What Is Substance Use Disorder
Substance use disorder, which has also been referred to as abuse, dependence and addiction, is diagnosed if certain criteria occur within a 12-month period as defined by the DSM-5 . The criteria include:
1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
3. A great deal of time is spent to obtain, consume and recover from a substance.
4. Craving, or a strong desire or urge to use the substance, occurs.
5. Continued use of the substance results in a failure to fulfill major role responsibilities at work, school or home.
6. Use of the substance is contributing to relationship problems.
7. Important social, occupational or recreational activities are given up or reduced because of use of the substance.
8. Use of the substance is recurrent in situations in which it is physically hazardous .
9. Continuing to use the substance despite knowing that it has an impact on physical or psychological problems likely caused by the substance .
10. Tolerance, which means that the person needs more of a substance to get a desired effect or the same amount of a substance doesnt produce the desired effect any longer.
11. Withdrawal, such that when the substance is not taken, a person experiences substance-specific withdrawal symptoms.
Can I Prevent Substance Use Disorder
Yes. Preventing drug addiction starts with education. Education in schools, communities and families helps prevent misusing a substance for the first time. Other ways to prevent substance use disorder:
- Dont try illegal drugs, even one time.
- Follow instructions for prescription medications. Don’t ever take more than instructed. Opioid addiction, for instance, can start after just five days.
- Dispose of unused prescriptions promptly to reduce risks of misuse by others.
What Is Substance Abuse
Substance abuse is not the same thing as addiction, though it is still a cause for concern. Both overusing a substance and using a substance in a manner other than its intended use are signs of substance abuse. For example, if you are prescribed a painkiller but you take it more often, or in higher doses, than your prescription dictates, this is a sign of substance abuse.
- Regularly missing work, school, or social events
- Failing to fulfill obligations
- Denying the severity of the drug use problem
- Isolating oneself from family and friends
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Treatment Programs For Veterans With Co
Veterans deal with additional challenges when it comes to co-occurring disorders. The pressures of deployment or combat can exacerbate underlying mental disorders, and substance abuse is a common way of coping with the unpleasant feelings or memories associated with PTSD in military veterans.
Often, these problems take a while to show up after a vet returns home, and may be initially mistaken for readjustment. Untreated co-occurring disorders can lead to major problems at home and work and in your daily life, so its important to seek help.
Do Men And Women Differ In Terms Of Their Risk Of Addiction
Yes. Overall, men are about one and a half to two times more likely to have a substance use disorder than women. Data from the National Survey on Drug Use and Health indicate that in 2019, approximately 10.7% of males 12 years of age and older and 6.3% of females met criteria for an SUD in the prior year. It is important to note, however, that when children 12 to 17 were examined apart from adults, the rates for boys and girls were much closer and even slightly higher for girls than for boys .
Similarly, epidemiological research has found that among younger women and men in the U.S., the gender differences in rates of binge and heavy drinking are smaller than are seen for older adults. This suggests that women are essentially catching up to men in unsafe use of alcohol, and this has significant implications for their health and safety and that of their children, both unborn and born.
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A Note From Addiction Policy Forum
Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. Many families are wrongly told to wait for rock bottom and that their loved one needs to feel ready to seek treatment in order for it to work. The idea that we should wait for the disease to get worse before seeking treatment is dangerous. Imagine if we waited until stage 4 to treat cancer. Decades of research has proven that the earlier someone is treated, the better their outcomesand that treatment works just as well for patients who are compelled to start treatment by outside forces as it does for those who are self-motivated to enter treatment.
How Is Substance Use Disorder Diagnosed
The first step to diagnosing a drug addiction is recognizing the problem and wanting help. This initial step may start with an intervention from friends or loved ones. Once someone decides to seek help for addiction, the next steps include:
- Complete exam by a healthcare provider.
- Individualized treatment, either inpatient or outpatient.
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Recognizing A Dual Diagnosis
It can be difficult to identify a dual diagnosis. It takes time to tease out what might be a mental health disorder and what might be a drug or alcohol problem. The signs and symptoms also vary depending upon both the mental health problem and the type of substance being abused, whether its alcohol, recreational drugs, or prescription medications. For example, the signs of depression and marijuana abuse could look very different from the signs of schizophrenia and alcohol abuse. However, there are some general warning signs that you may have a co-occurring disorder:
- Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?
- Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Or drink when youre feeling anxious or plagued by unpleasant memories?
- Has someone in your family grappled with either a mental disorder or alcohol or drug abuse?
- Do you feel depressed, anxious, or otherwise out of balance even when youre sober?
- Have you previously been treated for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?
Dual diagnosis and denial
Resources To Learn More
Defines and describes several types of SUDs, including opioid use disorder and stimulant use disorder.Organization: Substance Abuse and Mental Health Services Administration
Pain in the Nation Update: Alcohol, Drug, and Suicide Deaths in 2018 Document Outlines changes and trends in annual deaths from alcohol, drugs, and suicide in the U.S from 1999 to 2018. Highlights policies, programs, and research to reduce and prevent deaths due to alcohol, drugs, and suicide.Organization: Trust for America’s Health Date: 05/2020
Patterns and Characteristics of Methamphetamine Use Among Adults United States, 2015-2018 Document Examines methamphetamine use rates in the United States and characteristics associated with past-year methamphetamine use using data estimates from the 20152018 National Surveys on Drug Use and Health .Author: Jones, C., Compton, W., & Mustaquim, D. Citation: Morbidity and Mortality Weekly Report , 69, 317323 Date: 03/2020
Substance-Related and Addictive Disorders Document Describes the changes in the DSM-5 manual combining DSM-IV categories of substance use disorder into a single disorder measured on a continuum from mild to severe.Organization: American Psychiatric Association
What is Addiction? Website Defines SUDs, identifies commonly misused substances, provides an overview of treatment options for addiction, and touches on prevention methods and programs.Organization: American Psychiatric Association
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What Causes Drug Abuse Or Dependence
Cultural and societal factors determine what are acceptable or allowable forms of drug or alcohol use. Public laws determine what kind of drug use is legal or illegal. The question of what type of substance use can be considered normal or acceptable remains controversial. Substance abuse and dependence are caused by multiple factors, including genetic vulnerability, environmental stressors, social pressures, individual personality characteristics, and psychiatric problems. But which of these factors has the biggest influence in any one person cannot be determined in all cases.
Substance Use And Mental Health Disorders
There is a significant correlation between mental health disorders and substance abuse. Studies have shown that 50% of people with a mental illness also have co-occurring substance use issue, and vice versa. 12 People with anxiety disorders such as generalized anxiety, depression, and post-traumatic stress disorder are more likely to be diagnosed with substance use disorder.13 Integrated treatment of the substance use disorder and co-occurring disorder has been shown to decrease substance use and psychiatric functioning.
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Types Of Substance Use Disorders
Different Types of Substance Use Disorders
Patients are diagnosed with a specific type of disorder based on the primary substance that they misuse, such as an alcohol use disorder, or opioid use disorder, stimulant use disorder, marijuana use disorder or sedative use disorder. However, many patients diagnosed with SUD misuse more than one kind of substance–also known as a polysubstance use disorder.
Different Types of Substance Use Disorders:
An excerpt from Navigating Addiction and Treatment: A Guide for Families, Addiction Policy Forum, 2020.
What Is Substance Use And Addiction
Many people use substances such as drugs or alcohol to relax, have fun, experiment, or cope with stressors, however, for some people the use of substances or engaging in certain behaviours can become problematic and may lead to dependence.
Addiction is a complex process where problematic patterns of substance use or behaviours can interfere with a persons life. Addiction can be broadly defined as a condition that leads to a compulsive engagement with a stimuli, despite negative consequences.i This can lead to physical and/or psychological dependence. Addictions can be either substance related or process-related, also known as behavioural addictions .ii Both can disrupt an individuals ability to maintain a healthy life, but there are numerous support and treatment options available.
A simple way of understanding and describing addiction is to use the 4Cs approach:
- Loss of control of amount or frequency of use
- Compulsion to use
- Continued substance use despite consequencesiii
How common is substance use and addiction?
Substance use is quite common on an international scale and statistics vary depending on the substance being consumed. It is estimated that nearly 5% of the worlds population have used an illicit substance, 240 million people around the world use alcohol problematically, and approximately 15 million people use injection drugs.iv
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Helping A Loved One With A Dual Diagnosis
Helping someone with both a substance abuse and a mental health problem can be a roller coaster. Resistance to treatment is common and the road to recovery can be long.
The best way to help someone is to accept what you can and cannot do. You cannot force someone to remain sober, nor can you make someone take their medication or keep appointments. What you can do is make positive choices for yourself, encourage your loved one to get help, and offer your support while making sure you dont lose yourself in the process.
Get more help
Co-Occurring: Mental Health and Substance Abuse Advice and help for individuals with co-occurring disorders and their loved ones.
Comorbidity: Addiction and Other Mental Illnesses The link between substance abuse and mental health.
Substance Use Disorders The relationship between anxiety and substance use.
Mental Health Disorders and Teen Substance Use Why its especially risky for kids with emotional or behavioral challenges to drink or use drugs.
Helplines and support groups
UK: Call the SANEline at 07984 967 708.
Australia: Call the Sane Helpline at 1800 187 263.
Canada: Visit Mood Disorders Society of Canada for links to provincial helplines.
India: Call the Vandrevala Foundation Helpline at 1860 2662 345.
Treating Substance Use Disorder
Medical treatment is available for substance use disorders. Programs should follow these principles of addiction treatment:
- Addiction is a complex but treatable health condition.
- Theres no single treatment that works for everyone.
- Treatment is readily available.
- Treatment focuses on your multiple needs.
- Treatment addresses your mental health. Your treatment needs are regularly evaluated to ensure your treatment is meeting them.
- Its critical to remain in treatment for an adequate amount of time. Voluntary and involuntary treatment can be effective.
- Potential substance use is monitored during treatment because relapses can and do happen.
Treatment programs should also check and assess for infectious diseases while providing risk-education counseling. This empowers you to take control of your health so you dont contract or transmit infectious diseases.
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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 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 dont 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: 23 symptoms
- outpatient treatment
Various SUD treatment programs stem from three basic models:
Most substance use treatment is centered around talk therapy. The psychological therapies most commonly used in treating substance use disorder include:
Its 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.
What Are Some Tips For Preventing Substance Abuse Disorders
There are a variety of things that you can do to help prevent substance abuse disorders. Some of these include avoiding drugs and alcohol, staying in school, and participating in positive activities.
Additionally, you can talk to your doctor about your risk factors for developing substance abuse disorders. And finally, you can get help if you think you or someone you know may have a problem with substance abuse.
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What Are Substance Use Disorders
The DSM-5-TR recognizes substance-related disorders resulting from the use of 10 separate classes of drugs:
While some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.
The activation of the brains reward system is central to problems arising from drug use. The rewarding feeling people experience due to taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.
The pharmacological mechanisms for each class of drug are different. But the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a high.
The DSM-5-TR recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders. Some people have lower levels of self-control that predispose them to develop problems if exposed to drugs.
Substance Use Disorders And Addiction Series
Over the past few decades great advances have been made towards understanding the psychology of substance use disorders and addictions. This five-part series is designed to provide psychologists and psychology students with cutting-edge information about SUDs and addictive behaviors. This series is a collaboration with the American Psychological Association Office of Continuing Education in Psychology, the APA Science Directorate, the APA Center for Learning and Career Development, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the Society of Addiction Psychology .
In addition, the American Psychological Association, in consultation with Carlo DiClemente, Ph.D., and made possible through grant funding from the Substance Abuse and Mental Health Services Administration , has created a Substance Use Disorders curriculum that was designed to address the need for graduate-level psychology education and training in the assessment and treatment of substance use disorders . Please access the APA Substance Use Disorders curriculum on the APA Website.
Is Treatment For Drug Addiction Inpatient Or Outpatient
Both inpatient and outpatient treatment plans are available, depending on your needs. Treatment typically involves group therapy sessions that occur weekly for three months to a year.
Inpatient therapy can include:
- Therapeutic communities or sober houses, which are tightly controlled, drug-free environments.
Self-help groups such as Alcoholics Anonymous and Narcotics Anonymous can help you on the path to recovery. Self-help groups are also available for family members, including Al-Anon and Nar-Anon Family Groups. Participation in 12-step based recovery work has been proven to improve outcomes.
Tip : Make Healthy Lifestyle Changes
Exercise regularly.Exercise is a natural way to bust stress, relieve anxiety, and improve your mood and outlook. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days.
Practice relaxation techniques. When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce symptoms of stress, anxiety, and depression, and increase feelings of relaxation and emotional well-being.
Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more stressed or anxious. Getting enough healthy fats in your diet can help to boost your mood.
Get enough sleep. A lack of sleep can exacerbate stress, anxiety, and depression, so try to get 7 to 9 hours of quality sleep a night.
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