Each time I watch the commercial for a certain anti-depressant, I begin to mouth the words along with the narrator: “Where does depression hurt? Everywhere. Who does depression hurt? Everyone.” These same public health concepts can be applied to addiction treatment.

A similar commercial for an addiction treatment would sound something like, “So where does addiction hurt? Everywhere - physically, emotionally and spiritually. Who does addiction hurt? Addiction hurts everyone: individuals, communities and families.”

The impact of addiction, specifically on the family and even more specifically on the suburban family is complex and worthy of examination. In order to understand the impact of addiction on the suburban family, it is important for us to explore addiction and factors that may be more prevalent for suburban families than others.

Addiction

Addiction can be defined as a disease process characterized by the continued use of a specific psychoactive substance despite physical, psychological or social harm (American Psychiatric Association, 2000).

Substance abuse and substance dependence are seen as separate by professionals. The major characteristic of addiction is compulsive use of a substance despite hazardous situations, psychological illness, or physical consequences. While there are a host of factors (called criteria) that determine each as a diagnosis, they are mainly separated by the potential for withdrawal (dependence includes significant withdrawal whereas substance abuse does not).

It is important to note that in the upcoming 2013 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Illness (DSM-V), all disorders related to compulsive substance use will be categorized as Substance Use Disorders (SUD). In this fifth revision of the original text, the group of professionals charged with the task of proposing the diagnostic criteria, the Substance-Related Disorders Workgroup, will make a distinction between Substance Use Disorders, Substance Intoxication and Substance Withdrawal. A parent might ask, “How does this affect my child?” or a concerned daughter might ask “Where do I fit in with any of this?” To these affected family members this may sound like pure jargon, and it is.

However, it is important for family members to be able to identify the patterns of SUD in order to find the answer to the more important question, “What are we going to do about this?”

In conjunction with family make-up and dynamics, several other factors determine the impact and the prevalence of substance use.

Determining Factors

In the 80’s ( in certain areas of the country), crack cocaine became popular. In the decade that followed, “designer” or “club” drugs like MDMA were popular, as well as “wet” joints (marijuana cigarettes dipped in embalming fluid) or PCP (sherm or sherm sicks). At the same time, trends showed the rise of prescription pain medication (Oxycontin, Vicodin) and anti-anxiety medication (Xanax, Atavan). The latest research has shown a sharp rise in heroin in the U.S. suburbs as well as violence in rural areas.

Why focus on determining factors? Isn’t life essentially the same wherever you go, barring a few changes here and there? This can be true but for example, suburbanites may be likely to fall victim to what one of my favorite social commentators, George Carlin, referred to as “N.I.M.B.Y.” or Not in My Back Yard!

The erroneous assumption that higher per capita income rates, better school systems, safer streets and greater parent involvement render our communities immune to high rates of drug use is just that – an error. An historically economically depressed urban area might live with a culture of “nobody cares about us, so why even try?”

Many variables impact individual areas and rates of usage such as the area of a state or country, socioeconomic status of the residents, political beliefs, community cohesion, ethnicity and many others. What may occur in a largely Caucasian Northern suburb may differ greatly from what might occur in what The Brookings Institute calls a “melting pot” suburb of the Southeast.

For example, one urban city in a state may have a higher prevalence of crack cocaine whereas a similarly populated urban city in the same state may have a higher prevalence of heroin; this may be attributed to the “supply and demand” of drug users and dealers. In a state like Hawaii, methamphetamines continue to be the primary substance of abuse for those admitted to treatment.,  

According to the National Institute on Drug Abuse (NIDA)‘s research findings from selected research reports, the following data have been reported about the occurrence of drug use throughout the country: Marijuana use continues to escalate. The use of club drugs like GHB and MDMA (Ecstasy) continues to be reported across the country. Methamphetamines are primarily a western problem with fewer reports of its use being made in the Midwest.

Cocaine remains the nation’s dominant drug problem and heroin shows mixed trends (its use is up in some cities and down in others). Club drugs (MDMA, GHB, ketamine) and those drugs that fall in the “other” category (DXM, readily found in some over the counter cough syrups) are on the rise with their recipes and other information about obtaining the drugs on the internet.

Based on these data, it can be seen that what is perceived by popular culture and quite often the community, is far more complex upon exploration. Why the need to regurgitate research findings? It is the knowledge of these data that will in turn help us to identify where to focus our efforts in addition to empower us to be able to foresee where usage issues are growing.

Impact

Usage analysis and statistics are more than just numbers. Those numbers represent real individuals and families. A simple formula to apply is the if-then reasoning given to us by Aristotle. For example, if a woman was taught by her family that she is the primary caretaker and responsible for keeping her family close, then if her husband begins drinking everyday after work, this woman may let her caretaking go into overdrive, displaying symptoms of a codependent. In another example, if a five year old boy adapted to his mother’s heroin use by finding an empty room in the home where he could feel safe then that same boy at age fifteen might adapt with isolation in his room or run away from home. If on the other hand his five year old reaction was to seek attention from his mother, he might begin acting out at school or in the home. The combinations and outcomes can be calculated to the highest of probabilities. By applying the knowledge of drug use trends and the if-then formula to a specific individual or family, that individual or family can be pointed in the best direction to seek treatment.