Crises Related to Substance Abuse

The media, celebrities, and politicians have been campaigning against drugs since the "just Say No" push of Nancy Reagan in the 1980's. In the 1960's and 1970's, by contrast, the slogans were "Tune in," "Trip Out," "Experience," "Turn On," and "Try it, you'll like it." Drug use was in; now, drug abuse is no longer a respectable recreation. Why, then, will so many families and individuals be severely affected by alcohol and drug abuse?

Any crisis interventionist will in time see a considerable number of substance abusers and/or their significant others. Substance abuse as refers to the use of alcohol and drugs when it affects a person's occupational, academic, family, social, emotional, or behavioral functioning.

Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12 month period:

1. Tolerance - As defined by either of the following:
  a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect
  b. Markedly diminished effect with continued use of the same amount of substance

2. Withdrawal, as manifested by either of the following:
  a. The characteristic withdrawal syndrome for the substance
  b. The same (or closely related) substance taken to relieve or avoid withdrawal symptoms

3. The substance often taken in larger amounts or over a longer period than intended

4. A persistent desire or unsuccessful efforts to cut down or control substance abuse

5. A great deal of time spent in activities necessary to obtain the substance (e.g. multiple doctor visits or driving long distances), use the substance (e.g. chain smoking), or recover from its effects

6. Important social, occupational, or recreational activities given up or reduced because of substance abuse

7. Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

The Crisis Prone Person

Not everyone who experiences a stressor in life will succumb to a crisis state. No one is sure why certain people seem to cope with stress easily whereas others deteriorate into disequilibrium when faced with stress or trauma. If a person does not receive adequate crisis intervention during a crisis state but instead comes out of the crisis by using ego defense mechanisms such as repression, denial or dissociation, the person is likely to function at a lower level than he or she did before the stressing event. The ego, which has been hypothesized to be part of the mind that masters reality in order to function, must then use its strength to maintain the denial of anxiety or pain associated with the precipitating event. Such efforts take away the individual's strength to deal with future stressors, thereby leading to another crisis state the next time a stressor hits. This next crisis state may then be resolved by more ego defense mechanisms after several weeks, leading to an even lower level of functioning if the person does not receive adequate crisis intervention.

This pattern may go on for many years until the person's ego is completely drained of its capacity to deal with reality; such people often commit suicide, kill someone, or have a psychotic breakdown. Until then, this type of individual is often viewed as having a personality disorder. And people with personality disorders are usually seen as suffering from emotional instability, an inability to master reality, poor interpersonal and occupational functioning, and chronic depression. Defense mechanisms and substance abuse are common ways in which people overcome crisis states when they fail to seek professional help. If such people had received help before resorting to defense mechanisms for overcoming the crisis state, quite possibly, a personality disorder would not have evolved.

Developmental Crises

For conceptual purposes, we can identify two types of crises. Developmental crises are normal, transitional phases that are expected as people move from one stage of life to another. they take years to develop and require adjustments in the family as members take on new roles. Clients often seek counseling because of their inability to cope with the evolving needs of one or more family members. Crisis workers must be sensitive to the special issues surrounding this type of precipitating event.

Situational Crises

Situational crises are those that emerge with the occurrence of uncommon and extraordinary events that an individual has no way of forecasting or controlling. Some examples of situational crises are crime, rape, death, divorce, illness and community disaster. The chief characteristics that differentiate these from developmental crises are their: 1. Sudden onset 2. Unexpectedness 3. Emergency Quality 4. Potential impact on the community