Table of Contents
Substance use disorders comprise of conditions such as the bipolar disorder whose main etiological factors are associated with substance abuse. The majorly abused substances include alcohol, cigarettes, prescription and illegal drugs taken by addicts to impart changes in their brains without medical directions. Self-regulation is an important aspect in the prevention of such substance abuse disorders as well as their control in persons already suffering from the condition through self-efficacy and addressing deficits of emotional self-regulation. The aim of this study was to explore various ways through which substance use disorders can be addressed through self-regulatory mechanisms. To achieve this, the researcher performed a literature search for related sources of evidence from online databases like Cochrane Library, ProQuest, MEDLINE, PsycINFO and CINAHL. Four academic journals were found relevant in responding to the search question and were exposed to critical analysis to adequately address the research topic. From the findings, self-regulation is a key factor in the prevention and management of substance use disorders. This study recommends the use of a combination of several self-regulation aspects in addressing major substance abuse disorders such as self-efficacy, self-control and self-motivation among others.
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Emotions bring about self-regulation in persons that struggle with drug and substance abuse considering that such emotions are accompanied by passions with the capacity for building or destruction (Wilens et al., 2013). In fact, most of the decision-making capacity according to neurosurgeons are determined by emotions rather than logic. Any injury affecting the brain portion that controls emotions also affects the ability of the individual to make decisions. Self-regulation is associated with emotions and decision-making on whether to quit or continue abusing substances. As noted by Wilens, Martelon, Anderson, Shelley-Abrahamson, and Biederman (2013), the mechanisms for self-regulation are apparently operation in substance use disorders and bipolar disorders. These authors, however, noted a gap in emotional self-regulation that they sought to address considering the emotional linkage to substance use disorders. Similarly, Köpetz, Lejuez, Wiers, and Kruglanski (2013) increased the pool of literature by discussing the motivational role and mechanism of regulating the incidence and management of substance use disorders. The authors invoke a convergence approach to consider existing mechanisms of approaching addiction and substance abuse disorders from a self-regulatory perspective. Research shows that there is a relationship between self-regulation and self-efficacy in the management of substance abuse disorders through abstinence. These relationships were explored by Chavarria, Stevens, Jason, and Ferrari (2012), providing a strong basis for isolating literature aspects of self-regulation and substance use disorders important for this study. Bakhshani and Hossienbor (2013) conducted a study to compare self-regulation among substance abusers and non-substance abusers with specific consideration of the factors that influence the incidence and maintenance of substance use.
Sources of evidence for this study were obtained from online databases such as Cochrane Library, the Medical Literature, Analysis, and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the PsycINFO, and ProQuest. The three databases are rich in all types of literature and were selected for their wide range of evidence related to the research topic. The search terms that guided the search for evidence included self-regulation, substance use disorders, addiction, emotions, and bipolar disorders. Further, the search strategy was limited to sources of evidence that addressed personal mechanisms of regulating the incidence and maintenance of substance use disorders including addiction. The exclusion criteria to further limit the search strategy entailed the use of literature sources published between 2012 and 2017 considering the importance of updated information on the study topic. All unpublished sources of information, however relevant they were to the research topic, were left out of this search strategy because of validity and authenticity issues. Lastly, the search for relevant materials to be used as sources of evidence was limited to the literature published in the English language to avoid incurring expenses for translation considering that the target group was English literate. The level of evidence of all the search outcomes warranted the use of the four academic journals in critical analysis.
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Table 1: Summary of evidence
|Author(s) and year||Title||Study design||Sample size||Data collection method||Theme and outcome||Type of journal||Country||Level of evidence|
|Bakhshani and Hossienbor (2013).||A comparative study of self-regulation in substance dependent and non-dependent individuals||Cross-sectional study||228 human subjects||Questionnaires||Self-regulation and control skills among participants are significantly lower in persons with low or no substance dependence.||Global Journal of Health Science||Iran||III|
|Chavarria et al. (2012)||The effects of self-regulation and self-efficacy on substance use abstinence||Randomized controlled trial (RCT)||150 adult individuals||Questionnaires||Changes in self-regulation and self-efficacy can induce abstinence among participants.||Alcoholism Treatment Quarterly||Chicago||I|
|Köpetz et al. (2013)||Motivation and self-regulation in addiction: A call for convergence||Descriptive survey||262 sources of evidence||Review of literature||The overall theme is motivation and self-regulation. Evidently, self-motivation can increase an individual’s sensitization about the abuse of substances with a possible increase in the tendency to avoid such detrimental behaviors.||Perspectives on Psychological Science||The United States of America||III|
|Wilens et al. (2013)||Difficulties in emotional regulation and substance use disorders: A controlled family study of bipolar adolescents||Randomized controlled trial (RCT)||203 families||Interviews||The theme here was the use of emotional regulation skills to manage and control substance use disorders. Increased deficits of emotional self-regulation increase the tendency of individuals to engage in substance abuse behaviors and as a result predispose themselves to substance use disorders.||Drug and Alcohol Dependence||USA||I|
Self-regulation helps an individual to make critical decisions such as taking proper diets, timely accomplishment of tasks and avoiding behaviors that may be harmful to themselves. In other words, self-regulation refers to the ability to change certain thoughts, responses or impulses for the benefit of an individual’s health parameters. Chavarria et al. (2012) reported that attitudes of self-regulation are beneficial in the reduction in the rate of alcohol abuse characterized by higher grade point average, between psychological adjustments as well as more optimized emotional responses Chavarria et al. (2012). The aspect of self-regulation functions in aspects such as restrictive behaviors in a mechanism similar to that of a normal body muscle whose consecutive use results in less performance. Just like the exercising muscle, prolonged use including everyday use of the same resource also results in bigger self-regulatory strength reserves. In fact, people who continuously exercise self-regulation not only in substance consumption but also in other life aspects exhibit improved regulatory capacity on detrimental behaviors. As such, it is evident that self-regulation can be increased when practised over a long time (Köpetz et al., 2013).
Self-regulation and Abstinence
There is a positive relationship between the self-regulatory scores and the rate of abstinence from substance abuse as reiterated by Chavarria et al. (2012) with the implication that an increase in the self-regulatory scores also increases the length of abstinence from substance abuse. While studying alcohol consumptions, it is notable that a depletion in self-regulation is responsible for a subsequent increase in blood alcohol concentration. Self-regulation, in this case, is closely related to self-efficacy in which the individual sets a goal to achieve regarding substance use disorders. Using self-efficacy, individual aims at using a certain amount of energy in refraining from certain detrimental behaviors. It is the attribute of self-efficacy that continuously keeps an individual on their toes to try much harder even if failure is imminent (Bakhshani & Hossienbor, 2013). Many people have managed to abstain from behaviors such as smoking, illicit drug abuse and alcoholism citing persistence in attempting to abstain driven by self-efficacy. In fact, follow-up protocols among heavy smokers who eventually quit the smoking show a greater percentage of individuals who managed to stay free from post-exposures are those with the highest degree of self-efficacy when compared to those that relapsed. Similar observations regarding self-efficacy are also made among users of illicit drugs and abusers of prescription drugs.
Under most circumstances, self-regulation is induced through human-made mechanisms such as the construction and management of Oxford House models, many of which are found in the United States of America (USA). Such environments are created with the aim of encouraging a zero tolerance to substance abuse conditions for willing members. From a research documented in Chavarria et al. (2012), it is evident that spending about six months under such conditions can cultivate a culture of self-regulation and self-efficacy that help a substance abuser to refrain from engaging in such detrimental behaviors. In general, an increase in self-regulation is directly proportional to refraining from using abused drugs and substances.
Persistence of Substance Use Disorders
For some people, abused substances become their preoccupations in a way that they ignore essential factors meant to enrich their social wellness. For instance, the individual may lack incentive sensitization alongside a decline in the executive control functioning. Since the behavior is automatically induced by certain drug-related cues, it becomes quite difficult to control the behavior. The exact mechanism involved in over-reliance on drugs is, however, undocumented. In fact, it is not clear whether it is a problem in itself for an individual not to control the abuse of substances or just the lack of resources. Furthermore, it is not clear whether the substance abuser just lacks the motivation to stop abusing substances or they just decide not to.
The pursuance of goals is an essential aspect of controlling an individual’s drug abuse although such an approach requires the use of resources. Self-regulatory resources may also get exhausted and render an individual incapacitated to control substance abuse on their own. As such, the allocation of resources regarding goal saliency and according to the importance of the specified approach is essential in an environment characterized by minimum resources. There is a need for an individual to shield the most important goals of life from being interfered with by other less important goals, most of which may increase the tendency to abuse substances. An analogy that may be used to explain substance abuse is a situation whereby eating is more important than dieting due to extreme hunger (Chavarria et al., 2012). Under such conditions, it is likely that an individual would consider anything for eating to satisfy their hunger without considering the calorie levels contained in the types of foods eaten. Prioritizing needs puts an individual in a position of considering what is more important between engaging in substance abuse and consolidating resources in more useful behaviors. The psychological salience of the proximal objective which in this case is locating and using the drug compared with the distal and pallid goal which is more important makes drug abuse irresistible.
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The tendency to abuse drugs requires a significant investment of resources and when the resources become scarce, the detrimental behavior is influenced by environmental factors as well as internal cues. When adequate processing resources are available, however, the individual can perform an assessment and ascertain the value of using the drug as opposed to engaging in alternative behaviors and eventually avoid pursuing the immediate goal irrespective of the initial impulse (Chavarria et al., 2012).
Since the resources necessary for abstinence are constantly depleted and replenished, it is expected that the exact resource requirements to achieve the goal always fluctuate. It is because of these fluctuations in the financial implications among users that the frequency of drug and substance abuse also fluctuates. For instance, an individual may refrain from abusing substances as long as the self-regulatory resources are available irrespective of the frequency of exposure to environmental and internal cues. On the contrary, the ability to maintain abstinence is constantly weakened by a depletion of the self-regulatory resources following increased fatigue and stress which are some of the regulatory factors (Bakhshani & Hossienbor, 2013). During the periods of weakening, the abuse of drugs and other substances is triggered by either drug-related cues whose effect is lapses or relapses.
Self-regulation and Bipolar Disorder
In the context of substance use disorders and the youth suffering from bipolar disorders, self-regulatory mechanisms become inevitable. A study of the deficits that occur in emotional self-regulation can comprehensively identify psychopathological disorders associated with substance use and misuse (Wilens et al., 2013). Most of these abusive effects of substances in this regard occur as a result of affect, emotional liabilities, reactivity, and gross irritability and lack of self-regulation. For children, psychopathology associated with substance abuse is measured using the Child Behavior Checklist. The deficits of emotional self-regulation such as mood swings and anxiety disorders are majorly associated with suicidal thoughts and extreme cases of psychiatric hospitalization. Even though these deficits are not specifically linked to mood disorders, they are also commonly diagnosed in pediatrics in the form of bipolar disorders (Bakhshani & Hossienbor, 2013). The comorbidities of bipolar disorder common among the children and pediatrics include attention deficit and hyperactivity disorder and the conduct and oppositional defiant disorders. Although these deficits are rarely associated with adults, when they occur the individual presents with a poor ability social adjustments, high rates of road accidents, a poor quality of life and increased rates of criminal engagements (Chavarria et al., 2012).
Deficit emotional self-regulation has also been found to play a significant role substance use disorders as well as smoking with a specific ability to enhance smoking motivation and increased barriers to stopping the behavior (Wilens et al., 2013). People with such defects also face a bigger risk of abusing marijuana among other opioids among people including those under remission. Under such circumstances, researchers may wonder whether deficit emotional self-regulation is a stable trait of persons at a higher risk of suffering from substance use disorders. In fact, Bakhshani and Hossienbor (2013) were able to prove that the described deficits offered no prediction for specific psychiatric disorders but rather predisposed the children studies to suicidal feelings, substance use disorders and poor overall function. Even among youths with severe affective diseases, it is difficult to correctly determine the relationship between the deficits of emotional self-regulation and substance use disorders (Köpetz et al., 2013).
Nonetheless, it is has been found that the deficits are associated with significantly high affective reactivity which is in a way linked to bipolar disorder implying a possible exposure to an increased potential for the onset of substance use disorders. Identifying youth or persons at a high risk of suffering from the substance use disorders is clinically important in the prevention of such conditions especially now that there are existing pharmacological and psychosocial interventions for the associated deficits (Wilens et al., 2013). The cause of these substance use disorders may also be specifically identified scientifically through the use of techniques such as neurocircuitry majorly linked to the deficits of emotional self-regulation. In summary, deficits in emotional self-regulation are linked to increased rates of smoking among the youth and predispose them to the probability of suffering from substance use disorders. Of importance in understanding these relations are efforts made to understand the temporal relationship, the etiology, neurocircuitry of the brain the ability to predict the deficits and substance use disorders.
Self-regulation and Drug Dependence
There are observable differences between dependent and independent individuals regarding how self-regulation in substance use and associated disorders occur. In fact, self-regulation among people who use drugs and other abused substances is significantly low when compared to the scales of those that do not abuse these substances. As such, it is evident that the insufficiency in controllability and the regulation of affect is linked to the proneness to using the associated drugs (Wilens et al., 2013). The people with established low self-regulation abilities are at a higher risk of suffering from substance abuse disorders. In other words, vulnerability to drug and substance abuse increases with dependence on the drugs and abused substances. High-risk behaviors such as drug abuse can be minimized by practising self-efficiency, exhibiting emotional independence and exhibiting skills for active regulation (Bakhshani & Hossienbor, 2013). Dependent people tend to exhibit lower self-efficiency when compared to independent individuals implying that they are at a higher risk of suffering from psychological disorders. In their study, Bakhshani and Hossienbor (2013) documented the role of an individual’s belief in their ability to decrease negative emotions, a factor which acts as a major mechanism through which self-regulation is achieved in the prevention of substance abuse. Such strong beliefs are different in different people illustrating that the ability of different people to resist the urge to abuse drugs would also be different (Wilens et al., 2013). The beliefs are also subjected to various aspects such as the goals set by an individual, decision-making capacity and persistence in dealing with challenges.
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In addition to reducing the possibility of suffering from substance use disorders, self-regulation and self-control belief among individuals also reduce the complexities associated with the treatment of such conditions. Furthermore, these beliefs have been found to boost the body’s immune system by modulating stress and via the autonomy and impulse control capacity of the individual. Bakhshani and Hossienbor (2013) reported the effects of low self-regulatory and self-control beliefs as increased alcohol consumption, uncontrollable smoking behaviors, substance misuse and other more life-threatening health behaviors.
Four sources of evidence were found relevant and applicable to address the topic of self-regulation and substance use disorders. An analytical exploration of these four literature sources proved the importance of personal regulatory mechanisms in an attempt to avoid abusing substances that may eventually result in associated conditions. From the study findings, self-regulation is more common among drug independent individuals when compared to the rate of self-regulation and control among drug-dependent persons. Furthermore, drug abstinence occurs as a result of self-regulation which is achieved through setting and adhering to goals and objectives in the process of self-efficacy. Personal motivation to achieve a certain goal in life including quitting unhealthy behaviors such as smoking, excessive consumption of alcohol and illicit drugs. The motivation encourages an individual to persist in positive behavioral change irrespective of the availability of resources for substance abuse. Most cases of bipolar disorders among the youth and adolescents were found to be preventable through pursuing the deficits of emotional self-regulation. The biggest limitation of the four sources of evidence used in this study is the use of a small sample size which limited the generalizability of the outcomes.
- Bakhshani, N. M., & Hossienbor, M. (2013). A comparative study of self-regulation in substance dependent and non-dependent individuals. Global Journal of Health Science, 5(6), 40.
- Chavarria, J., Stevens, E. B., Jason, L. A., & Ferrari, J. R. (2012). The effects of self-regulation and self-efficacy on substance use abstinence. Alcoholism Treatment Quarterly, 30(4), 422-432.
- Köpetz, C. E., Lejuez, C. W., Wiers, R. W., & Kruglanski, A. W. (2013). Motivation and self-regulation in addiction: A call for convergence. Perspectives on Psychological Science, 8(1), 3-24.
- Wilens, T. E., Martelon, M., Anderson, J. P., Shelley-Abrahamson, R., & Biederman, J. (2013). Difficulties in emotional regulation and substance use disorders: A controlled family study of bipolar adolescents. Drug and Alcohol Dependence, 132(1), 114-121.