Evaluating an Individual’s Treatment Needs
Addiction among Musicians, Signers, Writers, Painters
The National Survey on Drug Use and Health (NSDUH) consists of self-reported data regarding substance use and abuse compiled and published by the Substance Abuse and Mental Health Services Administration (SAMHSA). The NSDUH separates the notions of illicit drugs (including cannabis products, cocaine products, prescription drugs that are used for nonmedicinal purposes, inhalants, hallucinogens, and heroin) from alcohol use. According to the latest available information for 2008 through 2012:
- Of the occupations listed, the arts and entertainment industry compiled the third highest overall rates of past-year substance use diagnoses (12.9 percent). This figure is consistent with the findings for the previous reporting period (2003-2007), which had an overall rate of 13 percent.
- The percentage of individuals in the arts and entertainment industry reporting past-month heavy use of alcohol was 11.5 percent. This ranked third on the list of occupations but was generally consistent with findings from the previous period (12.9 percent).
- The percentage of individuals in the arts and entertainment industry reporting past-month illicit drug use was 13.7 percent. This figure was second on the list of occupations but generally consistent with the percentage in this occupation reporting the same behavior from the previous period (12.9 percent).
- The rate of diagnosed substance use disorders observed in the arts and entertainment industry was higher than the average rate over all industries; the average rate over all industries was 9.5 percent.
- The rate of past-month heavy alcohol use reported by individuals in the arts and entertainment industry was higher than the average rate of past-month alcohol usage over all industries (8.7 percent).
- The rate of self-reported illicit drug use in the arts and entertainment industry was higher than the overall average rate reported over all industries (8.6 percent).
- SAMHSA reports that the past-year rate of individuals diagnosed with substance use disorders in the United States is 8.4 percent, a figure that is relatively consistent with the data stratified by occupation.
Based on the data, it is obvious that individuals in the arts and entertainment industry have higher than expected rates of substance use disorders, self-reported previous heavy alcohol use, and self-reported use of illicit drugs. However, it is important not to make the wrong conclusions concerning this data.
Mistaken Notions of Causation
Even though the above data does indicate that individuals who are employed in the arts and entertainment industry have higher rates of substance use disorders than individuals in many other industries, and than is reported in the general population, it would be a mistaken notion to conclude that being in the arts and entertainment industry or being an artist, actor, musician, etc., causes one to develop issues with substance abuse.
Most readers are probably familiar with the phrase “correlation does not infer causation.” Unfortunately, many people do not actually understand what this phrase means. When the term correlation is used in this context, it is meant to represent a methodological approach to collecting and analyzing data and not a specific type of statistical calculation (e.g., the correlation coefficient).
In order to understand how research is conducted, we can basically divide up research methodologies into two major categories:
- Correlational-type research: Correlational research in this context would be any form of research that does not employ the methods of a true experiment. There are numerous types of correlational designs, including natural observation, survey methods, case studies, etc. These methods of research do not control for the numerous outside influences on the variables in the study that can influence the results or findings of the study. As a result, correlational research cannot make inferences regarding cause and effect.
- Experimental-type research: Experiments use a methodological control where the participants of the experiment are randomly assigned to the different conditions in the study. This mechanism is often referred to as random assignment to treatment conditions, which should not be confused with a getting a random sample. A random sample refers to how one gets research participants from the available research pool and not to controlling for extraneous variables. Random assignment refers to how the participants already chosen for the study are placed in the different conditions in the study. In the NSDUH data, the individuals being studied are not randomly assigned to different occupations but come to the study already employed in their specific job. When the research participants can be randomly assigned to the different conditions of the experiment, all of the extraneous variables that can affect the result are believed to be controlled for. Research studies that utilize random assignment to treatment conditions (true experiments) are able to make causal inferences regarding the results if all their other data collection methods, research protocols, techniques, etc., are performed within the recognized and accepted standards of research methodology.
The above distinction is admittedly overly simplified as there are several different types of research methodologies that attempt to combine both of these basic categories as well as additional controls that true experiments can use to further ensure that outside influences will not affect their variables of interest. However, the basic point is that the data produced by SAMHSA is correlational data and therefore cannot be used to infer that being in a particular occupation causes someone to become diagnosed with a substance use disorder, drink alcohol more frequently or in higher amounts, or use illicit drugs. Because it is virtually impossible to randomly assign individuals to specific careers for a research study, it is virtually impossible to develop an experimental research studies that could demonstrate that being in a specific occupation causes someone to develop a substance use disorder. Instead, there are specific risk factors that increase the probability that an individual will develop a substance use disorder that may be associated with individuals who are employed as musicians, actors, artists, etc.
The Development of a Substance Use Disorder
There is no condition or factor that will inevitably result in an individual developing any type of substance use disorder or addiction. For instance, there is no identified genetic component, environmental experience, or combination of heredity and experience that can definitively be shown to cause anyone to develop a substance use disorder. Instead, the development of all mental health disorders, including substance use disorders, is the result of a combination of factors that increase the probability or risk that an individual might develop a disorder. Certain factors have been demonstrated through empirical research methods to increase the risk that an individual will develop a substance use disorder or other form of mental illness. A risk factor is a specific condition or experience that increases the probability that one may be diagnosed with an illness, disease, or disorder.
Instead of simply making the attribution that being in the arts and entertainment industry is related to more issues with substance use disorders, it may be more conducive to understand how individuals in the arts and entertainment industry might be more vulnerable to these particular types of risk factors. According to the American Psychiatric Association (APA) and the American Society of Addiction Medicine (ASAM), general risk factors associated with substance abuse include:
- Family history: Having a relative who has a previous diagnosis of a substance use disorder is one of the most salient risk factors for the development of a substance use disorder in any individual. The risk increases with the proximity of the relationship to the individual, such that having a first-degree relative with a diagnosis of a substance use disorder represents a higher potential risk compared to having a more distant relative with such a history.Family histories are often used as evidence of significant genetic components that lead to increased risks; however, this may not always be the case. For instance, children learn numerous behaviors from their parents in both overt and covert ways. Thus, family history may represent a complex interaction of both genetic and environmental experiences. Research has indicated that heredity (genetics) is a significant risk factor for the development of a substance use disorder; however, there are no specific genes or other genetic factors that can be demonstrated to have a causal relationship in the development of substance abuse. Thus, it is unknown how an individual’s family history and higher rates of addiction in the arts and entertainment industry are related other than the general notion that having a family member with a diagnosis of a substance use disorder increases the risk for one to be diagnosed with a substance use disorder.
- Gender: Males are diagnosed with substance use disorders at higher rates than females; however, the development of a substance use disorder occurs more quickly in females than in males. Thus, males in the arts entertainment industry would be at higher risk to develop substance use disorders than females; however, as a group, females in the arts and entertainment industry who develop substance use disorders would be at a higher risk to display quicker progressions from social use to abuse to formal addiction than males.
- Peer pressure: A very salient factor in the development of a substance use disorder is being in an environment where substance use and abuse is relatively common. Individuals who work in environments where drugs and alcohol are relatively easy to get and commonly used are at an increased risk to develop addictions. In addition, being in an environment where substance use is acceptable or common is associated with the belief that the use of drugs and/or alcohol is an appropriate means to deal with stress or relax. When an individual accepts the notion that the use of drugs or alcohol is an appropriate coping mechanism, they increase their risk to develop a substance use disorder. Having close associates, friends, etc., who encourage the use of drugs or alcohol can increase the risk even more.
- The type of substance: The types of substances that individuals use can also increase the risk for the development of a substance use disorder. In circles where highly addictive drugs are commonly used and individuals are exposed to their use, it would be expected that there would be higher rates of substance use disorders. Nearly anyone who works in an environment where an addictive drug like cocaine is used with some regularity might be tempted to try the drug in an effort to see why others use it. Every substance use disorder diagnosis can, of course, be traced back to some initial use.
- Stress: Having to deal with high levels of perceived stress has been identified as a very salient risk factor for the development of a substance use disorder. The key term here is perceived. There is actually no way to objectively measure an individual’s level of stress, and some individuals perceive events or experiences as highly stressful, whereas others perceive the same events as having little or no stress. Stress is also associated with the experience of negative emotions. Becoming extremely anxious, feeling lonely or depressed, or having to deal with situations that produce the perception of extreme uncertainty or unpredictability can be extremely stressful. Individuals in career paths where there is pressure to succeed and where reputations are important often suffer from these significant emotions. This can induce the need to quickly relieve feelings of stress or to escape. Such behaviors can lead to repeated uses of drugs or alcohol, which can lead to the development of a substance use disorder.
- Boredom or routine: Feeling unfulfilled or bored is also associated with substance use and abuse. Individuals in the arts and entertainment industry who are struggling to gain recognition or even to find steady work may suffer from significant stress as well as feelings of inadequacy, lack of fulfillment, and boredom associated with the routine of their chosen career. This could conceivably increase their risk for substance use and abuse.
- The presence of another mental health disorder: Having a psychological disorder increases the risk that one will also be diagnosed with a substance use disorder. Individuals who suffer from depression, personality disorders, obsessive-compulsive issues, etc., often use drugs or alcohol in excess. In addition, there does appear to be a mild relationship between creativity and the development of a psychological disorder. This relationship is a bit controversial and not an overwhelming one; however, there is a weak relationship between certain definitions of “creativity” and psychological functioning that is not well understood. Individuals in the arts and entertainment field who may be prone to issues with fantasy, poor reality testing, mood swings, etc., would obviously be at increased risk to develop a substance use disorder.
Reliable epidemiological data regarding the percentage of actors, musicians, artists, etc., who have issues with substance abuse do not appear to exist. Instead, most of this information is compiled as anecdotal evidence by therapists, individuals in the media, etc. However, one could predict that an individual in any of these occupations who expresses one or more of the above risk factors would have an increased liability to the development of a substance use disorder.
Being in an occupation where there is significant stress, peer pressure, and exposure to alcohol or drugs, or where the use of alcohol or drugs is considered commonplace, would represent high risk conditions for anyone. In addition, any situation that glamorizes the use of alcohol or drugs and does not focus on the practical issues and concerns with the use of substances would be considered a high-risk situation.
Even though the arts and entertainment industry is associated with higher than expected rates of substance use disorders, it would be wrong to think that being in this career causes an individual to develop a substance use disorder. Moreover, two other categories, the food service industry and the construction industry are associated with even higher rates of substance use disorders than the arts and entertainment industry, according to SAMHSA. Instead, it is far more productive to understand how the general risk factors associated with the development of substance abuse and substance use disorders are expressed in a particular situation, such as one’s occupation, and then to understand how these risk factors can increase the risk for substance abuse.
Even though there is a mild relationship between notions of creativity and the development of problems with drugs or alcohol; artists and entertainers are often considered to be more creative than others; and most people can readily recall individuals in the arts and entertainment industry who died of drug overdoses, the notion that being an artist, actor, musician, etc., causes one to abuse alcohol or drugs is unfounded. People often suffer from something known as the availability heuristic where more easily recalled information is used to set standards and make predictions than information that is not more easily recalled. It is far easier to recall that certain celebrities died of drug overdoses than it is to recall construction workers who overdosed or were in treatment for a substance use disorder. This can lead to the mistaken notion that being an actor or artist automatically means that someone has a substance abuse issue. Understanding how general risk factors associated with the development of mental health disorders can be found in all areas of life and how these factors influence the development of substance abuse should be the goal of researchers and treatment providers.
- NIDA: The National Institute on Drug Abuse offers numerous brochures and other information regarding treatment providers and what to look for in addiction and mental health treatment.
- SAMHSA: In addition to an online tool, the Substance Abuse and Mental Health Services Administration provides a 24-hour treatment locator hotline (1-800-662-HELP) for individuals who believe they may need treatment.
- EAPs: Individuals who work in an organizational environment, such as for television studios or production companies, may benefit from Employee Assistance Programs (EAPs) to help them deal with issues regarding substance abuse. Employees can check with a company’s HR department to see if these programs are available.
- AA, NA, and other 12-Step groups: Alcoholics Anonymous (AA) is a program designed to address issues with alcohol abuse, providing members with support and direction in recovery. Other 12-Step groups, such as Narcotics Anonymous, Cocaine Anonymous, etc., can also be accessed by individuals who have issues with these specific substances.