Monday Medical: How substance abuse starts

Susan Cunningham
For Steamboat Pilot & Today

Editor’s Note: This is part one of a three-part series on substance abuse. Part two will cover steps to recovery, and part three will cover prevention.

From the latest headlines to struggling relationships and health concerns, there’s no shortage of things to worry about. But for some people, constant stress can fuel a substance abuse issue.

“Often, the problems in our life can’t be resolved or fixed, and that lack of control can leave us feeling confused, disoriented and stuck,” said Amy Goodwin, a licensed professional counselor and behavioral health counselor at UCHealth Behavioral Health Clinic in Steamboat Springs. “Finding ways we can manage in unmanageable situations can take time. Substances can give us the illusion that we are relieving our stress or distress without altering or evolving our behavior.”

When people turn to substances as a way to tolerate stress, they can face a serious cost.

“Substance abuse robs us of our innate abilities to take care of ourselves and others,” Goodwin said.

Physical and mental impacts

“Right there, in the word intoxication, we have a clue about how damaging drugs can be,” Goodwin said. “By definition, once intoxicated, we are now altering our body and brain in unhealthy ways.”

Substances such as alcohol, nicotine, marijuana and cocaine change the production of natural brain chemicals, which in turn impact the central nervous system, organ function and more.

Heavy substance use can cause or exacerbate mental health conditions such as depression, anxiety, post-traumatic stress disorder and insomnia, and can also impact memory, the ability to bond with others, impulse control, and communication and problem-solving skills.

Various health conditions are also associated with substance abuse, including hypertension, cardiovascular diseases, chronic dehydration, cancer, liver failure, and stomach and digestive issues.

How is a habit formed?

“The human body is incredibly effective at letting us know when we are treating it poorly,” Goodwin said. “Hangovers are a wonderful example of our brain and body asking us not to overindulge.”

But to pay attention to the body’s signals, we have to be able to hear them. When someone is abusing substances, those warning signals become easier to ignore or even meaningless.

“The brain and body will start to increase the production of chemicals to balance us back out if we use drugs on a regular basis, so we develop tolerance to the drugs we are using,” Goodwin said. “We feel worse when not using as the body is again out of balance.”

For instance, alcohol causes the brain to over-release pleasure chemicals such as dopamine.

“That allows us to feel a sense of euphoria: things become ‘fun’ that may not have been all that great otherwise,” Goodwin said. “But the more we over-spend our dopamine, the less we have for day-to-day functioning. We can feel like life has become ‘boring’ and we now need alcohol to feel playful and to keep things pleasurable.”

Is it common to abuse more than one substance?

Yes. For instance, using increasing amounts of alcohol to get the same pleasure can chemically bankrupt the body, and someone may turn to another drug – such as cocaine, amphetamines, or nicotine – to provide a stimulant.

“It is not uncommon for people to begin to self-medicate the chemical imbalance they are inadvertently causing through their drug use,” Goodwin said.

Who is most at risk?

In a word, anyone.

“There is no one demographic that seems to be more at risk than another,” Goodwin said. “The single most predictive factor for substance abuse is some experience with trauma, meaning high stress exposure without the developed tools to manage the stress.”

How has the pandemic impacted substance abuse?

An increase in opiate-related overdoses and higher sales of legal, recreational drugs all point to increased substance abuse during the past two years.

That trend isn’t surprising to Goodwin, given the fear, stress and disruption to regular routines that the pandemic caused.

“We often build coping strategies into our daily routines,” Goodwin said. “When those routines were disrupted by quarantine restrictions, many people lost their stress outlets and we were left unprepared to manage stress in a radically different way.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at

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