Uncontrolled substance use despite negative consequences is a complex condition known as substance use disorder (SUD). People with SUD have a strong concentration on using a particular substance or substances, such as alcohol, cigarettes, or illegal narcotics, to the point where it interferes with their capacity to function in daily life. Even when they are aware that the substance is causing or will cause issues, people continue to use it. The most serious SUDs are occasionally referred to as addictions.
A substance use problem can lead to impaired thinking and actions in a person. People who experience strong cravings, personality changes, odd movement patterns, and other behaviors do so as a result of changes in the structure and function of their brains. Studies on brain imaging reveal alterations in the brain's regions.
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.
Stages of substance use disorder
There are several stages of drug use that may lead to addiction. Young people seem to move more quickly through the stages than do adults. Stages are:
Experimental use – Typically involves peers, done for recreational use; the user may enjoy defying parents or other authority figures.
Regular use – The user misses more and more school or work; worries about losing drug source; uses drugs to “fix” negative feelings; begins to stay away from friends and family; may change friends to not care about school and work; has obvious behavior changes; thinking about drug use is more important than all other interests, including relationships; the user becomes secretive; may begin dealing drugs to help support habit; use of other, harder drugs may increase; legal problems may increase.
Addiction – Cannot face daily life without drugs; denies problem; physical condition gets worse; loss of “control” over use; may become suicidal; financial and legal problems get worse; may have broken ties with family members or friends.
Causes of substance use disorder
The exact cause of substance use disorder is not known. A person’s genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors.
Many who develop a substance use problem have depression, attention deficit disorder, post-traumatic stress disorder, or another mental problem. A stressful or chaotic lifestyle and low self-esteem are also common.
Children who grow up seeing their parents using drugs may have a high risk of developing substance use problem later in life for both environmental and genetic reasons.
Commonly used substances include:
Opiates and other narcotics are powerful painkillers that can cause drowsiness, and sometimes intense feelings of well-being, elation, happiness, excitement, and joy. These include heroin, opium, codeine, and narcotic pain medicines that may be prescribed by a doctor or bought illegally.
Stimulants are drugs that stimulate the brain and nervous system. They include cocaine and amphetamines, such as drugs used to treat ADHD (methylphenidate, or Ritalin). A person can start needing higher amounts of these drugs over time to feel the same effect.
Depressants cause drowsiness and reduce anxiety. They include alcohol, barbiturates, benzodiazepines (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. Using these substances can lead to addiction.
LSD, mescaline, psilocybin (“mushrooms”), and phencyclidine (PCP, or “angel dust”) can cause a person to see things that are not there (hallucinations) and can lead to psychological addiction.
Marijuana (cannabis, or hashish).
Risk Factors of Substance substance use disorder?
Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years. Certain risk factors may increase someone’s likelihood of abusing substances.
Family history factors that influence a child’s early development have been shown to be related to an increased risk of drug abuse, such as
Chaotic home environment,
Ineffective parenting,
Lack of nurturing and parental attachment,
Parental drug use or addiction.
Other risk factors for substance abuse are related to the substance abuse sufferer him- or herself, like
Male gender,
Childhood attention deficit hyperactivity disorder (ADHD),
History of anxiety or other mood disorders,
Conduct disorder or antisocial personality disorder.
Factors related to a child’s socialization outside the family may also increase the risk of drug abuse, including
Inappropriately aggressive or shy behavior in the classroom,
Poor social coping skills,
Poor school performance,
Association with a deviant peer group or isolating oneself from peers altogether,
Perception of approval of drug-use behavior.
Symptoms of substance use disorder
Symptoms of substance use disorders may include:
Behavioral changes, such as:
Drop in attendance and performance at work or school
Frequently getting into trouble (fights, accidents, illegal activities)
Using substances in physically hazardous situations such as while driving or operating a machine
Engaging in secretive or suspicious behaviors
Changes in appetite or sleep patterns
Unexplained change in personality or attitude
Sudden mood swings, irritability, or angry outbursts
Periods of unusual hyperactivity, agitation, or giddiness
Lacking of motivation
Appearing fearful, anxious, or paranoid, with no reason
Physical changes, such as:
Bloodshot eyes and abnormally sized pupils
Sudden weight loss or weight gain
Deterioration of physical appearance
Unusual smells on breath, body, or clothing
Tremors, slurred speech, or impaired coordination
Social changes, such as:
Sudden change in friends, favorite hangouts, and hobbies
Legal problems related to substance use
Unexplained need for money or financial problems
Using substances even though it causes problems in relationships
Complications of substance use disorder
Drug use can have significant and damaging short-term and long-term effects. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. Here are some examples.
Methamphetamine, opiates and cocaine are highly addictive and cause multiple short-term and long-term health consequences, including psychotic behavior, seizures or death due to overdose.
GHB and flunitrazepam may cause sedation, confusion and memory loss. These so-called “date rape drugs” are known to impair the ability to resist unwanted contact and recollection of the event. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol.
Ecstasy or molly (MDMA) can cause dehydration, electrolyte imbalance and complications that can include seizures. Long-term, MDMA can damage the brain.
One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.
Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity.
Diagnosis of substance use disorder
A doctor’s evaluation
Sometimes a person’s self-report
Sometimes a substance use disorder is diagnosed when people go to a health care practitioner because they want help stopping use of a drug. Other people try to hide their drug use, and doctors may suspect problems with drug use only when they notice changes in a person’s mood or behavior. Sometimes doctors discover signs of substance use during a physical examination. For example, they may discover track marks caused by repeatedly injecting drugs intravenously. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
Health care practitioners also use other methods (such as questionnaires) to identify a substance use disorder. Urine and sometimes blood tests may be done to check for the presence of drugs.
Criteria for diagnosis
The criteria for diagnosing a substance use disorder fall into four categories:
The person cannot control use of the substance.
The person’s ability to meet social obligations is compromised by use of the substance.
The person uses the substance in physically dangerous situations.
The person shows physical signs of use and/or dependence.
Inability to control use
The person takes the substance in larger amounts or for a longer time than originally planned.
The person desires to stop or cut down use of the substance.
The person spends a lot of time obtaining, using, or recovering from the effects of the substance.
The person craves the substance.
Social impairment
The person fails to fulfill major role obligations at work, school, or home.
The person continues to use the substance even though it causes (or worsens) social or interpersonal problems.
The person gives up or reduces important social, occupational, or recreational activity because of substance use.
Risky use
The person uses the substance in physically hazardous situations (eg, when driving or in dangerous social circumstances).
The person continues to use the substance despite knowing it is worsening a medical or psychologic problem.
Physical symptoms
Tolerance: The person needs to use increasingly more of the substance to feel the desired effect.
Withdrawal: Unpleasant physical effects occur when the substance is stopped or when it is counteracted by another substance.
People who have 2 or more of these criteria within a 12-month period are considered to have a substance use disorder. The severity of the substance use disorder is determined by the number of criteria met:
Mild: 2 to 3 criteria
Moderate: 4 to 5 criteria
Severe: ≥ 6 criteria
Treatment for substance use disorder
Although there’s no cure for drug addiction, treatment options explained below can help you overcome an addiction and stay drug-free. Your treatment depends on the drug used and any related medical or mental health disorders you may have. Long-term follow-up is important to prevent relapse.
Chemical dependence treatment programs
Treatment programs usually offer:
Individual, group or family therapy sessions
A focus on understanding the nature of addiction, becoming drug-free and preventing relapse
Levels of care and settings that vary depending on your needs, such as outpatient, residential and inpatient programs
Detoxification
The goal of detoxification, also called “detox” or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center.
Withdrawal from different categories of drugs — such as depressants, stimulants or opioids — produces different side effects and requires different approaches. Detox may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, buprenorphine, or a combination of buprenorphine and naloxone.
Opioid overdose
In an opioid overdose, naloxone, an opioid antagonist, can be given by emergency responders, or in some states, by anyone who witnesses an overdose. Naloxone temporarily reverses the effects of opioid drugs.
While naloxone has been on the market for years, delivery systems such as Narcan (a naloxone nasal spray) and Evzio (a naloxone injection device) are now available, though they can be very expensive.
Evzio is a small injection device that provides voice instructions to guide the user and automatically insert the needle into the thigh to deliver the naloxone injection. Whatever the method of delivery, seek immediate medical care after using naloxone.
Behavior therapy
As part of a drug treatment program, behavior therapy — a form of psychotherapy — can be done by a psychologist or psychiatrist, or you may receive counseling from a licensed alcohol and drug counselor. Therapy and counseling may be done with an individual, a family or a group. The therapist or counselor can:
Help you develop ways to cope with your drug cravings
Suggest strategies to avoid drugs and prevent relapse
Offer suggestions on how to deal with a relapse if it occurs
Talk about issues regarding your job, legal problems, and relationships with family and friends
Include family members to help them develop better communication skills and be supportive
Address other mental health conditions
Self-help groups
Many, though not all, self-help support groups use the 12-step model first developed by Alcoholics Anonymous. Self-help support groups, such as Narcotics Anonymous, help people who are addicted to drugs.
The self-help support group message is that addiction is a chronic disorder with a danger of relapse. Self-help support groups can decrease the sense of shame and isolation that can lead to relapse.
Your therapist or licensed counselor can help you locate a self-help support group. You may also find support groups in your community or on the internet.
Inpatient Rehab
During inpatient rehab, patients live in a substance-free facility, receiving round-the-clock medical care and therapeutic support. Structured treatment programs designed to help with all facets of addiction are offered. Inpatient rehab is the best option for people battling chronic addiction, as well as those suffering from a co-occurring mental or behavioral disorder.
Outpatient Rehab
During outpatient rehab, patients receive many of the same treatments and therapies as inpatient rehab programs while living at home. Patients can continue to work and care for their families while still attending treatment sessions each week.
Since outpatient rehab programs don’t separate patients from their home environment, the risk of relapse is greater. Outpatient rehab is best suited for people with mild addictions who have a firm commitment to recovery.
Substance use disorder prevention models
Prevention programs target different populations at risk for substance use disorder (SUD). Prevention programs focus on helping individuals to develop knowledge and skills, or changing environmental and community factors that affect a large population. Providers, schools, public health departments, and other organizations in the community may collaborate to implement these programs. Programs can be implemented in settings such as schools, workplaces, and communities.
Three sorts of prevention activities are recognized:
In order to prevent substance use problems, universal preventative interventions reach the entire community.
Targeting subsets of the population who are at risk for substance use disorders is the goal of selective preventative treatments.
The suggested preventive interventions are directed at those who are showing early indications of a substance use disorder but have not yet received a diagnosis.
Given that early substance abuse increases the risk of developing an SUD, many SUD prevention and early intervention initiatives target children and adolescents. Preventing Drug Employ Among Children and Adolescents, a brief created by the National Institute on Drug Abuse, outlines strategies that communities can use to stop youth drug use. These prevention initiatives concentrate on enhancing preventative reducing risk factors.
Some SUD prevention strategies are still being tested. For example, in March 2016, the Centers for Disease Control and Prevention (CDC) published the CDC Guideline for Prescribing Opioids for Chronic Pain, which summarizes the risks and benefits associated with prescription opioids and provides an evidence-based guide for providers and patients in shared decision-making about the use of prescription opioids. The guidelines aim to stop over-prescribing of opioids to prevent opioid use disorder. Future research will indicate the effectiveness of prescribing guidelines on rates of SUD.
There is no “best mix” of universal, selective, and indicated programs for a given population. While many SUD prevention programs have shown evidence of success, not all programs have been tested in rural populations. In addition, few prevention programs have been tested for use in workplaces or among older adults.