Substance Use Disorders

What Is A Substance Use Disorder?

A substance use disorder (SUD) is a brain disorder that impacts a person’s behaviors and makes it challenging to stop misusing alcohol and drugs. For many, SUDs lead to negative consequences personally, professionally, academically, and socially.

The term “substances” refers to alcohol, prescription drugs, illicit drugs, and any other substance that causes intoxication. They are psychoactive substances that affect perceptions, moods, behaviors, judgments, and emotions.

Substances have different classifications or schedules to reflect their ability to lead to addiction and cause harm if someone misuses them. Some common substances that lead to substance use disorders include:

Alcohol

Alcohol products include:

• Beer
• Wine
• Malt beverages
• Liquor
• Homemade spirits

Alcohol is legal for purchase by anyone over 21. Alcohol leads to a dopamine boost in the brain at first, causing feelings of happiness and confidence. People continue to drink alcohol to continue these feelings. Eventually, drinking alcohol becomes a sedative, preventing a person from feeling happy, confident, or energized.

In America, 29.5 million people report having an alcohol use disorder (AUD), with 59.1% having a mild disorder and 20.7% having a severe disorder.

Prescription Opioids

Prescription opioids refer to drugs like:

• Codeine
• Oxycodone
• Hydrocodone
• Methadone
• Morphine
• Hydromorphone
• Demerol
• Fentanyl

They are highly addictive and dangerous, classifying them as Schedule II or III drugs. Prescription opioids are often misused when people ingest them in a way not prescribed, take more than prescribed, or trade them for illicit drugs. Opioids are the cause of most overdoses in America.

Research shows 5.6 million people have prescription opioid use disorders, with 4.9 million being adults over 26.

Heroin

Heroin is a white or brown powder or a black sticky tar-like substance known as black tar heroin, which can be smoked, snorted, and injected. It is illegal and classified as a Schedule I drug since it does not have any medical purpose but is highly addictive.

Heroin is known to make people feel euphoric, relaxed, and without stress. As soon as it begins to wear off, after about an hour, uncomfortable withdrawal symptoms can start to appear. People continue using the drug not only to experience the pleasurable sensations but also to avoid the painful withdrawal symptoms.

Out of the 900,000 people reporting to have a heroin use disorder, 864,000 were adults over 26.

Cocaine

Cocaine is available in a crystal white powder or as a white crystal rock, which is known as crack cocaine. Cocaine can be snorted, smoked, injected, or applied topically. Cocaine is illegal and classified as a Schedule II drug since it is highly addictive. It also has a medical purpose and may be used legally in hospitals.

Cocaine makes people feel talkative, energized, friendly, and confident for 20-30 minutes, after which the high begins to wear off. People continue using it to chase those pleasurable feelings.

According to reports, 1.4 million people claimed to have a cocaine use disorder. Adults over the age of 26 were the highest group of users, at 1.2 million.

Methamphetamine

Methamphetamines are illegal, dangerous stimulants that usually come in the form of a white powder, crystals that look like glass, or larger yellow chunks known as rocks. Methamphetamine can be inhaled, snorted, smoked, or consumed orally and is a Schedule II drug because it is highly addictive.

Methamphetamine makes a person feel euphoric, with a lot of energy and a lack of appetite. The drug increases heart rate and makes someone sweat profusely, leading to dehydration and other physical ailments. Users of methamphetamine quickly become addicted, increasing their tolerance and dependence.

Over 1.8 million people over 12 report having a methamphetamine use disorder in America, with 1.7 million being adults over 26.

Marijuana

Marijuana refers to the leaves, stems, flowers, and seeds from the cannabis plant that contain THC, the ingredient that makes it psychoactive. Marijuana is typically smoked, eaten in edibles, or drunk in brewed tea.

Marijuana may make some people feel relaxed while others feel paranoid. Because marijuana may sometimes be mixed with other drugs, the effects will vary. Marijuana is less addictive than substances like opioids or alcohol, which is one reason it is legal for medicinal and recreational use in some states. Although less addictive, chronic marijuana users may experience mild withdrawal symptoms when they stop using it.

Research shows 19 million people reported having a marijuana use disorder, with over 5.7 million being young adults between 18 and 25, 1.3 million adolescents, and nearly 12 million adults.

Tobacco

Tobacco products containing nicotine, an addictive substance, include:

• Cigarettes
• Cigars
• Smokeless tobacco
• E-juice (for vaping)

Nicotine products are legal to purchase over the counter for anyone over 21. Nicotine causes a release of dopamine in the brain that gives a very temporary feeling of calm or euphoria. To continue experiencing the effects, a person continues their use of tobacco.

Among Americans over age 12, 63.9 million people reported vaping or using tobacco products. Smoking cigarettes with nicotine or vaping nicotine were the most common forms of use. The group with the highest use was young adults between 18 and 25, with over 10 million.

Hallucinogens

Hallucinogens include:

• LSD
• PCP
• Peyote
• Psilocybin mushrooms
• Ketamine

Each drug has a different schedule based on danger and potential for addiction. Hallucinogens are taken orally, injected, smoked, and brewed in teas. Some hallucinogens, like ketamine, have medical purposes like treating treatment-resistant depression.

Hallucinogens alter perceptions and senses, giving some people a feeling of euphoria and open-mindedness. When using these drugs, people risk having a bad trip that can last for hours or days.

Around 8.5 million people reported misusing hallucinogens, with 2.7 million being between 18 and 25 and 5.5 million being over 26.

Inhalants

Inhalants are substances inhaled through the mouth or nose. They do not have a schedule classification because most are over-the-counter substances that anyone can purchase.

Examples of inhalants include:

• Computer duster
• Gasoline
• Paint thinner
• Nitrous oxide found in aerosol containers (whippits)
• Ether
• Chloroform

Inhalants destroy brain cells, making people feel dizzy, lightheaded, and lose consciousness.

Inhalant use disorders can form quickly and can be difficult to quit, which explains why 2.3 million people reported inhalant misuse. Adults over 26 had the lowest number of users, with 1.1 million.

Sedatives

Sedatives have a calming effect on the brain and body and include:

• Benzodiazepines
• Tranquilizers
• Barbiturates
• Muscle relaxants,
• Depressants

They are ingested or injected from pills, capsules, or liquids. They are available by prescription only, but many people with substance use disorders misuse them, which is why they are recognized as Schedule II, III, and IV drugs. Tolerance to sedatives quickly increases, meaning someone needs more of the drug to achieve the desired effects, leading to misuse and possible overdoses.

Sedative use disorders affected 2.4 million people in America, with 1.9 million being over 26.

Knowing the difference between substances and their effects can help someone relay helpful information in emergencies, which can occur at any time with substance misuse. Unfortunately, many people misuse more than one substance at a time, increasing their risk of overdose, accident, injury, or death.

What’s The Difference Between Substance Abuse And A Substance Use Disorder?

Substance abuse has been a source of confusion because people interpret it in different ways. Some consider it to mean the ways someone can misuse drugs or alcohol. Others think it means being dependent on substances, and yet others refer to it as addiction. Due to the various inferences, professionals have made necessary changes to the definitions.

The American Psychiatric Association made changes to various drug and alcohol-related terminology to ensure negative connotations were removed and to avoid stigmatizing language.

Changes made in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) include an updated substance use disorder definition. They replaced substance abuse and substance dependence with a single category of substance use disorder.

The substance use disorder DSM-5 criteria must be met to receive a diagnosis of a SUD, including level of severity. The 11 criteria include:

• Taking more of the substance or for longer periods than intended
• Making efforts to quit or control use but without success
• Spending much of their time misusing, seeking, or recovering from use
• Craving or having intense urges to drink
• Misusing the substance interferes with fulfilling obligations at home, work, school, or socially
• Continuing to misuse substances even though they cause interpersonal problems
• Continuing to misuse substances, knowing it may cause or worsen physical or mental problems
• Avoiding important activities to spend more time misusing a substance
• Misusing substances despite being in physically dangerous situations
• Building a tolerance or needing more substances to achieve the same effects
• Experiencing withdrawal symptoms when cutting back or going without the substance

Someone meeting two or three of the criteria has a mild SUD, whereas someone with four or five has a moderate SUD. Anyone with more than six criteria has a severe SUD.

It is important to note that someone can misuse substances and not develop a substance use disorder. Examples of substance abuse include occasionally binge drinking, taking another person’s prescription, or mixing alcohol with another drug at a party. While they may experience negative effects of their behaviors, they do not experience addiction.

Who Do Substance Use Disorders Affect?

Substance use disorders can affect anyone of any gender, race, and age. The effects of SUDs impact every culture, ethnicity, socioeconomic status, city, and neighborhood.

Research shows there are risk factors common among people with a substance use disorder. Risk factors are personal experiences and lifestyle elements that increase the chances of developing a SUD, such as:

• Genetics, or inheriting genes from relatives who have substance use disorders.
• Home environment, or living with people who misuse substances and encourage their use.
• Experiencing trauma or a life-changing event, like abuse, death of a loved one, natural disasters, or severe injury or illness.
• Having co-occurring mental health disorders, like depression, anxiety, bipolar disorder, eating disorders, etc.
• Existing physical health conditions include diabetes, chronic pain, or injuries.
• Brain chemistry imbalances of neurotransmitters and how they communicate.
• Stressful environments at work, home, or school.
• Age of first substance use being in the teens or earlier.

Fortunately, protective factors can overcome risk factors, which is a key component of substance use disorder treatment. A person must find the best environments to work and live in, acquire sober friends, and maintain care for physical or mental conditions. The more protective factors they can create, the higher their chances of recovery success.

How Common Are Substance Use Disorders?

According to the latest results of the National Survey on Drug Use and Health, 40.3 million Americans over the age of 12 had a SUD in the year before the survey. There were 28.3 million with an alcohol use disorder, 18.4 million with an illicit drug use disorder, and 6.5 million with a combination of alcohol and illicit drug use disorder.

Additional statistics regarding SUDs in the U.S. are alarming and show:

• 5.2 million people between 18 and 25 have a SUD.
• 22.4 million people over 26 have a SUD.
• 712,000 adolescents between 12 and 17 have a SUD.
• 17 million have co-occurring a mental health disorder and a SUD.
• 5.7 million have co-occurring severe mental health disorders and a SUD.

Some people develop multiple SUDs or polysubstance use disorders. For example, they may consume alcohol and misuse prescription opioids. Some may even combine more than two substances, further increasing their risk for life-threatening outcomes.

What Are The Symptoms Of Substance Use Disorders?

Recognizing the symptoms of substance use disorders as early as possible is crucial to prevent long-term physical, psychological, professional, and personal consequences. While every person will exhibit unique symptoms, many people show common behaviors, including:

• Isolating themselves or avoiding family and friends
• Hanging out with new friends who may also misuse substances
• Making up excuses to continue misusing substances
• Experiencing changes in their appetite
• Exhibiting changes in their appearance and hygiene
• Being defensive when questioned about their behaviors
• Being more aggressive toward others
• Taking money or items without permission
• Lying about where they are going or what they are doing
• Borrowing money from family or friends
• Displaying poor performance at work or school
• Facing legal troubles or consequences

Someone with a SUD may seem preoccupied with seeking and misusing substances. They may also exhibit psychological symptoms, including:

• Mood swings
• Paranoia
• Fatigue
• Trouble concentrating
• Low self-esteem
• Depression
• Anxiety
• Poor judgment
• Sleep disturbances
• Memory loss

Any unusual changes in a person’s routine, performance, attitude, appearance, and behaviors can signal that something is wrong. Don’t wait for symptoms to become overwhelming or unmanageable to intervene.

How Does A Substance Use Disorder Develop?

Substance use disorders do not happen overnight. They develop through a series of processes, starting with changes in the brain. Every person who develops a SUD has personal risk factors that contribute to the disease, such as how long they misused the  substance and the amount they misused.  

Substance Use Disorders And The Brain

Upon consuming alcohol or drugs, the substances travel through the bloodstream and directly to the brain, where they change how the brain functions. Some substances cause neurons in the brain to release substantial amounts of neurotransmitters, such as dopamine. Doing so makes a person feel overly calm, relaxed, and euphoric.

Substances affect specific parts of the brain that make developing a substance use disorder more likely, including:

• The Basil Ganglia is responsible for creating habits, routines, and motivations.
• The Amygdala creates uncomfortable withdrawal symptoms because it stores memories of how good it feels when taking a substance.
• The prefrontal cortex is responsible for thinking, judgments, planning, and controlling impulses, all impaired by substance misuse.

Alcohol and drugs cause a reaction in the brain that produces a release of dopamine, the feel-good chemical. The reward circuit in the brain is then magnified. As dopamine levels drop once the substance metabolizes, the brain creates thoughts and symptoms to encourage a person to continue misusing the substance, seeking another dopamine release. Quickly, a vicious cycle begins.

Substance Use Disorders And Tolerance

When someone continues to misuse a substance, they may develop a tolerance to it. Tolerance refers to needing more of the substance to feel the same effects they previously experienced.

For example, someone who takes a prescription opioid for pain may notice that, after a week or two, the opioids are not treating the pain as well. They may choose to increase the amount of opioids they take to achieve the same pain relief. Increasing the dose will continue as the body becomes used to the substance. Tolerance does not mean addiction, but it is one factor that can lead to a SUD.

Substance Use Disorders And Dependence

Becoming physically or psychologically dependent on a substance can lead to a substance use disorder. With dependence, your body and mind begin to rely on the substance to function. A person may believe they cannot survive without continuing the use of alcohol or drugs. To support their theory, when they try to stop or cut back on misusing substances, they experience painful withdrawal symptoms.

Withdrawal symptoms may include the following:

• Nausea
• Vomiting
• Muscle spasms
• Headaches
• Flu-like symptoms
• Intense cravings
• Agitation or irritability
• Uncontrollable crying
• Depression or anxiety
• Hallucinations
• Seizures
• Trembling
• Restlessness

Withdrawal symptoms will vary for each person due to numerous factors, including metabolism, type of substance, and if they are receiving treatment.

How Is A Substance Use Disorder Diagnosed?

Diagnosis of a SUD must be made by a licensed doctor, psychiatrist, psychologist, therapist, or other mental health and substance abuse professional. The diagnostic process may include the following:

• A comprehensive exam of substance misuse history
• Current and past physical or psychological issues
• Family history of substance misuse
• Withdrawal symptoms and history
• Treatment history
• Substance use disorders DSM-5 criteria

Diagnoses help professionals create a unique treatment plan for anyone wanting to recover from a substance use disorder. Therefore, they will consider all factors of a person’s life, including risk, protective, and environmental factors.

Treatment For Substance Use Disorders

Effective treatment for substance use disorders is a combination of medications, therapy, and recovery support. Many treatment programs also offer alternative and holistic therapies.

Treatment Programs

The more severe a substance use disorder, the more likely the individual is to begin treatment on an inpatient basis. Those with mild or moderate withdrawal symptoms may be able to start treatment at an intensive outpatient program. Treatment center options include the following:

• Inpatient detoxification
• Inpatient rehabilitation
• Residential rehabilitation
• Partial-hospitalization program
• Intensive outpatient program
• Standard individual therapy

The initial assessment will help determine the most appropriate place to begin treatment. It’s crucial to be open and honest and express all your needs so that the treatment recommendation can be accurate and beneficial.

Medication

Medications exist to help treat substance use disorders in two ways: to help treat the disorder itself and to help ease withdrawal symptoms that occur when stopping the substance.

Many people have painful withdrawal symptoms that interfere with their ability to learn new life skills. Doctors can treat specific symptoms, which can help reduce cravings and the desire to leave the program.

Additionally, medications are available to help treat alcohol and opioid substance use disorders. Medications for treating AUDs include acamprosate, naltrexone, and disulfiram.

For opioid use disorders, buprenorphine, methadone, and naltrexone are useful treatments.

These medications normalize brain chemistry and reduce the effects of euphoria or pleasure. They are safe to use long-term and are beneficial in preventing overdoses that may occur due to drug or alcohol misuse. However, in case of overdose, a naloxone-based treatment, Narcan, can be administered to reverse the effects of opioids and save a person’s life.

Methadone is another effective medication assistance treatment program to help someone overcome an opioid use disorder. People check in at a methadone clinic to receive a daily dose of medicine that curbs cravings and greatly reduces withdrawal symptoms.

Behavioral Therapies

Behavioral therapies teach people in treatment how to improve thought processes that will eventually improve their behaviors. They learn relapse prevention skills, such as recognizing and avoiding triggers. Behavioral therapies include:

• Cognitive-behavioral therapy (CBT)
• Dialectical-behavioral therapy (DBT)
• Contingency management (CM)
• Motivational enhancement therapy (MET)
• Family therapy
• Peer support groups
• Digital interventions

Individual and group programs teach participants life skills that will help them maintain sobriety once they leave treatment. In addition to individual and group therapies, they can attend family therapy, peer support groups, 12-step facilitation groups, and alternative therapies.

Alternative therapies may include art or music therapy, equine or animal support therapy, acupuncture, nutrition and exercise, meditation, or yoga.

How Can I Prevent A Substance Use Disorder?

Preventing a substance use disorder involves increasing the amount of protective factors and reducing risk factors a person has at home, school, work, and socially.

Leaders in the field of SUDs recommend the following training to people of all ages:

• Self-regulation
• Social skills
• Stress-management
• Parenting
• Employment
• Education
• Refusal skills
• Drug and alcohol education

Offering prevention services is only one part of reducing substance use disorders. Programs must also exist for families, communities, and neighborhoods. Programs must also consider special populations, like teens, minorities, or those involved with the justice system.

Important Takeaways

Substance use disorders disrupt all aspects of a person’s life and can prevent them from reaching goals at work, home, and school. Substance misuse can also influence social and personal relationships. Fortunately, SUDs are treatable, and many people recover and go on to live long, fulfilling lives without the use of drugs or alcohol.

You can be successful in recovery, too. Completing an assessment, receiving an accurate diagnosis, and participating in recovery treatment will help you maintain sobriety long-term.

You can start today by contacting your doctor or another medical professional who can connect you to resources or treatment centers that can help you on the path to long-term sobriety.