Everyone can have a little too much to drink at points in their lives. Drinking alcohol is often seen as a part of everyday life, particularly in some cultures, like the Greek culture. This means that it is not only socially acceptable but, often, seen as important to highlight special occasions and even as a rite of passage (celebrations when reaching the legal drinking age spring to mind). The consumption of drugs, although certainly frowned upon by most, is not always illegal or socially unacceptable. For example, in the United States, the recreational use of marijuana is not only socially acceptable on a large scale but even legal in several states. The issue with substances like drugs and alcohol lies in abuse, not use. The problem here is that these substances aren’t being used solely for recreational purposes but also to cope with the difficult things in life like loss, fears, disappointment and any bad thing that can ever happen to anyone. And, when the use becomes, let’s say, medicinal, and when it becomes something that you need to do on a daily basis, problems begin.
But let’s examine the clinical aspect of this situation:
Substance abuse is a serious issue that affects everyone. Although the group most at risk is between the ages 17 – 30, everyone at any point can develop issues with substance abuse. Although certain substances like alcohol can have a positive effect on mood and physical health in small quantities, prolonged and excessive use can lead to many problems.
Substance abuse can have detrimental effects in the health of an individual since chronic use of alcohol and drugs can damage the individual in many ways. Particularly, substance abuse can cause memory loss, headaches, nausea or vomiting, muscle weakness, cardiovascular diseases, liver, lung and kidney problems, convulsions, tremors, hyperactivity and brain damage.
On the psychological domain, substance abuse can cause violent, aggressive reactions, hallucinations, panic attacks and it can also be a cause for depression and anxiety. Aside from these effects, substances lower inhibitions which can lead to risky and unsafe behaviors such as driving under the influence, unsafe sex or violent altercations and all the problems these behaviors can lead to.
Substance abuse can affect work performance and attendance and can often lead to unemployment and limited career prospects. People who work under the influence of substances are more prone to make mistakes and not be focused, which in physically demanding or dangerous jobs can be catastrophic and lead to accidents that may result to injury or death.
Seafarers are an at risk population for substance abuse.
WHAT ARE THE FACTORS?
Factors that can lead them to turn to substances are the long working hours, the high degree of responsibility, prolonged separation from their loved ones and loneliness, limited recreational activities, job insecurity, trauma following injury or pirate attack, fatigue, or to cope with the anxiety and / or depression that can result from combinations of the above.
When dealing with substances, we must always take into account the cycle of tolerance and withdrawal. Tolerance is the ability we have to tolerate substances, defined as the amount we need to consume before feeling affected by them. Tolerance differs between people. For example, if two friends go out for a drink and drink the same amount of alcohol, one can get drunk while the other may only get lightheaded. However, prolonged use of any substance increases our tolerance, meaning that if someone wants to get the same effect of a substance that he or she has become tolerant to, a bigger amount of the substance will need to be consumed in order to produce the desired effect. Tolerance is one of the reasons for substance overdose, since, in order to produce an effect that the body has become desensitized to, people can consume an amount of the substance that is larger than the body can handle, which often leads to death.
Withdrawal is an intricate mechanism that is one of the main reasons for substance dependence. Chronic substance use affects brain chemistry. Essentially, different substances affect different parts of the brain, suppressing certain neurotransmitters and stimulating areas of the brain that make us feel good. The body, however, is always minimizing energy costs during every day functioning and, when the brain interprets the overflow of certain substances as overproduction it reduces production of the natural versions of these substances, leading to adverse effects once the effects of the substances have worn off. For example, endorphins are our body’s natural painkillers and alleviate small aches that occur from normal body functions that we don’t normally feel. When opiates overflow the brain, the brain perceives this as an overproduction of endorphins and ceases the production, leading to intense pain once the opiates leave the system. Withdrawal duration and intensity depends on the individual and the nature of the substance.
There are two types of withdrawal, physical and emotional. Physical withdrawal is defined as how the body reacts to the absence of the substance.
Symptoms of physical withdrawal are listed below
Tightness in the chest
Nausea, vomiting, or diarrhea
Emotional withdrawal is defined as how the mind reacts to the absence of the substance.
Symptoms of emotional withdrawal are listed below.
The type of withdrawal each person experiences can differ based on the specific substance, since certain types of substances put different emphasis on withdrawal. For example, opiate withdrawal is largely physical while marijuana withdrawal is largely emotional. Type of withdrawal experience can also vary depending on the person on duration, type and intensity and doesn’t signify the absence of addiction if it’s not severe.
If substance use is persistent despite increased tolerance and withdrawal and despite the presence of physical and psychological health problems, the individual can be diagnosed with a substance abuse disorder.
Substance Abuse Disorders
Substance Abuse Disorders is diagnosed when substance abuse continues despite adverse psychological and physical effects and if it’s presented alongside certain factors. There are several substance abuse disorders with different symptoms between them but they all share a common cluster of criteria, which are listed below.
Impaired control: The individual takes the substance for longer periods of times or in larger amounts than intended and has difficulty controlling the substance use. Although the individual may express a desire to stop using the substance, attempts will usually be unsuccessful. The individual may spend an excessive amount of time obtaining substances or thinking about obtaining and using substances and will get intense cravings when presented with stimuli associated with a substance.
Social impairment: The individual can ignore or be unable to fulfill his or her roles in work, family, education and social life because of the substance use. The individual will continue using the substance despite these difficulties. Eventually, occupational, family and social obligations will be ignored in order for the substance use to continue.
Risky use: The individual continues to use the substance despite having physical health problems that are either caused from or get worse by using the substance.
Pharmacological criteria: The continuation of the substance use despite the symptoms of tolerance and withdrawal described above.
When looking at substance abuse disorders, it is important to understand that not all the symptoms mentioned above need to be present to diagnose someone with a substance abuse disorder. People, depending on their individual circumstances and culture, may consume alcohol or substances on occasion without it meaning addiction. When examining the symptoms, the focus shouldn’t be one – sided but on deviations from the norm. In the case of substance abuse, the focus should be on functionality when the substance isn’t consumed and it shouldn’t be self – diagnosed. So, if you suspect that you or someone close to you may suffer from a substance abuse disorder or an addiction, it is crucial to turn to a licensed mental health professional.
In simpler terms, if you think that someone close to you may have a problem, ask someone who can tell you for sure before jumping into assumptions. Issues with mental health are both serious and sensitive and should be treated as such. Diagnoses can be scary but knowing the nature of a problem is the first and best step taken to deal with it.
In substance abuse and addiction cases, treatment options include rehabilitation, therapy and medications.
Medications given for substance abuse treatment depend on the substance and are usually given to alleviate withdrawal or withdrawal related symptoms.
Rehabilitation programs vary in type, duration and intensity but most, if not all, mandate complete abstinence from all substance use. Both inpatient and outpatient programs are available, depending on individual needs. Methods and techniques can vary based on the program and there are many programs tailored for the needs of specific populations. Programs also entail sponsor systems and support groups.
Therapeutic interventions for substance abuse usually involve behavioral therapies, which change the behaviors associated with substance use, triggers, and cravings and also address the causes that led to the substance abuse, and motivational interviewing, which aims to enhance the individual’s natural motivation for change.
To better help seafarers, the conditions that lead to substance abuse should first be addressed. Better pay and job security, as well as less time away from their families can reduce anxiety and reduce stress and depression that can lead to substance abuse. Reducing working hours and ensuring rest, improving the occupational conditions by doing whatever possible to minimize accidents and having more accessible first aid, and reducing the time spent at sea can help improve both the physical and psychological wellbeing of seafarers. Giving seafarers bigger windows to rest will improve both their mood and performance. Implementing more shore leave can have a positive effect on seafarer’s psychological health. Drug screening and education can help with prevention and offering rehabilitation and treatment programs, as well as education on substance abuse, can have a positive effect in substance abuse on board. Referring seafarers to support groups, meetings, or providing them with rehabilitation can help them overcome the difficulty and be viable and valued members of the workforce. The strength of any business is their workers and the maritime industry is no exception; taking care of seafarers and acknowledging the difficulties they face will go a long way to have a stronger, more productive workforce.