Substance use disorder (SUD) and addictions are complex and challenging conditions. But recovery is possible with the right treatment plan.
Substance use disorder (SUD) and addiction affect all people, independent of their age, gender, or economic or social status — no population is above it.
In fact, more than 20 million Americans ages 12 and older had a SUD in 2018.
You may know someone who started taking pain relievers like opioids they were prescribed after an injury. Then, as their body experienced dependence, efforts to cut back or quit on their own proved to be extremely painful — or next to impossible.
Substance use disorder is a complex condition stemming from the recurrent use of alcohol or other substances despite the harmful life and health consequences it may cause.
A SUD can be mild, moderate, or severe.
Addiction often occurs when the substance overactivates the brain’s reward center, which involves an abnormally high release of the neurotransmitter dopamine.
Continued use of the substance results in changes to the brain’s function and structure, which eventually leads to cravings, tolerance, and withdrawal symptoms when the substance isn’t used.
What are the different types of SUD?
Substances for which a person may form a SUD include:
- hallucinogens (including LSD and PCP)
- opioids (including heroin and prescription medication)
- sedatives, hypnotics (sleep meds), or anxiolytics (anti-anxiety meds)
- stimulants (like amphetamines or cocaine)
Is addiction and SUD the same?
An addiction is the compulsive and repeated use of a substance, or any behavior or activity that a person feels helpless to stop.
Addictions that don’t involve drugs or alcohol may include:
Note that of these, only gambling disorder and internet gaming disorder are recognized behavioral addictions in the
Still, even though they’re not recognized diagnoses in the DSM-5, these other behaviors — like sex, social media, and shopping — many cause problems when done in excess or compulsively. No matter your concern, it’s valid and you can seek professional help to address it.
Substance use disorder is an addiction that involves a habit-forming substance. This can include alcohol or any prescription or illegal drug.
The exact causes of SUD are unknown. Some influencing factors include:
- personality traits
- the substance’s action
- family history of use
- peer pressure
- mental health conditions, such as anxiety, depression, and attention deficit hyperactivity disorder (ADHD)
Exposure to trauma, especially in childhood, is strongly associated with substance use as well. In fact, SUDs are commonly seen in people with post-traumatic stress disorder (PTSD).
Among veterans getting first-time care within the Veterans Health Administration (VHA) system, nearly 11% meet criteria for a SUD diagnosis.
Studies with twins and families have shown that both genetic and environmental factors play a role in developing SUD.
For example, genetics played a role in first-time alcohol use in
The results of another review of twin studies also suggests that addiction runs in the family, with
Signs and symptoms of substance use and addiction vary widely from person to person and 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?
Most clinicians use the following DSM-5 criteria when diagnosing a substance use disorder:
- 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:
Treatment for SUD may be delivered in two basic settings — inpatient and outpatient.
The main goal is to place people in the most effective — but least restrictive — environment needed to begin the process and then move them along a continuum of care.
From most intensive to least, this continuum of care includes:
- inpatient hospitalization
- residential treatment
- intensive outpatient treatment
- outpatient treatment
Various SUD treatment programs stem from three basic models:
- Medical model. This approach emphasizes the biological, genetic, or physiological causes of the SUD. It requires treatment by a physician and using medication to relieve symptoms.
- Psychological model. This approach focuses on the person’s potentially harmful motivations or emotional dysfunction as the primary cause of the SUD. It may include psychotherapy or behavioral therapy.
- Sociocultural model. This approach addresses any deficiencies in the person’s social and cultural environment that can be improved by altering your physical and social environment, including the use of self-help or spiritual activities. Treatment is often facilitated by people with personal experience with addiction and who are also in recovery.
Most substance use treatment is centered around talk therapy. The psychological therapies most commonly used in treating substance use disorder include:
- Motivational interviewing (MI). This refers to client-centered counseling developed to help the person find the internal motivation to quit.
- Motivational enhancement therapy. This approach combines the style of motivational interviewing with psychological counseling, and presents a new way of thinking to people who may be fearful or defensive.
- Prize-based contingency therapy. This approach uses positive reinforcement (monetary or other) for drug abstinence. However,
researchindicates that it may not be effective long term.
- Seeking Safety. This approach, which is based on cognitive behavioral therapy (CBT), was developed for people with both SUD and PTSD.
Research indicatesit may be more effective for improving symptoms of PTSD compared with SUD, and that it’s most helpful when combined with other treatment methods.
- Guided self-change. This approach combines CBT with motivational counseling. Some
research suggestsit may be beneficial as an early intervention for teens with SUD.
- Other behavioral and cognitive behavioral-based techniques.
It’s important to note that many inpatient rehab centers are modeled around what your insurance company will pay for — not necessarily the best treatment outcome for each person.
For most people, an outpatient treatment approach will be just as effective and much more affordable than inpatient therapy.
Still, keep in mind that 12-step programs aren’t for everyone.
Living with and managing an addiction and substance use is a marathon, not a sprint.
One helpful measure is turning toward healthy activities you love. Scientific evidence suggests that
There are also many resources and coping skills you can turn to for help living with this condition.
It’s challenging to watch someone you care about develop or live with addiction. What can make it even harder is when it seems your loved one doesn’t want help.
Some people may find it very difficult to see or acknowledge that they have a SUD, even when co-workers, friends, and family believe it’s true. They may also be ashamed or afraid to come forward or ask for help.
It’s important to remember that the person with the addiction needs to be the one who seeks treatment.
Insisting that your loved one stops using is rarely going to bring about positive change. Instead, family members and friends should reach out to the person, offer emotional support, and let them know about available resources.
Recovery from substance use is very possible but requires strong commitment.
Many people begin their journey to recovery by discussing their addiction with a trusted doctor.
An initial screening may be used to detect a person’s risk for SUD. Then, it may be followed by a comprehensive evaluation and referral to an addiction specialist who can further explain the various treatment options.
The specialist can recommend an approach based on the severity of the addiction and resources available in your local community.
Importantly, treatment for substance use disorder is not a one-size-fits-all solution. Every person who enters treatment for SUD has unique needs.
For some people, intensive inpatient care may be the way to go, while others may benefit from part-time outpatient support. Plus, people may need different types of treatment at different times.
Many people want to do their own research or find a support group before deciding on a specific treatment approach.
Here are some resources worth checking out:
- SAMHSA. The Substance Abuse and Mental Health Services and Administration’s (SAMHSA) national helpline (1-800-662-4357) is a free and confidential 24-hour referral and information service (in English and Spanish) for individuals and families facing mental health or substance use disorders.
- AA and NA. Alcoholics Anonymous and Narcotics Anonymous are well-known 12-step groups for individuals recovering from alcohol or drug addiction.
- Double Trouble in Recovery. This is a 12-step fellowship for people managing both a mental illness and substance use disorder.
- Drugs and Me. Created by a group of scientists, educators, and analysts, the site Drugs and Me offers an extensive list of educational materials for various types of substance use.
- NHRC. The National Harm Reduction Coalition is an advocacy group for people with SUD.
Substance use disorder can affect anyone.
Behavioral addictions like gambling disorder, gaming disorder, or internet addiction are also somewhat common, though
Though SUD and addiction are challenging, recovery is possible with the right treatment plan and a support network by your side.
If you find your substance use or certain behavioral habits are hard to control, consider reaching out to a trusted healthcare professional or to one of the many resources and support groups available.