As no two people are alike, there is no one single cause of a drug or alcohol addiction.
With this in mind, the question often asked by researchers is – what makes one person more susceptible to a substance use disorder (SUD) than another? Traditional risk factors associated with addiction include genetics and the environment. However, how people actually view and process these risk factors, also called cognitive orientation, is becoming increasingly more relevant when studying addiction recovery. There is still a missing link that connects substance abuse to both genetic and environmental factors, and we are discovering how cognitive-based therapies can be the bridge to those connections – leading to more effective addiction treatment.
The Cost and Risk Factors of Addiction
In America alone, drug addiction costs $740 billion annually in lost workplace productivity, healthcare expenses, and crime-related costs (National Institute on Drug Abuse, 2019). Despite all of the research on the causes of this disorder, there are still limitations on the two major risk factors for addiction – genetics and environment. The National Institute on Drug Abuse identified that gene expression accounts for 40%-60% of one’s risk for drug abuse (NIDA, 2019). However, scientists are still unsure of how and which, genes or combination of genes, affect this risk. Environmental factors such as homelessness, peer pressure, abusive home life, and lack of educational resources are also associated with substance use disorders. However, people tend to react differently to these factors, and these responses do not always lead to addiction.
The truth is, any combination of these elements can lead to a higher risk of SUD – but what remains a mystery is how some factors increase the risk, and some have no effect at all. To design more personalized treatments in addiction recovery, clinicians are now tasked with trying to understand which combination of risk factors is affecting patients’ ability to achieve sobriety.
How can we help clinicians better treat their patients in addiction recovery? It’s time we look at how people view the world around them and how their perceptions change over time.
Using Cognitive Orientation – The Missing Link in Addiction Treatment
Rather than connecting the dots between biological and environmental factors to SUD, both factors can be further analyzed through a cognitive lens – also called cognitive orientation or cognitive mechanism. Simply put, cognitive orientation measures how a person perceives the world and how they process information relative to their biological make-up and the environment around them. Pinpointing a person’s perception and how they make decisions, as well as their environmental and inherent factors, can truly help in finding the root cause of their addiction. Research also suggests that understanding both genetic and neurobiological foundations helps to improve matching patients to pharmacological treatments when necessary (Tomko, et al 2016).
When you combine biological and environmental elements with a person’s everyday stressors such as financial issues, kids, and relationships, this can cause a “cognitive collision” or continually experiencing different levels of mental discord such as stress and anxiety. This combination acts as a pressure cooker which can lead a person to drug and alcohol abuse. However, if we expand the scope of environmental factors to include life habits, academic or work-related tasks, diet, as well as psychological and social variables, addiction treatment professionals can effectively identify the causes of anxiety or other mental health challenges. Incorporating the cognitive orientation gives a more personalized insight into an individual’s overall reaction to stress and can help create a more individualized treatment plan – leading to higher success during addiction recovery.
What Does the Research Say?
A study using cognitive enhancement therapy to treat schizophrenic patients suffering from addiction showed an increase in positive reaction to treatment compared to traditional therapy. Patients used a cognitive remediation approach that integrates computer-based training in attention, memory, and problem solving with a group-based social cognition studies in addition to psychiatric care. Patients were then assessed every six months, and treatment was modified based on changes in outcome. The results were a game-changer. The study showed that patients using cognitive-based therapy, along with their traditional treatment, were less likely to use substances than those using only traditional therapy (Eack, et al 2016).
Understanding a person’s cognitive orientation and how they perceive the world early on in treatment can help relieve cognitive collision. For example, a patient that has high impulsivity is less likely to have success overall in SUD treatment (Tomko, et al 2016). Knowing what causes a person to act impulsively will likely lead to more productive treatment. Cognitive-based therapies help to fill in the gaps that traditional psychological and psychiatric interventions leave behind. These modalities have also been also shown to retrain the brain to dampen drug-related sensory cues and strengthen self-referential processing (Zilverstand, et al 2016).
Treating the Whole Patient
Each individual has a unique set of biological and environmental factors that contribute to their susceptibility to a substance use disorder. These elements can also affect how well they respond to specific cognitive-based therapies. By identifying the interplay of biological, environmental, and cognitive factors, we can understand how this affects drug initiation, continued use, cessation, and relapse. Identifying the cognitive mechanism during addiction recovery adds a new dimension to treating the whole patient.
A person’s personality and circumstances are continually changing and evolving throughout their life. Addiction treatment that is specifically tailored to address these changes can yield effective, long-term results. Providing patients with on-going, real-time insights into their cognitive orientation can help those in recovery maintain a healthy and successful life in sobriety.
References
Eack, S. M., Hogarty, S. S., Bangalore, S. S., Keshavan, M. S., & Cornelius, J. R. (2016). Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study. Journal of Dual Diagnosis, 12(1), 74–82. doi: 10.1080/15504263.2016.1145778
Tomko, R. L., Bountress, K. E., & Gray, K. M. (2016). Personalizing substance use treatment based on pre-treatment impulsivity and sensation seeking: A review. Drug and Alcohol Dependence, 167, 1–7. doi: 10.1016/j.drugalcdep.2016.07.022
National Institute on Drug Abuse. (n.d.). National Institute on Drug Abuse (NIDA). Retrieved from https://www.drugabuse.gov/
Zilverstand, A., Parvaz, M. A., Moeller, S. J., & Goldstein, R. Z. (2016). Cognitive interventions for addiction medicine. Progress in Brain Research Neuroscience for Addiction Medicine: From Prevention to Rehabilitation – Methods and Interventions, 285–304. doi: 10.1016/bs.pbr.2015.07.019