The experience of pain or the seeking of euphoria as causes of substance use disorders can be measured physically or can be perceived by the individual without obvious physical indicators. The relative importance ofpain and euphoria in determining the development and maintenance of substance use disorders requires consideration of the contributions of at least five potential sources of behavioral and physical status: genetic predisposition, dysregulation during development, dysregulation from trauma at any time during the life span, the environment, and learning. Any of these can result in or interact to produce the pain or feelings of euphoria that can lead to substance use disorders.
The key commonality in pain-induced substance use disorders is that the organism experiences pain that it does not tolerate. Genetic predisposers of pain include inherited diseases and conditions that interfere with normal pain tolerance. Developmental dysregulations include physical and behavioral arrests and related differences from developmental norms. Trauma from physical injury or from environmental conditions can also result in the experience of pain, as can the learning of a pain-producing response.
Several theories of pain-induced substance use disorders can be summarized as self-medication theories. In essence, these state that individuals misuse substances in order to correct an underlying disorder that presumably produces some form of physical or emotional distress or discomfort. Self-medication theories are useful because they take into account the homeo-static (tendency toward balance) nature of the organism and because they include the potential for significant individual differences in problems with pain.
Relief from pain by itself does not account entirely for drug use that goes beyond improvement in health or reachievement of normal status and certainly cannot account entirely for drug use that becomes physically self-destructive. Thus, the use of substances to achieve positive effects such as euphoria or pleasure are also important to consider as causes of these disorders. Associative conditioning and operant conditioning effects play an important role as well. This type of substance misuse can be distinguished from the relief caused by substance use to decrease pain because the substance use does not stop when such relief is achieved but continues until the person experiences the pleasurable effects.
Euphoria-inducing substance use, or pleasure seeking, is characteristic of virtually all species tested. Some theorists have proposed that pleasure seeking is an innate drive not easily kept in check even by socially acceptable substitutes. Other theorists believe that these types of substance use disorders related to the positively reinforcing aspects of the substances may have developed as a function of biological causes such as evolutionary pressure and selection. For example, organisms that could eat rotten, fermented fruit (composed partly of alcohol) may have survived to reproduce when others did not; people who could tolerate or preferred drinking alcohol instead of contaminated water reproduced when those who drank contaminated water did not live to do so.
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