What is Substance Use Disorder?

Substance Use Disorder (SUD) is a mental disorder marked by compulsive use of a substance despite its harmful effects. Individuals with SUD experience an intense preoccupation with the use of alcohol, tobacco, and other psychoactive substances, impairing their ability to function in daily life.

The repeated use of these substances eventually affects brain functioning, making it difficult to stop even when the consequences are highly debilitating. Upon removal of the drug, withdrawal symptoms such as anxiety, irritability, and cravings can develop, making it challenging to quit without help.

Here are 5 Common forms of SUD:

• Alcohol Use Disorder
• Opioid Use Disorder
• Cannabis Use Disorder
• Cocaine Use Disorder
• Tobacco Use Disorder

What are substances?

Substances are a class of chemical compounds capable of modifying normal brain functions and altering mental or physical health. The most commonly misused substances include the following:

Alcohol:

A widely used legal psychotropic substance that may cause dependence and addiction.

Opioids:

Painkillers that are prescribed – herein referred to as oxycodone – and illegal drugs like heroin.

Stimulants:

These include drugs such as cocaine, methamphetamine, and some prescription medications, like most ADHD drugs.

Cannabis:

As much as it might be legal in some states, its use may lead to abuses and dependence.

Tobacco:

A legally available drug that contains nicotine, the most addictive drug.

Hallucinogens:

These are drugs such as LSD and ecstasy, which distort perception and alteration in mood.

What’s the difference between substance use/misuse and substance use disorder?

The difference between substance use/misuse and a substance use disorder is based on the severity, frequency, and impact of the taken substance.

Substance Use

This refers to the use of a substance that may or may not cause harm. For example, having a drink occasionally without negative effects is considered substance use.

Substance Misuse

This involves the use of a substance in a way that is harmful to oneself or others. Misuse is less severe than addiction but strong enough to meet some diagnostic criteria for Substance Use Disorder (SUD). It is associated with significant harm and can lead to SUD over time.

Substance Use Disorder

SUD is a diagnosable medical condition wherein a person meets at least two of the criteria from DSM-5, such as, “Taking the substance in larger amounts or over a longer period than was intended” or “A persistent desire or unsuccessful efforts to cut down or control substance use despite a wish to do so.” SUD is more serious than misuse in that it very often requires professional treatment and intervention.

What is the difference between substance use disorder and addiction?

Substance Use Disorder (SUD) and addiction are commonly used interchangeably, but they do not refer to the same issue. SUD is a medical diagnosis that represents a continuum of problematic substance use, ranging from mild to severe. In contrast, addiction refers to the most extreme form of SUD, where an individual has lost control over their substance use and continues despite harmful consequences.

While SUD is the broad category encompassing addiction, addiction itself does not cover all cases of SUD. In other words, SUD can be viewed as a spectrum of severity, with addiction representing a more advanced and entrenched level of the disorder that can be particularly debilitating.

Who does substance use disorder affect?

Substance Use Disorder (SUD) can affect anyone, regardless of age, gender, or socioeconomic status. SUD can be diagnosed among teenagers, adults, and even elderly individuals.

In most cases, factors such as genetics, environment, mental health, and trauma play a significant role in the diagnosis of SUD. Some individuals may be more predisposed to the disorder, particularly those with family histories related to addiction, which can contribute to higher levels of stress or trauma.

How common is substance use disorder?

Substance Use Disorders (SUD) are a prevalent concern in the United States. According to the Centers for Disease Control and Prevention (CDC), in 2020, an estimated 40.3 million people aged 12 years and older reported having SUD in the past year, accounting for about 14% of that age group.

What is the most common substance use disorder?

The most common form of Substance Use Disorder (SUD) is Alcohol Use Disorder. Alcohol misuse is a significant problem affecting millions of people in America and can lead to various substantial health and social issues. Although alcohol is a legal drug, its overuse can result in serious consequences, ranging from liver disease to impaired judgment and damaged relationships.

Symptoms and Causes

What are the signs and symptoms of substance use disorder?

Substance Use Disorder (SUD) affects behavior, physical health, and social well-being. Recognizing the signs and symptoms early can be crucial in seeking help.

Common Behavioral Symptoms

• Feeling a strong urge or craving to use the substance, often leading to regular use—sometimes daily or multiple times a day.
• Difficulty in cutting down or controlling substance use, even when the person wants to stop.
• Needing more of the substance to feel its effects over time.
• Failure to fulfill important responsibilities at work, school, or home due to substance use.
• Engaging in dangerous activities while under the influence, such as operating machinery or driving.

Physical and Psychological Signs

• Poor hygiene
• Red eyes
• Weight loss
• Irritability
• Anxiety
• Aggressive behavior or eagerness to fight
• Nausea or vomiting
• Confusion
• Dizziness
• Tremors
• Irregular heartbeats

Social and Emotional Indicators

• Withdrawing from family, friends, and activities once enjoyed.
• Continuing to use Substances despite continuing problems in personal or work relationships.

How does substance use disorder develop?

Substance use disorder (SUD) is a condition that develops over time based on multiple factors:

Brain Chemistry

Repeated use of drugs or alcohol alters brain chemistry, leading a person to lose the capacity to enjoy almost everything in life except that particular substance. As this process continues, the brain begins to depend on the substance to trigger its reward system, resulting in cravings and, eventually, dependence.

Genetics

Studies have shown that a family history of substance use disorders can increase vulnerability due to inherited characteristics that influence how substances affect the brain.

Mental Health Disorders

Conditions such as anxiety, depression, and trauma can lead individuals to use substances as a coping mechanism, thereby increasing their vulnerability to SUD.

Access and Exposure

Easy access to drugs or alcohol and being in an environment that promotes substance use are significant risk factors.

Adverse Childhood Experiences (ACEs)

Trauma during childhood, such as neglect or abuse, can cause emotional pain, leading individuals to numb their feelings with substances.

Diagnosis and Tests

How is substance use disorder diagnosed?

There is no single test for diagnosing Substance Use Disorder (SUD). Healthcare providers diagnose the condition through a comprehensive assessment that includes medical history, substance use behavior, and psychological evaluation. Common diagnostic signs may include:

• Neglect of personal hygiene
• Red eyes
• Symptoms of depression, anxiety, or sleep disturbance
• Weight loss
• Chronic Fatigue
• Abnormalities in laboratory results
• Changes in heart rate or blood pressure

Medical professionals can assess the severity of substance use using various screening tools and questionnaires. Additionally, drug and alcohol tests can indicate the type and amount of substances present in an individual’s system. Diagnosis may be conducted by a family doctor, psychiatrist, or mental health professional.

Treatment

What is the treatment for substance use disorder?

Treatment for Substance Use Disorder (SUD) is individualized and typically involves a multifaceted approach to ensure long-term recovery:

1. Cognitive and Behavioural Therapies

Cognitive Behavioral Treatment (CBT): CBT helps individuals recognize and alter the thought patterns and behaviors that lead to substance use. It is effective in managing triggers and developing healthier coping strategies.

Dialectical Behavior Therapy (DBT): DBT focuses on mindfulness and acceptance, equipping individuals with skills to regulate extreme emotions, reduce self-destructive behaviors, and enhance relationships.

Contingency Management (CM): CM reinforces abstinence by offering rewards for positive behaviors, such as attending therapy sessions or remaining sober.

2. Detoxification

Detoxification involves discontinuing substance use to rid the body of the substance. This process can be physically and emotionally challenging and is often conducted under medical supervision to manage withdrawal symptoms.

3. Medication

Medications are often used to manage cravings or withdrawal symptoms. FDA-approved medications include methadone and naltrexone for opioid addiction, as well as naltrexone and acamprosate for alcohol dependence.

4. Sober Living

Sober living houses provide a supportive environment with structured spaces tailored to the needs of individuals recovering from SUD. These homes offer daily schedules, peer support, and a substance-free living environment to promote long-term sobriety. 

You can learn more about how sober living can be used to treat substance use disorder and support long-term recovery.

Recovery is a continuous process, and the best outcomes are usually achieved through a combination of therapy, medical interventions, and ongoing community support.

Prevention

How can I prevent substance use disorder?

Preventing Substance Use Disorder (SUD) can be challenging due to its causes, which range from genetic predispositions to environmental circumstances and direct exposure to substance use. While not all cases of SUD can be prevented, certain strategies may help lower the risk:

• Encourage awareness in families, schools, and communities to decrease first-time use.
• Take prescription medications as directed, and never more than the prescribed dose.
• Exercise, hobbies, and mindfulness during times of stress are helpful.
• Contact a mental health professional if stress or emotional problems arise.
• Store drugs safely. Use take-back programs offered for disposal.

Though these steps cannot guarantee complete prevention, they can significantly minimize the risk of developing SUD.

Outlook / Prognosis

What is the outlook for substance use disorder?

The prognosis for Substance Use Disorder (SUD) varies based on several factors:

• Type of Substance and Severity: The specific substance involved and the severity of the disorder can significantly influence the recovery process.
• Genetics: Genetic factors may affect how individuals respond to treatment and their likelihood of relapse.
• Coping Mechanisms: Developing effective coping strategies during times of stress can greatly impact the long-term outlook.
• Commitment to Recovery: Ongoing commitment to treatment and recovery practices is crucial for long-term success.

While SUD is considered a chronic illness, recovery is possible. This highlights the importance of support groups, such as Narcotics Anonymous, and continued therapy in maintaining sobriety. Relapses can occur and should not be viewed as failures but rather as part of the recovery journey.

What are the possible complications of substance use disorder?

Complications associated with Substance Use Disorder (SUD) can be dangerous and even life-threatening. Here are some potential complications:

• Social effects: Broken relationships, isolation, and so forth.
• Mental health: Impacts include an increased risk of depression and anxiety.
• Physical health: Chronic consumption is associated with cancer, liver disease, and heart malfunctions.
• Legal issues: Job loss, legal troubles, and broken relationships.
• Infections: Sharing needles can result in the transmission of HIV or hepatitis virus.
• Overdose: This is the major complication of SUD, and it is usually fatal.

Living With

How can I help a loved one with a substance use disorder?

Supporting a loved one with Substance Use Disorder (SUD) requires empathy, patience, and education about the issue. Here are 6 meaningful ways to provide support:

1. Educate Yourself: Learn about SUD to better understand what your loved one is experiencing and how you can effectively support them.
2. Encourage Honest Conversations: Foster a safe, non-judgmental space for open discussions about their struggles, allowing them to express their feelings without fear of criticism.
3. Assist in Seeking Treatment: Offer to help your loved one find treatment options, such as rehab facilities, therapists, or support groups. Sometimes, a gentle nudge can motivate them to take the first step toward recovery.
4. Provide Emotional Support: Be there for your loved one while avoiding enabling behaviors that may unintentionally support their substance use.
5. Create a Safe Environment: Offer a substance-free space that encourages healthy lifestyle choices and emotional well-being.
6. Set Boundaries: It’s essential to establish boundaries for yourself to ensure your own mental and emotional needs are met while supporting your loved one.