Substance abuse and addiction are problems that affect more and more people. According to the 2012 national Survey on Drug Use and Health, an estimated 20.7 million Americans have a substance use disorder. Because of the tendency to under report use, particularly of illegal substances, the number is probably even higher.

A substance use disorder can be diagnosed when people have difficulties fulfilling obligations at work, at school, or at home because of their use, when they encounter legal problems because of it, or when they continue to use despite negative consequences. Those negative consequences can be as small as frequent arguments with a spouse or as severe as an overdose. Addiction or dependence is diagnosed when the use is more frequent and regular and the person experiences the “need” to keep using. This often includes physical dependence on a substance. However, the line between abuse and addiction is not clear-cut and the treatment is quite similar.

The brain plays a major part in the development of substance abuse problems. When we use a mind-altering substance, such as alcohol, marijuana, amphetamines, or opioids, the neurotransmitter dopamine is released in the brain. It is the same neurotransmitter that is released when we have pleasurable experiences like a ride in the amusement park, a great meal, a sexual interaction, or the like. Our brain then connects the experience of the substance use with pleasure and we are more likely to repeat it. If we use with the same people or in the same setting, those people and settings will also be connected to the pleasurable experience and can easily trigger cravings.

With some substances, we also develop physical dependence and experience withdrawal symptoms when we try to stop using them. But even after the physical withdrawal is over, the connections in the brain are still intact and cravings can be triggered again at any time.

Some people are more susceptible to developing a substance abuse problem because of their biological or genetic make up. People who have relatives with addiction problems are more at risk to become addicted themselves. Undiagnosed or untreated mental health problems, such as depression, anxiety, or ADHD, are also factors that increase the risk for substance abuse. Many people with mental health problems use mind-altering substances to self medicate. It is often the only time they feel “normal” or happy.

But even though genetics and biology are important, the environment plays a major role, too. For example, research has shown that the attitude of parents toward alcohol and illegal substances has a huge influence on the behavior of their children. Also, positive connections to schools, churches, or communities are factors that seem to protect children and teens, and even adults, from drinking and using drugs.

Treatment for substance abuse is generally not easy. Many clients are court-ordered into therapy and might not feel the need or the wish to change their behavior. Even people who are not court-ordered often come to treatment because of pressure from their family or employer, and have little internal motivation to actually engage in counseling.

Clients who are willing to face their substance abuse problem and who are motivated to change often find that it is very difficult. They might have used substances for years to cope with their problems or feelings and now need to learn new strategies to do that. They also need to learn to face their difficult emotions and take responsibility for any harm they might have caused. Many clients find it necessary, but very painful, to change their social group. Their friends or even family members are the ones they used with and might not support their sobriety. Familiar people, situations, or places can trigger cravings or relapses and they might not be safe for a person who is in recovery.

Even though change is hard, it is possible. Counseling and treatment programs are available and many counselors will work with court-ordered as well as voluntary clients.

In counseling, a person can learn to identify triggers, avoid them, or address them in healthier ways. Clients can learn how to develop a new support system and how to deal with temptations and difficult situations. Most importantly, clients can learn how to cope with their emotions and mental health problems without the negative consequences of using substances.