergic systems, the nucleus accumbuns, anterior cortex, basal forebrain, and the amygdala. These structures together comprise the extended amygdala which is the brains reward circuitry and a highly studied portion of the neuroanatomy in the field of addiction.
Abuse is the term used to describe a level of substance use which is harmful but the person who is using or acting does not yet have a physiological dependence. Often in the stage of substance abuse, other people in the person’s life may bother them about common risks. Dependence is the term which defines the neuroanatomical and biological changes which happen when a person has been using a substance and are now unable to stop without the effects of withdrawal. Some forms of substance withdrawal can be life threatening and should happen in a hospital setting.
Denial is the psychological defense mechanism most commonly related to addiction, without denial in place the addicted person would likely make efforts to give up the substance or behavior. Until an addicted person is able to recognize the harmful consequences or risks to their behavior, they may become irritated when others try to persuade them to quit or cut back.
If you or someone you know is experiencing substance abuse, or substance dependence, you may be thinking about attempting to make the first steps toward recovery. Recovery happens in several stages, including; denial and active abuse or dependency, detox and withdrawal, recovery, and late stage recovery or maintenance. Each of the steps comes with unique potentials and challenges. Recovery for each forms of addiction is unique and requires a separate treatment plan. Therapy in an outpatient setting is indicated for substance abuse recovery and particularly late stage recovery or the maintenance phase. For substance abuse and dependence, medically assisted detox may be necessary before any outpatient therapy is indicated, this is especially true of opioid, amphetamine, and alcohol dependence.
Fortunately, for those who have achieved detox and are ready to continue on the path to healing and sobriety, there are many treatment options. Newly, Pennsylvania has approved medicinal marijuana to assist opioid recovery, just as with any medically assisted recovery program the individual must participate in therapy or counseling. Also, the maintenance and late stage recovery can be assisted in an outpatient mental health center with the help of a therapist or other experienced mental health professional. Many of the therapists at the Counseling and Wellness Center of Pittsburgh have decades of experience in working with addicted populations, having been in management at treatment centers in Pittsburgh and Western Pennsylvania. At our Integrative Counseling Center, holistic treatment options are utilized with the collaboration of experts who will help manage rebuilding life, reducing reactivity to triggers, and identifying and healing dual diagnosis including mental health labels and trauma.