Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day to day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems.
Overview
People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain’s structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavioral control.
Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate effects of the substance wears off, or in other words, after the period of intoxication. Intoxication is the intense pleasure, euphoria, calm, increased perception and sense, and other feelings that are caused by the substance. Intoxication symptoms are different for each substance.
When someone has a substance use disorder, they usually build up a tolerance to the substance, meaning they need larger amounts to feel the effects.
Symptoms
Symptoms of substance use disorder are grouped into four categories:
Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use
Risky use: substance is used in risky settings; continued use despite known problems
Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)
Many people experience substance use disorder along with another psychiatric disorder. Oftentimes another psychiatric disorder precedes substance use disorder, or the use of a substance may trigger or worsen another psychiatric disorder.
Types of This Disorder
Opioid Use Disorder (Fentanyl, Heroin, Prescription Pain Medications)
Marijuana Use Disorder
Nicotine Use Disorder (Cigarettes, Chewing Tobacco, Nicotine Mints)
Stimulant Use Disorder (Cocaine, Methamphetamine, Prescription Grade Amphetamines)
Sedative Use Disorder (Xanax, Klonopin, Other Prescription Sedatives or Anti Anxiety Medications)
Hallucinogen Use Disorder (LSD, Magic Mushrooms, Other Psychedelics)
Alcohol Use Disorder
Causes
Like many mental health disorders, several factors may contribute to the development of drug addiction. The main factors are:
Environment. Environmental factors, including your family’s beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
Genetics. Once you’ve started using a drug, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.
Changes in the brain
Physical addiction appears to occur when repeated use of a drug changes the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate. These changes can remain long after you stop using the drug.
Risk factors
People of any age, sex or economic status can become addicted to a drug. Certain factors can affect the likelihood and speed of developing an addiction:
Family history of addiction. Drug addiction is more common in some families and likely involves genetic predisposition. If you have a blood relative, such as a parent or sibling, with alcohol or drug addiction, you’re at greater risk of developing a drug addiction.
Mental health disorder. If you have a mental health disorder such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, you’re more likely to become addicted to drugs. Using drugs can become a way of coping with painful feelings, such as anxiety, depression and loneliness, and can make these problems even worse.
Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people.
Lack of family involvement. Difficult family situations or lack of a bond with your parents or siblings may increase the risk of addiction, as can a lack of parental supervision.
Early use. Using drugs at an early age can cause changes in the developing brain and increase the likelihood of progressing to drug addiction.
Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or opioid painkillers, may result in faster development of addiction than other drugs. Smoking or injecting drugs can increase the potential for addiction. Taking drugs considered less addicting — so-called “light drugs” — can start you on a pathway of drug use and addiction.
Diagnosis
Diagnosing drug addiction (substance use disorder) requires a thorough evaluation and often includes an assessment by a medical or clinical provider such as an MD, psychiatrist, or licensed therapist. Blood, urine, or other lab tests are used to assess drug use, but they’re not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery.
For diagnosis of a substance use disorder, we use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Treatments
Effective treatments for substance use disorders are available.
The first step is recognition of the problem. The recovery process can be delayed when a person lacks awareness of problematic substance use. Although interventions by concerned friends and family often prompt treatment, self-referrals are always welcome and encouraged.
A medical professional should conduct a formal assessment of symptoms to identify if a substance use disorder is present. All patients can benefit from treatment, regardless of whether the disorder is mild, moderate, or severe. Unfortunately, many people who meet criteria for a substance use disorder and could benefit from treatment don’t receive help.
Because SUDs affect many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s specific situation and any co-occurring medical, psychiatric, and social problems is optimal for leading to sustained recovery.
Medications are used to control drug cravings, relieve symptoms of withdrawal, and to prevent relapses. Psychotherapy can help individuals with SUD better understand their behavior and motivations, develop higher self-esteem, cope with stress, and address other psychiatric problems.
A person’s recovery plan is unique to the person’s specific needs and may include strategies outside of formal treatment. These may include:
Hospitalization for medical withdrawal management (detoxification)
Therapeutic communities (highly controlled, drug-free environments) or sober houses
Outpatient medication management and psychotherapy
Intensive outpatient programs
Residential treatment (“rehab”)
Many people find mutual-aid groups helpful (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery)
Self-help groups that include family members (Al-Anon or Nar-Anon Family Groups)
13 principles of effective drug addiction treatment
These 13 principles of effective drug addiction treatment were developed based on three decades of scientific research. Research shows that treatment can help drug-addicted individuals stop drug use, avoid relapse and successfully recover their lives.
Addiction is a complex, but treatable, disease that affects brain function and behavior.
No single treatment is appropriate for everyone.
Treatment needs to be readily available.
Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
Remaining in treatment for an adequate period of time is critical.
Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment.
Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.
Many drug-addicted individuals also have other mental disorders.
Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
Treatment does not need to be voluntary to be effective.
Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.