COPING AND DRUG USE

Coping is the capacity to surmount negative emotional states, including Anxiety, Depression, anger, loneliness, and alienation. These aversive states are induced by internal psychological conflict or by external Stress. Effectiveness in appraising and overcoming emotional distress that results from predisposing or triggering stressors determines, to a large extent, psychological well-being. In contrast, ineffectiveness in coping, as well as a subjective perception of ineffectiveness, exacerbates emotional distress, which comprises for some people an important factor in promoting Alcohol, Tobacco, and other drug (ATOD) consumption.

The association between ATOD use and coping is complex. In some individuals there is a direct connection. In effect, Psychoactive Drugs are consumed to reduce tension and associated negative emotions. The consumption of drugs is motivated by their palliative effects. In most individuals, however, the connection between drug consumption and coping is more complicated. Numerous factors such as psychiatric illness, low self-esteem, deviant social values, maladaptive learned behaviors, inadequate social support, poor social skills, and personality disposition moderate and mediate the relationship between ATOD use and coping. No specific association has been established between coping style and Vulnerability to drug use or abuse. Thus, whereas it is generally recognized that a substantial proportion of the ATOD-using population is deficient in coping capacity, it is important to understand that many factors influence this association.

Coping and substance use and abuse become so intertwined over time that cause-effect relationships cannot always be discerned. Deficient coping capacity initially may, directly or indirectly, lead to ATOD consumption. Neurobehavioral, psycho-pathological, and social adjustment disturbances that occur along with chronic ATOD consumption may also diminish coping ability.

Substantial variation among individuals occurs with respect to both coping capacity and drug-use behavior across the life span. Drug consumption among youth is most frequently related to negative feelings such as depression and anxiety, social deviancy, and interpersonal problems—whereas substance use among the Elderly is more commonly associated with life crises, psychiatric disorder, bereavement, sleep disturbances, and unremitting pain.

Drug-abusing youth and adults, as a group, exhibit less ability to cope than the general population (Peele, 1985). It is essential to emphasize, however, that ATOD use and abuse may also be motivated by reasons other than the need to cope. In this context, ATOD consumption often stems from the desire for a euphoric effect or some other desirable state, a desire that may reflect accurate as well as inaccurate beliefs about the pharmacological effects of the chosen drug. For example, ATOD consumption may be motivated by perceived Aphrodisiac effects, energy or alertness enhancement, or social facilitation.

Among those whose ATOD consumption is motivated by deficient coping skills, it appears that augmenting competency improves the likelihood of successful treatment. In other words, treatments designed to enhance their coping skills are superior to treatments that emphasize their exploration of feelings (Getter et al., 1992). Furthermore, active coping strategies present 2 years after treatment are associated with a superior outcome at 10-year posttreatment follow-up (Finney & Moos, 1992).

The role of coping in ATOD use needs to be evaluated on a case-by-case basis. Assessment can be conducted using the Ways of Coping scale (Lazarus & Folkman, 1984) or the more comprehensive Constructive Thinking Inventory (Katz & Epstein, 1989). Severity of ATOD-use disorder can be efficiently quantified by employing the Drug Use Screening Inventory (Tarter, 1990). This brief self-report evaluates the severity of the disorder in ten key domains: (1) substance use, (2) psychiatric disorder, (3) behavior patterns, (4) health status, (5) family system, (6) work adjustment, (7) social competence, (8) peer relationships, (9) school adjustment, and (10) leisure/recreation. A treatment protocol to enhance coping has also been developed for alcoholics (Kadden et al., 1992); this practical approach to intervention is also applicable for treating individuals with other types of drug abuse.

(See also: Relapse ; Treatment Types: Cognitive Therapy of Addictions )

BIBLIOGRAPHY

Finney, J. W., & Moos, R. H. (1992). The long-term course of treated alcoholism: II. Predictors and correlates of 10-year functioning and mortality. Journal of Studies on Alcohol, 53, 142-153.

Getter, H., et al. (1992). Measuring treatment process in coping skills and interactional group therapies for alcoholism. International Journal of Group Psychotherapy, 42, 419-430.

Kadden, R., et al. (1992). Cognitive behavioral coping skills therapy manual. Project MATCH Monograph Series, Vol. 3, DHHS Publication No. (ADM) 92-1895.

Katz, L., & Epstein, S. (1989). Constructive thinking and coping with laboratory induced stress. Journal of Personality and Social Psychology, 61, 789-800.

Lazarus, R., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.

Peele, S. (1985). The meaning of addiction. Lexington, MA: Lexington Books.

Tarter, R. (1990). Evaluation and treatment of adolescent substance abuse. A decision tree method. American Journal of Drug and Alcohol Abuse, 16, 1-46.

Ralph E. Tarter