Substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus--sometimes called an addiction--on using a certain substance(s) such as alcohol, tobacco, or other psychoactive substances, to the point where their 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.
Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate intoxication wears off. Intoxication is the intense pleasure, euphoria, and calm that is caused by the substance; these symptoms are different for each substance. With continued use of a substance, tolerance can develop, where someone may require larger amounts in order to fell these effects. Additionally, discontinuing use can lead to symptoms of withdrawal and intense cravings to return to use, often experienced as anxiety.
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.
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:
- To feel good — feeling of pleasure, “high” or "intoxication."
- To feel better — relieve stress, forget problems, or feel numb.
- To do better — improve performance or thinking.
- Curiosity and peer pressure or experimenting.
People with substance use and behavioral addictions may be aware of their problem but not be able to stop even if they want and try to. The addiction may cause physical and psychological problems as well as interpersonal problems such as with family members and friends or at work.
Symptoms of substance use disorder are grouped into four categories:
- Impaired control: the experience of 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 may be cut back or given up entirely.
- Dangerous use: substance is used in unsafe 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. Another psychiatric disorder can, but does not necessarily, precede another psychiatric disorder. It is also possible that the use of a substance may trigger or worsen another psychiatric disorder.
Top 10 Things Everyone Should Know About Addiction (.pdf)
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 are optimal for sustained recovery.
Medications are used to control 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 or outpatient guidance 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").
- Mutual-aid groups (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.
Source: National Institute on Drug Abuse. These principles are detailed in NIDA's Principles of Drug Addiction Treatment: A Research-Based Guide.
Some suggestions to get started:
- Learn all that you can about alcohol and drug dependence and addiction.
- Speak up and offer your support. Talk to the person about your concerns, and offer your help and support, including your willingness to go with them and get help. Like other chronic diseases, the earlier addiction is treated, the better.
- Express love and concern. Focus the conversation on specific behaviros and avoid name-calling, which may cause the person to shut down.
- Do not expect the person to change without help. Treatment, support, and new coping skills are needed to overcome addiction.
- Support recovery as an ongoing process: once your friend or family member is receiving treatment, or going to meetings, remain involved. The goal is to let them know you care and are availalble when they need someone in their corner.
Some things to avoid:
- Avoid lectures, threats, bribes, or emotional appeals, which can worsen shame and lead to isolation or the compulsion to use.
- Do not cover up, lie or make excuses for their behavior; open and honest communication is vital for people with SUD to get the help they deserve.
- Avoid confrontations with someone who is intoxicated; they will likely not be able to have a meaningful or rational conversation and could escalate to violence.
- Do your best to not feel guilty for their behavior; people with substance use disorder are suffering from an illness and, like other forms of disease, it is not caused by any one person or action.
- Do not join them; drinking or using alongside someone with SUD will harm not only them but also you.
Adapted from: National Council on Alcoholism and Drug Dependence and One Love Foundation's "How to Talk to a Friend."
Opioid Use Disorder
Opioids produce high levels of positive reinforcement in the brain, increasing the odds that people will continue using them despite experiencing negative consequences. Opioid use disorder is a chronic lifelong disorder, with serious potential consequences including disability, relapse, and death. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) describes opioid use disorder as a problematic pattern of opioid use, including experiencing tolerance or withdrawal symptoms and leading to impairment or distress. More about opioid use disorder.
Gambling Disorder
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder is included in a category of behavioral addictions. This reflects research findings that gambling disorder is similar to substance-related disorders and these similarities will help people with gambling disorder get the necessary treatment and services, and may help others better understand the challenges. More about gambling disorder
Internet Gaming
Internet gaming disorder is included in DSM-5 in the section of disorders requiring further research. This reflects the scientific literature showing that persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. The condition criteria do not include general use of the Internet or social media. More about internet gaming
E-Cigarettes and Vaping
The use of e-cigarettes, informally called "vaping," involves using electronic cigarettes to inhale vapor created from a liquid heated inside of the device. E-cigarettes have become the most commonly used tobacco product among youth since 2014. The aerosol from vaping generally can contain harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents, according to the CDC. More about vaping.
Caffeine Intoxication and Withdrawal
Caffeine intoxication and caffeine withdrawal are included in DSM-5-TR. Caffeine use disorder, however, is in the section of DSM-5-TR for conditions requiring further research. While there is evidence to support this as a disorder, experts conclude it is not yet clear to what extent it is a clinically significant disorder.
- Brigette Torrise, M.D.
- April 2024