A case study of substance abuse and depression

Cassandra: Case Study

There is evidence that substance abuse and other mental disorders associated with substance abuse such as anxiety and depression have strong genetic links. In the case of Cassandra, her father and her brother both have had substance abuse issues. For example, "a NIDA-sponsored study of alcohol dependent patients treated with naltrexone found that patients with a specific variant in an opioid receptor gene, Asp40, had a significantly lower rate of relapse (26.1%) than patients with the Asn40 variant (47.9%)" (Genetics of addiction, 2008, NIDA). However, the genetics of addiction are not like the genetics of sickle cell anemia, in which a single, targeted variation causes the illness. At best, there are certain genetic patterns which increase the tendency to develop certain addictions, in the presence of other social factors.

Cultural influences, such as an environment where addiction is the norm rather than the exception can lead genetically vulnerable people like the individuals in Cassandra's family to develop addiction. However, epigenetics, or how genes can be 'turned on' or 'turned off' in the environment must also be taken into account. "Changes in gene expression in brain reward regions are thought to contribute to the pathogenesis and persistence of drug addiction" (Renthal & Nestler 2008). Drug addiction can effectively rewire the brain's reward-seeking mechanisms. Drugs cause a flood of 'feel good' chemicals to flood the brain and eventually the brain stops making adequate amounts on its own, requiring more and more of the drug on the part of the addict not simply to feel high but just to feel 'normal.' Thus although the brain of addicts may begin as somewhat different from those without a predisposition for addiction, the act of addiction itself causes brain changes that foster and support chemical dependence.

Cassandra has grown up in a home where violence is the norm, specifically violence against women. The males in her immediate family acted violently towards the women in their lives as well as were substance abusers. This might indicate that their substance abuse has roots in anxiety and depression, given that it is very common for persons suffering from these conditions to self-medicate with drugs and alcohol. This is particularly true of persons without adequate access to mental health care, as appears to be the case with Cassandra's family. "People with depression and anxiety disorders often self-medicate by drinking, which can make things worse" (Depression and anxiety facts, treatment and prevention, 2013, UHC). Although it may seem odd to think of violent people as 'depressed,' this is, in fact, a very common way for depression to manifest itself in males, particularly males from cultures such as Cassandra's which seem to place a high degree of value on machismo. Women, in contrast, are more likely to act violently against themselves when depressed.