What is substance use disorder?

Substance use disorder (SUD), previously known as drug addiction is a mental health issue. It means that someone has a pattern of using substances that harm their health and quality of life.

These substances change how the brain works over time. They increase dopamine, a brain chemical that creates pleasure, but this feeling fades when the substance wears off. As a result, the brain and body crave that good feeling, even if it is harmful. SUD can severely affect your emotions, relationships, work, and education. In many cases, it can be life-threatening.

SUD can range from mild to severe. No matter how serious it is, this condition can be treated, and help is available when you are ready.

Common types of substance use disorder include:

• Alcohol use disorder
• Cocaine use disorder
• Cannabis use disorder
• Tobacco use disorder
• Methamphetamine use disorder
• Opioid use disorder

Many individuals have more than one at a time, such as alcohol use disorder and tobacco use disorder, an example of a polysubstance use disorder.

Which kind is the most common?

In the United States, the most prevalent substance-use disorder of either type is alcohol-use disorder.

What are the symptoms of drug use disorder?

The symptoms of substance use disorder depend on the type of drug used. There are two main groups of symptoms:

1. Intoxication: These are the immediate effects of the drug. You might feel sleepy, calm, excited, or have strong emotions. The drug can also affect how you think and make decisions, as well as your physical and mental abilities.
2. Withdrawal: These symptoms happen when the effects of the drug wear off and it starts to leave your body. These can be uncomfortable and may include nausea, vomiting, diarrhea, sweating, trouble sleeping, muscle cramps, and mood changes.

What are the signs of substance use disorder?

The American Psychiatric Association lists several signs of substance use disorder:

• Taking more of the substance than intended or using it for longer than prescribed.
• Having a strong urge to use the substance.
• Trying and failing to cut down or control your substance use.
• Spending a lot of time getting the substance, using it, or recovering from it.
• Neglecting work, school, or home duties due to substance use.
• Using the substance despite problems in your relationships.
• Stopping social, work, or leisure activities because of the substance.
• Using the substance even when it is dangerous.
• Continuing to use it even if it harms your physical or mental health.
• Needing more of the substance to feel the same effects.
• Withdrawal symptoms, which abate when more of the drug is taken.
• Medical attention when you experience signs of a substance use disorder.

What causes substance use disorder?

No one knows for sure. However, studies have shown that the chemical changes to your brain's reward system might be responsible for the condition, given your substance's addictive potential.

How does a substance use disorder develop?

Many factors may be implicated in the development of an SUD. These may include the following:

• Social pressure.
• Substance effect Curiosity.
• Performance enhancement is used to enhance performance at work or school.
• Emotional escape (relieving stress, anxiety, fear, or depression).

Development of a substance use disorder follows this pathway:

• Experimental use (or prescription use): Attempting to use a substance just once or using a medication as it is prescribed.
• Occasional use: You take a substance socially, or you use prescriptions that are not as prescribed.
• Heavy use: You take a substance daily, with just a few days off the substance in a week.
• Substance use disorder: You take the substance every day or even several times a day. There are rarely days when you don’t use it. This condition can look very different for each person and can vary in severity.

How is substance use disorder diagnosed?

There is no such test available for diagnosing a substance use disorder. Instead, doctors rely on an in-depth analysis of your medical history and behaviors regarding the use of substances. They can even order tests to determine the amount and types of substances present in your body at a particular time. They also evaluate reports from prescription drug monitoring programs database of distributed controlled substances.

A provider will also inquire about your mental health history, as it is common to have an SUD and a mental health condition.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that to be diagnosed with substance use disorder, a person must have at least two signs of symptoms over the past 12 months.

Substance use disorder can vary in severity:

• Two to three signs show a mild substance use disorder.
• Four to five signs show a moderate substance use disorder.
• Six or more signs show a severe substance use disorder.

Learn how to prevent relapse of substance use disorder.

How is substance use disorder treated?

Withdrawal management is the first treatment step for substance use disorders. This is where you stop consuming the substance, which in turn leaves your system. A healthcare provider may offer medications to reduce withdrawal symptoms if they are severe because these can be physically and psychologically quite ugly.

The course of treatment for a disorder can continue with therapy after detox and possibly medication.

SUD treatment is very individualized. You may need different types of treatment at different times in your recovery. There are a number of possible treatment settings, including inpatient and outpatient settings, as well as short-term care and long-term therapeutic communities.

SUD therapy

Many types of therapies are helpful in the treatment of SUD as well as co-occurring mental disorders. Some examples of effective therapies for adults with SUDs include:

• Assertive community treatment (ACT): ACT provides mental health services in your community instead of in a hospital or residential setting. Your treatment plan is personalized and focuses on your strengths, needs, and future goals.
• Cognitive behavioral therapy (CBT): CBT helps you spot harmful thoughts and behaviors. You will set goals to find healthier ways to cope.
• Contingency management: This therapy encourages you to set personal goals. When you reach a goal, you get a reward.
• Dialectical behavior therapy (DBT): DBT is a talk therapy like CBT. It helps you manage strong emotions and understand how your thoughts affect your actions.
• Family therapy: Family therapy helps improve relationships and behaviors within your family or group.
• Motivational enhancement therapy: This therapy motivates you to set achievable goals. A mental health professional can help you take steps to reach your goals.
• Therapeutic communities (TCs): TCs are long-term residential treatments that help you develop new, healthier values and behaviors related to substance use and co-occurring mental health issues.

Another important role in SUD treatment is playing through self-help programs, such as Narcotics Anonymous. These programs promote behavioral change through self-help and peer support. Group therapy helps addicted individuals avoid substance use and act impulsively.

Medical professionals may prescribe medications separately or with other therapies.

SUD medications:

Medications can alter your brain chemistry to help manage some SUDs. Medication-assisted treatments approved by the U.S. Food and Drug Administration can help reduce cravings and withdrawal symptoms.

• Opioids are methadone, buprenorphine, and naltrexone.
• For alcohol are Naltrexone, Acamprosate, and Disulfiram.
• For tobacco, A nicotine patch, nasal spray, gum, or lozenge; bupropion or varenicline.

What risk factors bring about a substance use disorder?

This disorder of substance applies to people of all ages, races, sexes, genders, and income levels.

You become more at risk if:

• You possess an underlying condition of a mental disorder.
• Have a family member with a SUD.
• Experienced difficult situations in childhood.
• Have a genetic risk that makes SUDs more likely.
• Have easy access to drugs or alcohol.
• A serious problem related to substance use disorder is overdose. An overdose occurs when someone takes too much of a substance, and it is a medical emergency.

Other substances cause other parts of your body to be affected. For instance, if you overdose on opioids, it affects the part of your brain that controls your breathing. If not treated promptly, your breathing becomes slower and eventually stops, resulting in death.

SUD complications are wide-ranging and dependent on severity and type. Some common complications may include:

• Cancer.
• Depression
• Infections (hepatitis B, hepatitis C, and HIV).
• Memory loss.
• Academic or career setbacks.
• Interpersonal relationship issues.
• Risk-taking, illegal or unsafe behaviors.

Can we prevent substance use disorder?

You can't stop every case of substance use disorder because many factors can affect how it develops, and some of these are beyond your control. You can take steps to reduce your risk.

Education in schools, communities, and families may lower your chances of using an illicit substance or abusing a prescription drug for the first time. Other forms of prevention include:

Adhering to directions for prescription drugs. Don't take more than directed. For example, opioid use disorder can begin after just five days of misuse.

Never share your prescription drugs with anyone. Keep them stored safely out of reach of children.

If you have unused prescription medications, like opioids, at the end of your treatment, please find a local drug take-back program or a pharmacy mail-back program to dispose of them safely.

Stress and change can lead to substance use. For adults, events like divorce, job loss, or the death of a loved one can increase this risk. For teenagers, moving, family divorce, or changing schools can be challenging and may also increase the risk.

During tough times, focus on healthy coping methods. Try exercising, meditating, or learning a new hobby. If you find it hard to manage stress, consider talking to a mental health professional.

What is the prognosis for SUD?

The prognosis (outlook) for this condition varies, depending on several factors, including:

• The type and severity of the SUD.
• The individual's level of commitment to treatment and recovery.
• Genetics
• How you cope during stressful situations.

Substance use disorder is a lifelong disease. But recovery is possible. Different tools work for different people. Many find success through support groups such as Narcotics Anonymous and on-going therapy.

Relapses are common with SUD. A relapse is returning to a substance after stopping it for a period of time. You'll need to detox again and restart your treatment cycle from the beginning. This can be a frustrating process. Relapses can happen years after you last took a substance. It helps to have a strong support system to rely on if you may be at risk of relapse.

Your provider should review your treatment plan periodically. Your goals or lifestyle may change, and this can mean trying a different type of therapy or a new medication. A provider can help you make adjustments throughout your life as needed.

When should I see a healthcare provider?

If you are using a substance regularly and feel it is becoming an addiction that you cannot stop by yourself, see a healthcare provider. A provider can also provide a physician with advice on how to talk to your children about SUD and how to get them help if you believe they're at risk.

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