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    Addictions

    Substance Use Disorder and Addiction

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    Substance Use Disorder and Addiction

    The conditions of substance use disorder (SUD) and addiction are intricate and demanding, but with a suitable treatment plan, it is feasible to attain recovery.

    Substance use disorder (SUD) and addiction can impact anyone, regardless of their age, gender, economic or social status, indicating that no population is immune to these conditions.

    In 2018, over 20 million individuals aged 12 and above in the United States had a SUD.

    It is possible that you know someone who initiated the use of painkillers such as opioids, which were prescribed after an injury. Eventually, their body developed a dependence, and attempts to reduce or stop using the drugs independently proved to be highly painful or almost impracticable.

    Regardless of how the use of substances commences, recovery is achievable. However, individuals with moderate to severe addiction usually require extra assistance, as it is not effortlessly surmountable by oneself.

    What is substance use disorder?

    Substance use disorder is a complicated ailment that arises from the repetitive usage of alcohol or other substances, despite the negative consequences it may have on one’s life and health.

    The severity of SUD can be categorized as mild, moderate, or severe. The occurrence of addiction frequently transpires when the substance causes an overstimulation of the reward center in the brain, leading to an abnormal surge of the neurotransmitter dopamine.

    The continuous consumption of the substance triggers alterations in the brain’s structure and function, eventually resulting in intense desires, tolerance, and withdrawal symptoms when the substance is not consumed.

    What are the different types of SUD?

    Substances for which a person may form a SUD include:

    • alcohol
    • cannabis
    • hallucinogens (including LSD and PCP)
    • inhalants
    • (including heroin and prescription medication)
    • sedatives, hypnotics (sleep meds), or anxiolytics (anti-anxiety meds)
    • stimulants (like amphetamines or cocaine)
    • tobacco

    Is addiction and SUD the same?

    An addiction refers to the repetitive and uncontrollable utilization of a substance, activity, or behavior that an individual feels powerless to cease. Examples of non-substance-related addictions may encompass:

    • ganbling
    • sex or pornography
    • internet or social media
    • shopping
    •  video Games
    • food

    It is worth noting that among these, only gambling disorder and internet gaming disorder are officially recognized as behavioral addictions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

    Although they are not formally classified as addictions in the DSM-5, behaviors such as excessive or compulsive engagement in activities like sex, social media, and shopping may lead to problems.

    It is important to note that any concern regarding such behaviors is valid, and seeking professional assistance is a viable option. On the other hand, substance use disorder constitutes an addiction that involves the excessive use of habit-forming substances, which can encompass alcohol, prescription medications, or illegal drugs.

    What causes substance use disorder?

    The exact causes of SUD are unknown. Some influencing factors include:

    • genetics
    • personality traits
    • stress
    • the substance’s action
    • family history of use
    • peer pressure
    • mental health conditions, such as anxiety, depression, and

    Experiencing trauma, particularly during childhood, has a strong link to substance use. Individuals with PTSD are commonly diagnosed with SUDs.

    Within the Veterans Health Administration (VHA) system, almost 11% of veterans receiving initial care meet the criteria for a SUD diagnosis.

    Findings from studies involving twins and families have indicated that the development of SUD is influenced by both genetic and environmental factors.

    Studies conducted on twins have demonstrated that environmental factors have a greater impact than genetics in relation to the development of alcoholism. However, as individuals enter early adulthood, genetics begin to play a more significant role in influencing drinking patterns.

    An instance where genetics played a role in initial alcohol consumption was observed in 18% of girls (compared to 0% in boys) at the age of 14. This percentage increased to 33% for both sexes by age 16, and by the age of 18, the influence of genetics on initial alcohol use was observed in 50% of cases.

    Another review of twin studies suggests that addiction tends to be heritable within families, with a heritability range of 40% to 60%.

    What are the signs and symptoms of substance use disorder and addiction?

    The indications and symptoms of substance use and addiction can differ significantly from one person to another, and may depend on:

    • the substance or behavior
    • the length and severity of use
    • the user’s personality

    Below are the general symptoms of substance use and addiction:

    • continued use even though it may affect health, relationships, or other aspects of life negatively
    • craving the substance or behavior
    • regular overconsumption
    • worrying about overuse
    • using in situations that may not be safe, such as driving under the influence, using a syringe that’s not sterile, or having sex without condoms or other barrier methods
    • giving up previously enjoyed activities due to use
    • spending a lot of time using or trying to use and recovering
    • neglecting responsibilities at home, work, or school
    • building up a tolerance
    • experiencing withdrawal symptoms when trying to quit

    How is SUD diagnosed?

    When clinicians are diagnosing a substance use disorder, they usually refer to the following DSM-5 criteria:

    • feeling like you have to use the substance on a regular basis (daily or several times per day) and more than originally planned
    • spending a large amount of time seeking, using, and recovering from the substance
    • craving the substance
    • needing more of the substance to get the same effect
    • experiencing withdrawal symptoms when you don’t use the substance
    • neglecting responsibilities at home, work, or school
    • recurring thoughts of quitting but being unable to accomplish this goal
    • continuing to use despite problems it may cause in relationships
    • continuing to use despite mental or physical health problems caused or worsened by it
    • giving up or cutting back in social or recreational activities due to substance use
    • using the substance under conditions that may not be safe

    Depending on how many of these symptoms a person shows within a 12-month period, a SUD can be diagnosed as:

    • Mild: 2–3 symptoms
    • Moderate: 4–5 symptoms
    • Severe: 6 or more symptoms

    How is substance use disorder treated?

    There are two primary settings in which treatment for SUD can be provided, and the primary objective is to place individuals in the most efficient, yet least restrictive environment necessary to initiate the process and subsequently advance them along a continuum of care.

    This continuum of care ranges from the most intensive to the least intensive, and includes:

    • inpatient hospitalization
    • residential treatment
    • intensive outpatient treatment
    • outpatient treatment

    Various SUD treatment programs stem from three basic models:

    Medical model. This approach focuses on the biological, genetic, or physiological origins of SUD and necessitates medical treatment with the use of medication to alleviate symptoms. It requires the supervision of a physician.

    Psychological model. This approach places emphasis on the person’s underlying emotional dysfunction or potentially harmful motivations as the main causes of SUD. It may involve psychotherapy or behavioral therapy as forms of treatment.

    Sociocultural model. In this approach, the focus is on the person’s social and cultural environment and how it may contribute to their SUD. Treatment involves modifying their physical and social surroundings to address any deficiencies. This may involve self-help or spiritual activities and is often facilitated by individuals who have personal experience with addiction and are in recovery themselves.

     

    The primary focus of substance use treatment is typically on talk therapy. The psychological therapies that are frequently utilized in the treatment of substance use disorder are:

    • Motivational interviewing (MI) is a type of counseling that focuses on the person’s own motivation to quit substance use. It is client-centered and designed to help the individual find the internal drive to change their behavior.
    • Motivational enhancement therapy is a combination of motivational interviewing and psychological counseling, aimed at presenting a new perspective to individuals who may be defensive or scared.
    • This method, called prize-based contingency therapy, incentivizes drug abstinence with rewards such as monetary prizes. However, studies have shown that its effectiveness may not last in the long term.
    • Seeking Safety is a cognitive behavioral therapy-based approach designed for individuals with both substance use disorder and PTSD. Research suggests that it may be more effective in improving PTSD symptoms than substance use disorder symptoms and that it works best when combined with other treatment methods.
    • Guided self-change. This approach combines CBT with motivational counseling. Some research suggests it may be beneficial as an early intervention for teens with SUD.
    • Other behavioral and cognitive behavioral-based techniques.

     

    It should be emphasized that some inpatient rehab centers prioritize their treatment models based on insurance coverage instead of individualized treatment plans for the best possible outcome. For most individuals, outpatient treatment can be as effective as inpatient therapy, while being more cost-effective.

    Some individuals find that popular 12-step programs like Alcoholics Anonymous and Narcotics Anonymous can be beneficial as a supplement to their treatment, particularly for the sense of community and support they provide.

    Living with and managing life with addiction

    Living with and managing an addiction and substance use is a marathon, not a sprint.

    To live with and manage addiction is a long-term process rather than a quick fix. One effective way to aid in this process is by engaging in healthy activities that you enjoy. Research has shown that exercise and mindfulness meditation may be beneficial for individuals in recovery, but further research is necessary to confirm these findings.

    Helping someone with SUD or addiction

    Watching a loved one develop or live with addiction can be challenging, especially when it seems like they don’t want help.

    Some individuals may struggle to acknowledge or accept their SUD, even when friends and family believe it to be true.

    They may feel ashamed or afraid to seek help. It’s crucial to understand that the person with the addiction must be the one to seek treatment.

    Pressuring them to stop using rarely leads to positive outcomes. Instead, loved ones should offer emotional support and inform them of available resources.

    Recovery from substance use is very possible but requires strong commitment.

    Seeking guidance and support from a trusted doctor can be a crucial first step for many people on their path to recovery from addiction.

    A preliminary assessment can be conducted to identify a person’s susceptibility to SUD. This can be followed by a thorough evaluation and referral to an addiction expert who can provide further information on various treatment options.

    The specialist can suggest a strategy depending on the severity of the addiction and available resources in the local community. It is important to note that there is no single approach to treating substance use disorder that works for everyone, and each person seeking treatment has unique needs.

    Some may require intensive inpatient care, while others may benefit from part-time outpatient support, and treatment requirements may change over time.

    Many individuals may choose to conduct their own research or seek out support groups before selecting a specific treatment option.Here are some resources worth checking out:

    Next steps

    Substance use disorder can affect anyone.

    Behavioral addictions, such as gambling disorder, gaming disorder, and internet addiction, are also prevalent, although it can be challenging to determine their exact prevalence due to the lack of standardized diagnostic criteria.

    Despite the challenges of SUD and addiction, recovery is possible with the appropriate treatment plan and support network.

    If you find it difficult to control your substance use or certain behavioral habits, consider seeking help from a trusted healthcare professional or one of the many available resources and support groups.

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