Substance Abuse

Introduction

Substance abuse is not only a behaviour referring to the occurrence and/or frequency of drug use, but it also supposes a particular lifestyle. Drug use, which may or may not lead over time to abuse, is one more behaviour of the many carried on by an individual in the process of adaptation to the environment in which he or she lives. It does not necessarily have to mean a change in lifestyle; it may affect just one specific area and be limited to that. On the other hand, development of an addiction is associated with a radical change in the individual, which is far greater in the case of illegal substances. An evaluation of addiction must also involve an assessment of all the variables potentially involved in the development of the addiction. Addiction appears to be an interactive product of social learning in a situation involving physiological events: both the social and psychological factors, and the physiological elements are indispensable features of the total experience and process of addiction. In this entry, we will refer in general to the assessment of consumption of illegal drugs, in the belief that all the variables evaluated in legal drug use are included here (Table 1).

The Evaluation Process

An approach like this involves the use of multiple assessment procedures and a focus on multiple target behaviours. This means that we have to know the topography and functionality of self-administration of a psychoactive substance, and all the behaviours which are included in this lifestyle, as well as the areas which have been affected and the aspects of the context and of the subject which may have effect or be affected, in order to decide whether they are or are not problem behaviours, the variables to be modified or the points of support or of departure in the rehabilitation process. The characteristics of the [Page 944]substance are important in trying to explain the addiction to consumption of that product (whether tobacco, alcohol, opiates, designer drugs or any other), but there are other variables which are just as important in the explanation of the addiction, such as basic repertoires of behaviour of the individual, the learning history, or the risk variables of the context. In short, the evaluation process, to be implemented, must have an integrating effect and make possible the use of a variety of sources and techniques which allow its reliability to be enhanced. In this sense, account is not only taken of information provided by the consumer, by also that from family members and peers. The aim of the assessment must be to decide on the functional relations in place between the different variables involved (of the behaviour, the subject and the context), so as to design the most appropriate intervention procedure for the particular case. Functional analysis allows the following:

• Detection of the problem behaviours.
• Knowledge of the function variables making up the interaction.
• The other variables, not part of the interaction or specific to it; they are, rather, facilitating variables as much of the individual as of the surroundings, and affecting the likelihood that the interaction will happen.
• Design of a specific intervention for each individual; to establish targets: to choose the most suitable device; to decide whether support resources are needed; to select the therapeutic programmes; and to determine the specific intervention techniques.

Addictive conduct is highly complex and requires multiple interventions from a number of standpoints, depending on the aim of the intervention to be carried out, and the timing (e.g. a drug-free programme or a damage-limitation programme). The decision-making assessment for this decision is different, as is the weighting of the variables: this means that if a decision is to be made as to the most suitable detoxification procedure, biological and social variables will have greater weight. However, it will be particularly the biological and social variables which will decide on the treatment procedure and the specific intervention programmes in the phase for escape from the habit.

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