Substance use disorders (SUDs) are destructive mental health conditions involving the overuse of drugs and alcohol. They can lead to several harmful consequences, both emotionally and physically. Luckily, treatment options are available and many have successful recoveries.

Substance Use Disorder Defined

A substance use disorder (SUD) is a mental health condition marked by your inability to control the use of a specific substance (or substances) even when presented with destructive consequences. Simply put, SUD is the misuse of drugs or alcohol despite it harming your life. ¹

SUD symptoms can range from mild to severe, with severity levels determined by how many of the diagnostic criteria you meet. More specifically: ²

• Mild cases are when you display 2 to 3 symptoms.
• Moderate cases are when you display 4 to 5 symptoms.
• Severe cases are when you display 6 or more symptoms.

SUD Statistics

SUDs are fairly common in the United States. Since the 1990s, there’s been a rise in prescription medication. This has been directly linked to misuse of opioids which led to the opioid epidemic. According to a 2015 systematic review, “About 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.” ³

However, opioids aren’t the only drugs abused. The Substance Abuse and Mental Health Services Administration (SAMHSA) released a national survey. This details people ages 12 and older in the U.S. who’ve dealt with some form of SUD over the past year (2019):

• 4 million people had an SUD.
• 5 million had an alcohol use disorder.
• 6 million had a marijuana use disorder.
• 1 million had a cocaine use disorder.
• 438,000 had a heroin use disorder.
• 1 million had a methamphetamine use disorder.
• 558,000 had a prescription stimulant use disorder.
• 681,000 had a prescription tranquilizer or sedative use disorder.
• 4 million had a prescription pain reliever disorder.
• 6 million had an opioid use disorder.

This survey also collected data concerning the need for substance use treatment:

• In the past year, 1 million people aged 12 and older with an SUD received treatment.
• 9 million individuals aged 12 and older had an SUD in the past year but did not receive treatment at a specialty facility.
• Of these, 1 million felt they didn’t need treatment.
• 236,000 felt they needed treatment and made an effort to get it.
• 577,000 felt they needed treatment but didn’t make an effort to get it.

Is There a Difference Between a Substance Use Disorder and Substance Abuse?

While “substance use disorder” and “substance abuse” are commonly used interchangeably, they are NOT the same thing. Simply put: ²

• A substance use disorder is a diagnosable medical condition, requiring at least 2 of 11 diagnosis criteria.

• Substance abuse, or substance misuse, is a term used regarding people who harm themselves or those around them due to their addiction.

As such, substance abuse cannot be diagnosed. However, substance abuse can lead to an SUD.

Signs and Symptoms of a Substance Use Disorder

Signs of an SUD vary depending on the substance being used. However, the most common physical, behavioral, and social changes include: ⁴

• Appetite or sleep changes
• Asking for money
• Bloodshot eyes or small pupils
• Changes in social circle
• Frequent fights, accidents, or legal trouble
• Lack of motivation
• Mood swings or irritability
• Poor physical appearance
• Personality or attitude changes
• Secretive or suspicious behavior
• Skipping school or missing work
• Smelly breath or clothing
• Sudden weight changes
• Tremors, slurred speech, or impaired coordination
• Unusual hyperactivity or energy

Types of Substance Use Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are ten classes of SUD. These do not include caffeine or tobacco. ⁵

• Alcohol use disorder
• Cannabis use disorder (or, marijuana use disorder)
• Inhalant use disorder
• Opioid use disorder
• Other hallucinogen-use disorder (i.e. psilocybin)
• Phencyclidine use disorder (a type of hallucinogen)
• Sedative, Hypnotic, or Anxiolytic use disorder (i.e. benzodiazepines)
• Stimulant use disorder (i.e. cocaine)

What Causes a Substance Use Disorder?

While most initially develop an SUD through experimentation, research has found there are other causes of drug addiction. These include:

• Biology – The brain becomes neurologically rewired when substances are used. This is especially true for hard drugs, such as cocaine and heroin. ⁶

• Psychological – You may turn to substances when facing severe mental illnesses, such as anxiety and depression. ⁷

• Social – If you face specific types of traumas, such as homelessness and poverty, you’re more vulnerable to substance use. ⁸

• Spiritual – Some people use drugs to reconnect with their minds and bodies. ⁹

Substance Use Risk Factors

There are various different risk factors when it comes to SUDs, including: ¹⁰

• Beginning substance use at a young age
• Easy access to alcohol and drugs (especially at an early age)
• Exposure to extensive advertising of substances (i.e. alcohol)
• Genetics (i.e. family history of substance misuse)
• History of trauma (i.e. abuse, neglect, family violence)
• Lots of family conflict
• Low parental supervision
• Mental health diagnosis

Mental Illness and Substance Abuse

If you struggle with a mental health condition, such as depression, you become more vulnerable to substance abuse. The risk here is you may use a substance to self-medicate from the symptoms of a mental illness. ¹¹

In some cases, a doctor may prescribe you an addictive substance for mental health. For example, benzodiazepines (i.e. Xanax, Valium) are commonly prescribed for anxiety disorders. However, benzodiazepines are extremely addictive. ¹²

Can You Prevent Substance Abuse?

You may assume preventing substance abuse is as simple as not taking drugs or alcohol. However, addiction is a disease, not a choice. Even though you may decide to take a substance, you don’t decide to become dependent on that substance. Furthermore, this decision is determined by a complexity of risk factors.

Still, there are some steps you can take to prevent an SUD. These include: ¹³

• Talk openly and honestly about your drug use (or drug curiosity).
• Listen to what others have to say.
• Develop self-confidence through healthier measures (i.e. exercise).
• Make and maintain strong values.
• Avoid peer pressure and accept yourself for who you are.
• Encourage healthy, creative activities (i.e. writing).
• Know when to help others when they have a drug problem.

Stages of Addiction

Before addiction arises, you must go through three stages. These include:

1.) Experimental Use

Your initial choice to take drugs or alcohol is likely for recreational purposes, usually due to peer pressure. In such cases, this stage tends to begin in adolescence.

However, you may decide to experiment with drugs to self-medicate. These cases can occur at any age.

2.) Regular Use

You think regularly about your drug use and sometimes worry about losing your drug source. You may become aware of your need to fix negative feelings (avoid withdrawal). Within this stage, you may only surround yourself with other users and avoid family or friends. You’ll also develop a tolerance to your drug of choice, leading you to need more of it to get “high.”

3.) Problem/Risky Use

You no longer care about responsibilities (i.e. work or school) or previous interests. This brought about several behavioral changes, including: ¹⁴

• Aggression
• Cognitive/memory problems
• Insomnia
• Mood swings
• Reduced appetite

On top of this, you participate in riskier behaviors to obtain more drugs (i.e. selling drugs or having unsafe sex).

Substance Use Disorder Diagnosis

SUDs are diagnosed by medical professionals if you meet at least 2 of the following diagnostics criteria: ⁵

• Using the substance for extended periods or in greater quantities than planned
• Being unable to reduce or quit substance use
• Devoting significant time to obtaining, using, and recovering from the substance
• Having cravings or strong urges for the substance
• Neglecting responsibilities at home, work, or school due to substance use
• Persisting in substance use despite interpersonal or social issues caused or exacerbated by it
• Abandoning social, recreational, or professional activities because of substance use
• Engaging in substance use in hazardous situations
• Continuing substance use despite physical or mental health problems likely caused by it
• Developing tolerance, requiring more of the substance to achieve the same effects
• Experiencing withdrawal symptoms when ceasing substance use

Substance Use Disorder Treatment

While SUD treatment is difficult, it’s very possible. In fact, SUD is one of the few mental health conditions that can be cured.

We do not recommend attempting SUD treatment without rehab. You want to talk to your healthcare provider about finding the right treatment path because:

1. There are some dangers when it comes to substance withdrawal. ¹⁵
2. If you quit on your own terms, you’re more likely to relapse.

The first step of treatment is finding a reputable facility. This is important because it provides a drug-free environment with a network of people in the same boat as you. Furthermore, since you’re under constant medical supervision, you can expect a safe withdrawal process.

Treatment facilities will offer two types of programs: ¹⁶

• Inpatient Program – When you live at a facility for some time (generally 3 to 6 months) under constant supervision.

• Outpatient Program – when a person stays outside a facility but continues to receive treatment from that facility. Usually, people who need to maintain responsibilities (such as school or work) opt for an outpatient program.

Within both programs, you’ll find treatment works in five steps. These include:

1.) Medical Assessment

You’ll need to complete a medical evaluation involving interviews (concerning your health state and family history) and a drug test. The purpose of this assessment is to find out what your best treatment path is.

2.) Detoxification

Upon quitting a substance, you’re likely to experience withdrawal symptoms. These can be extremely painful and dangerous, occasionally resulting in fatal cases. Withdrawal syndrome occurs because your brain and body have adapted many natural functions to a drug. Therefore, it’s unable to process how to maneuver these functions without drug use. ¹⁷

Withdrawal symptoms vary depending on the drug. However, the most common include:

• Aches and pains
• Anxiety
• Cravings
• Depression
• Diarrhea
• Fatigue (tiredness)
• Hallucinations (seeing things that are not there)
• Inability to sleep
• Irritability
• Mood changes
• Nausea and vomiting
• Shaking
• Sweating

A detox clinic will monitor your withdrawal symptoms and provide you with the tools you need to overcome them. On top of this, they’ll ensure your medical safety if your brain or body is in jeopardy. ¹⁸

3.) Psychological Treatment

Once your body is clean, your brain will still crave substances. To prevent relapse, you’ll be provided with a form of psychotherapy. Through this, you’ll change your thoughts, patterns, and beliefs into healthier lifestyle choices. ¹⁹

The most common of these is cognitive behavioral therapy (CBT). Also known as talk therapy, this is provided in either a one-on-one or group setting. ²⁰

4.) Educational Sessions

While you undergo psychotherapies, it’s important to enroll in education sessions. These will teach you about addiction and how it affects the brain. The purpose of this is to make you aware of the dangers and repercussions created by drug or alcohol dependence. With this knowledge, the idea is to prevent you from relapsing. ²¹

5.) Support Systems

Most treatment facilities will provide several supportive services used during and after treatment. The most common include:

• Al-Anon
• Alateen
• Financial assistance
• Housing assistance (sober living homes)
• Legal assistance
• Medical assistance
• Narcotics Anonymous (NA)
• Vocational training

Though this help is optional, it’s highly recommended you use it. These supports may just be the key to preventing relapse. ²²

References

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