Drug Use: Opioids
Arthur is a forty-year-old white male who has been married for 16 years and is the father of three children. He lives in his own home in a middle-class suburb; he has lived in the same house for 12 years. He has been steadily employed as a union carpenter with the same construction firm for five years. During the last 10 years, Arthur has used heroin on weekends, occasionally injecting during the week; but during the previous five years, mid-week use has not occurred.
Bob is a twenty-six-year-old white male who lives alone; he is a college graduate with a degree in psychology. Following separation from his wife and child three years ago, he has worked sporadically in part-time jobs. Dealing drugs has become his major source of income. He has used heroin at least three to four times per week since beginning use 30 months previously, and has had many periods of daily use lasting for as long as two weeks.
From a clinical perspective, how do you respond to each of these individuals? Does the differential frequency of use impact the neurobiological underpinnings of addiction? What are your recommendations for treatment?
Drug Use: Opioids
Opioids discussion 1
Each of the individuals, Arthur and Bob, has different issues related to drug use. In Arthur’s case, there is prolonged use of heroin, which is roughly 12 years, indicating prevalent addiction. He has used heroin during the weekends and occasionally during the week, but there has not been mid-week use during the previous five years, which is commendable. It is thus clear that he can stop using heroin gradually as he has managed to minimize the use in the last five years. In the case of Bob, he is relatively young, and his separation from his wife and child could be a significant contribution to his use of heroin (Moustafa et al., 2021). He has a higher use of heroin three to four times a week and has instances of daily use.
In his case, it would be ideal to first deal with the root cause of his addiction as this would help reduce the number of times he uses drugs, and eventually, he would be able to live a drug-free life. Differential frequency of use of drugs influences neurobiological underpinnings of addiction in the case of Arthur and Bob. This is because the reinforcing effects of substances help reduce repeated use (Volkow et al., 2019). This is termed tolerance and may lead to using substances reduced with repeated/constant use. This is referred to as tolerance and may result in the utilization of substances in more significant amounts and more frequency with an attempt to encounter the initial level of reinforcement.
In the case of Arthur and Bob, the treatment recommendations would be first to get to know the risk factors and their triggers/temptations, as this would help them avoid using the drugs. They could also focus on maintaining a healthy lifestyle and seize of using drugs. Most importantly, Cognitive behavioral therapy (CBT) could be used whereby they can be referred to a therapist. CBT is termed the most effective therapy for alcohol and drug use disorders; hence it would be substantial in helping them quit using drugs (Magill et al., 2019).
Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of consulting and clinical psychology, 87(12), 1093.
Moustafa, A. A., Parkes, D., Fitzgerald, L., Underhill, D., Garami, J., Levy-Gigi, E., … & Misiak, B. (2021). The relationship between childhood trauma, early-life stress, and alcohol and drug use, abuse, and addiction: An integrative review. Current Psychology, 40(2), 579-584.
Volkow, N. D., Michaelides, M., & Baler, R. (2019). The neuroscience of drug reward and addiction. Physiological reviews, 99(4), 2115-2140.