Substance Use Disorder in Colorado Part 1: Theories of Cause and Recovery

“The first time I tried alcohol, I was a teenager, and it immediately made everything feel better,” says Brook Jajczyk, a thirty-five-year-old single mother to twins. “A lot contributed to it becoming addicted; I had experienced trauma and a family history of substance use and mental health, and drinking helped me escape,” Jajczyk says that she went from a studious, college-bound student to a daily drinker, which evolved into using other substances.

“Everything got progressively worse,” Jajczyk recounts, “I did not live up to my potential: because of addiction, I did not go to college, I found myself in situations that resulted in more trauma, I ruined relationships and my career. I just kept digging myself into deeper and deeper holes with no clear solution.” 

Jajczyk found sobriety when pregnant with her twins. She had suffered miscarriages previously and described her successful pregnancy as her “white picket moment.” She was sober for the eight months she was carrying the children and continued to abstain through breast-feeding the pair. However, motherhood comes with countless stressors, and for extraverted Jajczyk, she found herself struggling with isolation. At six months, dealing with severe postpartum depression, she began to drink once again.

Unfortunately, Jajcyzk’s experience is not unique, with one in seven birth-giving individuals experiencing postpartum depression, and fifteen percent of whom find themselves engaging in binge drinking or elicit substance use to deal with the pain.

Over the next several years, Jajczyk would continue to search for sobriety, only to get knocked down by life events, such as a car accident that left her with a traumatic brain injury. Finally, in 2021, she found solace in treatment through the UC Health Center for Dependency, Addiction, and Recovery (CeDar.) It was not just her grit and determination that led to her lasting sobriety but also a balance of medication, therapy, group work, and community service. 

Jajcyzk’s experience: trauma, difficulty finding resources, and a history of mental health and addiction in the family are all unfortunately common in the foundation of those experiencing substance use disorder. Also working against those seeking recovery is the history of drug reform in the United States.

What Causes Substance Use Disorder

There is no cut-and-dry answer to what causes addiction; however, examining a person’s biology, psychology, and social (biopsychosocial) build can provide a better view of the leading theories, which are moral, biological, psychological, and social.

Moral Theory: While this theory is discredited more and more in modern society, it is still frequently used when practitioners are looking at a person with severe or chronic substance use. This theory points to a loss of self-control due to chronic drug use, leading to an increase in relapse or an inability to remain abstinent from substances. While this is still considered a legitimate cause for addiction, many treatment models do not incorporate it into treatment, especially as it places blame or weakness on the individual. This theory is often associated with the “disease” language used around use and treatment and can be seen in the twelve-step model.

Biological Theory: This theory looks at how genetic makeup, or brain chemistry changes, impacts the pleasure and reward receptors. There is some speculation that genes could affect the likelihood of addiction, but there is no hard evidence for this belief. What is understood is that damage to the prefrontal cortex, which can be caused by injury or heavy and chronic substance use, can lead to difficulty with impulse control. The biological perspective is helpful in better understanding Medication-Assisted Treatment.

Psychological Theories: Psychological theories are more of an umbrella perspective than the previous two concepts. This theory looks at how are conditioned to see the world to understand better triggers and cravings that could lead to chronic substance use and addiction.

Social Theories: This perspective examines what occurred to the individual via their history and family that could lead to a dependency on drugs or alcohol. This is the lens used by most researchers and evidence-based specialists today.

Trauma History

Trauma, especially that occurring during childhood, has been shown to correlate, with studies pointing to 59% of young people with post-traumatic stress disorder also experiencing substance use disorder during their life. Adverse Childhood Experiences (ACE) scores can help examine the stress that children are under due to their family or environment. ACE scores look at neglect, abuse, violence in the house or outside environment, and substance use in the home. Along with being correlated with higher instances of depression, heart disease, obesity, and diabetes, a person with an ACE score over five is four times more likely to struggle with addiction or illicit substance use later on in life.

Gabor Maté is the leading doctor behind the social theory of trauma and how it relates to addiction. In his book, In the Realm of Hungry Ghosts, he dives into how trauma and loss, especially in childhood, can lead to addiction and dependency. Maté points to dopamine deficiencies, poor self-esteem, a lack of coping skills, and behavioral patterns that were maladapted in childhood as some of the potential factors that lead to substance use disorder. While some of these factors come from neurological factors, they are also tied to childhood neglect or trauma.

Though a history of trauma might not be the root cause for every person dealing with addiction, using trauma-focused treatment can be extremely beneficial. Many adults, especially those who identify as male, are reportedly less likely to seek psychological support, meaning that substance use disorder recovery could be the first time they are receiving support for the trauma that has occurred in their lives.  Using trauma-informed care or working to help people heal from their trauma, rather than being re-traumatized or discredited, is crucial for people in recovery from substance use disorder. There have been links to the use of trauma-informed care and patients staying in treatment longer and finding success in their recovery.

Mental Illness Co-Occurring with Addiction

According to the National Institute of Drug Abuse, 37.9% of adults with Substance Use Disorder were also diagnosed with a mental health condition, most commonly depression, anxiety disorders, personality disorders, and schizophrenia. It is speculated that often substance use can be a way for a person to self-medicate and deal with a mental health condition that might not be diagnosed or understood. However, there are also theories that brain chemistry could lead to vulnerability in addiction. 

Recovery Methodology

Recovery is not easy and often takes more than willpower alone. Substance Use Disorder (SUD) treatment is most successful when rehabilitation programs are utilized. However, several barriers stand between a person struggling with addiction and recovery.

“The behavior and mental health world behind in their ability to make access easy. If you have a medical emergency, you would know exactly where to go; often, the process for mental health can feel cumbersome for someone struggling,” says Ronnie Vasquez, the Acute Care Director at Mental Health Partners of Colorado. Vasquez goes on to explain that the stigmatization of treatment for addiction can be a significant barrier to a person taking the first steps to finding support.

Colorado also faces the issue of not having enough beds available for those struggling with substance use disorder. While Counties such as Boulder and Denver have more resources, they are also faced with the burden of taking on patients from more rural counties where mental health services are not available.

We should look at what the individual needs to recover rather than the societal pressures to penalize those who are using. Jajczyk recounts, “The best people I have ever met in my life are in recovery or are addicts. It is hard to overcome and find stability in recovery, and the consequences are huge. I have almost died. People I know and love have died. If we live, there is jail, destroying relationships and families.” 

Medication Assisted Treatment

Medication Assisted Treatment (MAT) is an effective tool to help a person get through detoxification and the subsequent withdrawals. MAT uses FDA-approved drugs to help a person safely withdraw from a substance, as well as prevent future cravings with continued medicated use. “Data is showing a 90% relapse rate for heroin with the use of any MAT,” says Haddad, “it is really hard to do alone.”

For Opiate Use Disorder (OUD), there are three approved medications: Methadone and Buprenorphine, which prevent withdrawal and minimize cravings, and Naltrexone, which blocks the effects of opiates. Both Buprenorphine and Naltrexone can be prescribed and taken once the individual returns home, while Methadone is administered in clinics. Naltrexone is also used in treating Alcohol Use Disorder, often as an aid in helping a person begin to limit use. Acamprosate and Disulfiram are both used for individuals who have already stopped drinking and need to lessen their cravings.

For Jajczyk, the use of MAT completely changed her ability to stay sober. “I went on Nalprexone and a mood stabilizer. It suddenly made sense why people weren’t addicts; I didn’t wake up craving it every morning.” She adds that it was also beneficial for her to have other resources besides the medication, but the medication has kept her and others alive long enough to seek treatment.

While MAT has a high success rate, Dr. Conner warns, “There can be more doctor visits, and some of the medications have unpleasant side effects.” For this reason, it is helpful to maintain contact with a care team while undergoing MAT.

Abstinence (The twelve-step method)

Twelve-step programs take the perspective that substance abuse disorder should be viewed as a disease that can be maintained but never eliminated. Under this methodology of treatment, a person becomes sober at the start of their journey and avoids using substances again. This method is one of the most well-known and continues to support those seeking a solution.

While this method has seen success, criticism of it points to the need to find a higher power, isolating those who may not prescribe to spiritual beliefs, and the need for the person in recovery to stop use by going “cold turkey.” 

The risks of going “Cold Turkey.”

Cutting off substance use immediately, without intervention, is referred to as going “cold turkey.” While it might be an effective way to remove a person from a triggering environment, it comes with risks that can prove uncomfortable at best and deadly at worst. Dr. Haddad warns, “Detoxing from benzos [benzodiazepines] can cause seizures, and alcohol has the risk of Delirium Tremons, which there can be great support around in a detox or treatment center.” A sudden halt in alcohol use causes Delirium Tremons (DTs.) Because alcohol is a depressant, the sudden depletion in the system causes the brain and nervous system to get overstimulated, causing a spike in blood pressure, extreme excitability, and seizures.

While not all substances are deadly during withdrawal, many (such as opiates) have unpleasant symptoms that can make the person in recovery extremely sick. “It is uncomfortable, and it can be extremely tempting to use during that time.” Haddad continues explaining that even when the symptoms of withdrawal are gone, craving can remain, putting the individual at risk of relapse and accidental overdose.

Harm Reduction

The general principle of harm reduction is to minimize the impact of illicit substances, whether it is through abstinence, safer use practices, or management of use. This philosophy accepts that substance use and addiction are a part of the world, and supporting a person who is using is more effective than condemning the behavior.

MAT falls under the umbrella of harm reduction. Still, the practice also expands to preventing overdose and providing safe spaces and tools for individuals who are not ready to undergo it.

Evidence-based practices are the most up-to-date practices that a field of study agrees upon. In regards to SUD treatment, it refers to the medical and mental health treatment required to help a person struggling with addiction stay safe from overdose or lasting repercussions. “There has been a movement away from looking at addiction as if it were a criminal behavior to viewing it as an illness, and more recently, as a chronic illness,” says Dr. Brad Conner, the director of the Masters of Addiction Counseling program at Colorado State University. Conner goes on to explain the importance of not looking at relapse as a fault but rather as a piece of the recovery process, taking away the negative stigmatization of one-directional recovery. He explains that current evidence-based practices have moved away from a twenty-eight-day abstinence model and have started to view treatment as a lifelong process.

Understanding the root causes and treatment methodologies of substance use disorder is crucial in looking at the larger picture of where Colorado and Boulder County stand on their provided resources and criminology perspectives of addiction. In the coming weeks, Yellow Scene will dive more into the legal and government-provided resources available for those struggling with addiction.