People use the terms
“dependence” and “abuse” interchangeably when talking about
illicit drugs, but are they really the same thing? Some researchers
would say they are not the same thing at all because abuse refers to
behaviours, whilst dependence refers to psychological and physical
changes brought on by substance use. The simplest way to look at it
is that some people can abuse drugs or alcohol for years and never
develop dependence on either. As a result, researchers developed
criteria for defining dependence, which has implications for
employers. For example, should an employer treat two workers
differently when the person is not physically addicted to the drug
and could simply choose to change behaviours, whilst the other person
is dependent and has lost control? These are the types of difficult
questions that employers are faced with when dealing with substance
use in the workplace and makes having a drug and alcohol policy in
place even more important.
Instead of just saying
“dependence”, it is better to say “chemical dependence” or
“substance dependence” because the implications are more obvious.
A typical misunderstanding is that withdrawal and chemical dependence
are the same things. That is not necessarily true. Cocaine is an
addictive drug, but users may experience few observable withdrawal
symptoms. Yet the person could be dependent. In reverse, a person may
go through withdrawal but that still does not necessarily mean the
person is substance dependent. Some people stop using illicit drugs
and experience physical symptoms, but never mentally crave the drugs
again. They no longer believe the drugs and alcohol are necessary for
functioning and decide to stay away from the substances.
Dual Nature of
Dependency
Substance or chemical
dependency has both a psychological and physical component. The dual
nature of dependency is what sets it apart from abuse. A person who
is a chemical dependent has physical and psychological dependence but
does not necessarily experience withdrawal symptoms when chemical use
ends. The physical dependency symptoms are noticeable when the body
begins to experience unpleasant side effects as the drugs or alcohol
wear off or the substances are used less frequently. The physical
symptoms of withdrawal are different for each person and depend on
the drug. Effects include nausea, crawling sensations under the skin,
difficulty breathing, excessive sweating, tremors, and many others.
The psychological effects associated with withdrawal include anxiety,
irritability, poor concentration, depression, and so on. In some
cases, the withdrawal symptoms indicate a dangerous health situation,
like someone having grand mal seizures (physical) or hallucinations
(psychological).
Though employers need to
be familiar with withdrawal symptoms, they do not determine whether a
person is an abuser or dependent. As mentioned, someone can withdraw
from drugs or alcohol and not experience withdrawal symptoms.
Chemical dependency is best summarised with three words: Obsessive,
Compulsive, Excessive. This translates into a person who believes
that it is impossible to function without using the drugs or alcohol.
There is a continuum of substance use that goes like this: non-use,
experimental use, recreational use, problematic use, and dependent
use. A person reaching a condition of dependency feels a loss of
control and experiences intense cravings both psychologically and
physically. The life focus becomes ensuring there is always a supply
of drugs or alcohol ready for consumption or that can be easily
obtained.2
Signs, Signs,
Everywhere are Signs
Before a person becomes
chemically dependent, there will be signs the employer may notice
without realise what is happening. For example, problematic users
begin to have relationship, financial and health problems. Drug and
alcohol tolerance increases, but the substance user is avoiding
admitting the problem exists. Tolerance for the substances increases.
A drug abuser can often learn to change behaviours in a short-term
treatment or counselling program. However, a person who is dependent
is always “recovering” after stopping drug and alcohol use. The
person can stay off drugs and alcohol but may need a stronger,
ongoing support system. An abuser may be able to take a drink or use
cannabis (not advisable, of course) and not devolve into addiction. A
truly dependent person cannot use chemicals under any circumstances
because they trigger the life-altering cravings. Health professionals
are learning that some people recidivate over and over again because
they are chemical dependents and not just chemical abusers.
Dependence may or may not
include withdrawal symptoms. However, it always has characteristics
that include the inability to control use, expended effort to obtain
the drug, greater drug use than was intended, drug use time replacing
time for important activities, continued use despite awareness of
personal physical or psychological problems. Each chemically
dependent person does not necessarily have all of these issues. A
dependent person is defined as having three or more of these
characteristics with withdrawal symptoms and increased drug tolerance
possibly accounting for one or two of the symptoms.3
Drugs of Choice
Dependency is not limited
to illicit drugs. South Australia has a Drugs of Dependence Unit
(DDU) with drugs of dependence defined as prescription medicines that
have a higher potential than other drugs for misuse, abuse and
dependence. The drugs are recognised as having therapeutic value. The
list of drugs of dependence is long, and of real interest to
employers is the fact the prescription drugs contain some of the same
ingredients as illicit drugs. They include opioids like oxycodone and
stimulants like cocaine.1 However, the important fact
employers need to keep in mind is that a legal opioid threatens
workplace safety as much as an illicit opioid.
Most employers are not
qualified to assess whether a worker is a drug and alcohol abuser or
a chemical dependent. The random
drug & alcohol testing program is a means of identifying who is using
harmful substances in the workplace. Once it is determined an
employee is using substances that impact workplace health and safety,
possessing knowledge about the complexity of substance use and its
impacts helps employers make better decisions about the next steps to
take.
The
first step in identifying abusers and dependents is implementing a
quality random drug and alcohol testing program at all employer
locations. That is where Mediscreen can offer invaluable services.
Mediscreen (mediscreen.net.au)
routinely provides screening services aligned to workplace needs
wherever those needs exist.
This article has been taken from : http://www.mediscreen.net.au/chemical-abuse-or-chemical-dependence/