Substance use disorder
Substance use disorder is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include substance use problems and problematic drug or alcohol use. Along with substance-induced disorders they are encompassed in the category substance-related disorders.
Substance use disorders vary with regard to the average age of onset. It is not uncommon for those who have SUD to also have other mental health disorders. The coexistence of both a mental health disorder and a substance use disorder is referred to as co-occurring disorders. Substance use disorders are characterized by an array of mental, emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol ; cannabis; opioids; stimulants such as nicotine, cocaine and amphetamines; benzodiazepines; barbiturates; and other substances.
In the DSM-5, the DSM-IV diagnoses of substance abuse and substance dependence were merged into the category of substance use disorders. The severity of substance use disorders can vary widely; in the DSM-5 diagnosis of a SUD, the severity of an individual's SUD is qualified as mild, moderate, or severe on the basis of how many of the [|11 diagnostic criteria] are met. The ICD-11 divides substance use disorders into two categories: harmful pattern of substance use; and substance dependence.
In 2017, globally 271 million people were estimated to have used one or more illicit drugs. Of these, 35 million had a substance use disorder. An additional 237 million men and 46 million women have alcohol use disorder as of 2016. In 2017, substance use disorders from illicit substances directly resulted in 585,000 deaths. Direct deaths from drug use, other than alcohol, have increased over 60 percent from 2000 to 2015. Alcohol use resulted in an additional 3 million deaths in 2016.
Etiology
Substance use disorders are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction. Biological and social determinants of health are recognized factors that contribute to vulnerability to or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders.This section divides substance use disorder causes into categories consistent with the biopsychosocial model. However, it is important to bear in mind that these categories are used by scientists partly for convenience; the categories often overlap ; and these categories are not the only ways to classify substance use disorder etiology.
Similarly, most researchers in this and related areas, emphasize that various causal factors interact and influence each other in complex and multifaceted ways.
Social determinants
Among older adults, being divorced, separated, or single, having more financial resources, lack of religious affiliation, bereavement, involuntary retirement, and homelessness are all associated with alcohol problems, including alcohol use disorder. Issues may often be interconnected: people without jobs are more likely to abuse substances which then makes them unable to work. Not having a job leads to stress and sometimes depression which in turn can cause an individual to increase substance use. This leads to a cycle of substance abuse and unemployment. The likelihood of substance abuse can increase during childhood. Through a study conducted in 2021 about the effect childhood experiences have on future substance use, researchers found that there is a direct connection between the two factors. Individuals that had experiences in their childhood which left them traumatized in some way had a much higher chance of substance abuse.While SUD is often viewed as a person-centered issue, it is also a family disease. Individuals struggling with substance abuse frequently damage relationships with loved ones, and in severe cases, SUD can lead to family separation through divorce or intervention by government agencies like Child Protective Services. Unfortunately, it may even result in suicide, leaving families to grieve. SUD is commonly associated with a range of emotional and psychological problems, including anger, guilt, depression, anxiety, and violence. These issues not only affect the individual but also their family and community. To effectively combat SUD, it's crucial to address its causes particularly in mental health challenges. By improving access to mental health care, people can help prevent and treat substance use more effectively. There are many programs available to support individuals and families affected by SUD. These include therapy centers, support groups, and dedicated treatment facilities such as Bear River Health, Sacred Heart, Harbor Hall, and ATS. Peer support plays a vital role in recovery. Organizations like Al-Anon/Nar-Anon, AA/NA, Celebrate Recovery, and DHARMA provide the support to individuals and families navigating the challenges of substance use.
Psychological determinants
Psychological causal factors include cognitive, affective, and developmental determinants, among others. For example, individuals who begin using alcohol or other drugs in their teens are more likely to have a substance use disorder as adults. Other common risk factors are being male, being under 25, having other mental health problems, and lack of familial support and supervision.. Other psychological risk factors include high impulsivity, sensation seeking, neuroticism and openness to experience in combination with low conscientiousness.Biological determinants
Children born to parents with who have a substance use disorder have roughly a two-fold increased risk in developing a substance use disorder compared to children born to parents without this disorder. Other factors such as substance use during pregnancy, or the persistent inhalation of secondhand smoke can also influence a person's substance use behaviors in the future.Signs and symptoms
Symptoms for a substance use disorder include behavioral, physical and social changes. Changes in behavior include being absent from school or work; changes in appetite or sleep patterns; personality and attitude changes; mood swings, and anxiety. Signs include physical changes such as weight gain or loss; tremors, and bloodshot eyes. Different substances used can give different signs and symptoms.There are a number of psychological changes associated with substance use disorders, including anxiety and depression. Anxiety and depression symptoms are closely linked to greater substance use over time, especially in adolescents. Some adolescents who are current or lifetime users can experience clinical levels of anxiety and depression, screenable through the PHQ-4. Hallucinations can also occur due to the use of psychoactives such as cannabis, which may lead to onset of disorders like schizophrenia.
The list of physical health conditions associated with various substance use disorders is comprehensive; different substances tax the body in different ways, and each organ system experiences some form of distress or disruption as a result of substance use disorders. Some of the many health conditions are as follows:
- Language and Coordination impairment
- Memory loss
- Liver failure
- Hypertension
- Kidney failure
- Deep comatose states
- Transmission of HIV and other diseases carried on needles
- Osteoporosis
- Immunodeficiencies
Diagnosis
There are additional qualifiers and exceptions outlined in the DSM. For instance, if an individual is taking opiates as prescribed, they may experience physiologic effects of tolerance and withdrawal, but this would not cause an individual to meet criteria for a substance use disorder without additional symptoms also being present. A physician trained to evaluate and treat substance use disorders will take these nuances into account during a diagnostic evaluation.