Substance Use Disorder (SUD)

What is substance use disorder?

Substance use disorder (SUD), formerly known as drug addiction, is a mental health condition where you experience a problematic pattern of substance use that affects your health and quality of life.

Substances change how your brain functions over time. They release dopamine, a chemical in your brain that makes you feel good — until the substance wears off. Your brain and body want to continue this good feeling, even if it’s unhealthy. It can significantly impact your emotional well-being, relationships, education and career. And in many cases, it’s life-threatening.

SUD exists on a spectrum and may be mild, moderate or severe. No matter where you are, know that this condition is treatable and help is available when you’re ready.

What are the types of substance use disorder?

Some of the most common types include:

• Alcohol use disorder.
• Cocaine use disorder.
• Cannabis use disorder.
• Tobacco use disorder.
• Methamphetamine use disorder.
• Opioid use disorder.

It’s common to have more than one SUD at a time, like alcohol use disorder and tobacco use disorder. This is known as a polysubstance use disorder.

What is the most common type of substance use disorder?

Alcohol use disorder is the most common type of SUD in the U.S.

What are the symptoms of substance use disorder?

The symptoms and effects of substance use disorder vary based on the type of substance you use. There are two groups of symptoms based on when or if the substance is in your body. These include:

• Intoxication: This is the immediate and short-term effect of a substance in your body. Symptoms include feeling sleepy, calm, excited, intense emotions, etc. The substance can also affect your judgment and decision-making or physical and mental functioning.
• Withdrawal: These are symptoms that happen when the short-term effects of a substance wear off and the substance starts to leave your body. Symptoms are unpleasant and could include nausea and vomiting, diarrhea, sweating, difficulty sleeping, muscle cramping and mood changes.

What are the signs of a substance use disorder?

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the signs of substance use disorder include:

• Taking the substance in larger amounts and for a longer amount of time than you’re meant to if it’s a prescription.
• Having a strong desire or urge to use the substance.
• Having unsuccessful efforts to cut down on or manage substance use.
• Spending a lot of time obtaining or using the substance or recovering from its effects.
• Having issues fulfilling responsibilities at work, school or home due to substance use.
• Continuing to use the substance, even when it causes problems in relationships.
• Giving up social, occupational or recreational activities because of substance use.
• Using substances again and again, even when it puts you in danger.
• Continuing substance use despite an ongoing physical or psychological problem that’s likely caused or worsened by the substance.
• Developing tolerance (need for increased amounts to get the same effect).
• Experiencing withdrawal symptoms, which can be relieved by taking more of the substance.

Seeking medical care as soon as you have signs of substance use disorder is essential.

What causes substance use disorder?

The exact cause of a substance use disorder isn’t well understood. However, research shows that the changes to your brain’s reward system due to a substance’s addictive potential may cause the condition.

How does a substance use disorder develop?

Studies found that many factors may be involved in the development of an SUD. These could include:

• Social pressure.
• Curiosity of substance effects.
• Performance enhancement (to do better at work or school).
• Emotional escape (like relief from stress, anxiety, fear or depression).

The progression to a substance use disorder often follows this pattern:

• Experimental use (or prescription use): Trying a substance once or using the substance as directed.
• Occasional use: Taking a substance socially or using prescriptions not as directed.
• Heavy use: Taking a substance routinely, with few to no days off of the substance.
• Substance use disorder: You take the substance daily or multiple times daily. There are rarely times when you’re not using a substance.

This is just an example, as this condition looks very different and ranges in severity from person to person.

What are the risk factors for a substance use disorder?

Substance use disorder affects people of all ages, races, sexes, genders and socioeconomic levels.

You may be more at risk of developing it if you:

• Have an underlying mental health condition.
• Have a biological relative with a SUD.
• Have a history of adverse childhood experiences.
• Have a genetic susceptibility (a genetic variant makes SUDs more common).
• Have exposure or easy access to substances.

What are the complications of substance use disorder?

One of the more common and most deadly complications of substance use disorder is overdose. An overdose happens when you take too much of a substance. This is a medical emergency.

Different substances affect different parts of your body. For example, if you overdose on opioids, it targets the part of your brain that regulates your breathing. If not treated quickly, your breathing slows or stops completely, leading to death.

SUD complications are extensive and vary based on severity and type. Common complications may include:

• Cancer.
• Depression.
• Infections (hepatitis B, hepatitis C and HIV).
• Memory loss.
• Academic or career challenges.
• Interpersonal relationship difficulties.
• Unsafe, illegal or at-risk behaviors.

How is substance use disorder diagnosed?

There isn’t a single test available to diagnose substance use disorder. Instead, healthcare providers rely on a thorough evaluation of your medical history and behaviors surrounding substance use. They may order drug tests to see how much and how many types of substances are in your body at a time. They may also evaluate prescription drug monitoring program reports (a database of distributed controlled substances).

A provider will also ask about your mental health history, as it’s common to have an SUD and a mental health condition.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must have at least two signs in the symptoms section over 12 months to be diagnosed with substance use disorder.

It’s important to remember that this condition exists on a spectrum of severity:

• Two to three signs indicate a mild substance use disorder.
• Four or five signs indicate a moderate substance use disorder.
• Six or more symptoms indicate a severe substance use disorder.

How is substance use disorder treated?

The first step of substance use disorder treatment is withdrawal management. This is where you stop taking the substance, allowing it to leave your body. Depending on the severity, a healthcare provider may offer medications to lessen the effects of withdrawal symptoms, as they can be rough physically and mentally.

After detox, you may continue a course of treatment with:

• Therapy.
• Medication.

SUD treatment is highly individualized. You might need different types of treatment at different times during your recovery. Several types of treatment settings, including inpatient and outpatient settings, as well as short-term care and long-term therapeutic communities, are available.

SUD therapy

Many different types of therapy can help treat SUD and any other co-occurring mental health conditions. Some examples of effective therapies for adults with SUDs include:

• Assertive community treatment (ACT): ACT provides mental health services in a community setting rather than a residential or hospital setting. ACT is highly individualized. Your treatment plan will focus on your strengths, needs and goals for the future.
• Cognitive behavioral therapy (CBT): CBT helps you identify problematic patterns of behavior and thinking. You’ll set goals to find healthier ways to cope.
• Contingency management: This type of therapy encourages you to set personal goals. When you reach a goal, it’s reinforced with a reward.
• Dialectical behavior therapy (DBT): DBT is a type of talk therapy similar to CBT. It’s designed to help you manage intense emotions and understand how your thoughts influence your behaviors.
• Family therapy: Family therapy helps you improve relationships and behaviors within a family or group setting.
• Motivational enhancement therapy: This type of therapy encourages you to set attainable goals. A mental health professional will encourage you to take steps to reach these goals.
• Therapeutic communities (TCs): A TC is a long-term residential treatment that focuses on helping you develop new, healthier values and behaviors related to substance use and other co-occurring mental health conditions.

Participating in self-help programs, like Narcotics Anonymous, can also play a significant role in SUD treatment. These programs support behavioral modification through self-help and peer support. Group therapy supports people with SUD in maintaining abstinence and restraint.

Healthcare providers may recommend therapies alone or in combination with medications.

SUD medications

Medications can help modify your brain chemistry to help treat certain SUDs. They can also relieve cravings and withdrawal symptoms.

The following U.S. Food and Drug Administration (FDA)-approved medication-assisted treatments are available:

• Opioids: Methadone, buprenorphine and naltrexone.
• Alcohol: Naltrexone, acamprosate and disulfiram.
• Tobacco: A nicotine patch, nasal spray, gum or lozenge; bupropion or varenicline.

Can substance use disorder be prevented?

You can’t prevent all cases of substance use disorder because there are a lot of factors (many of which are outside of your control) that could play a role in how the condition develops. However, you can take steps to reduce your risk.

Education in schools, communities and families may reduce your risk of using a substance or misusing a prescription medication for the first time. Other ways to prevent SUD include:

• Following instructions for prescription medications. Don’t take more than instructed. Opioid use disorder, for instance, can start after just five days of misuse.
• Never sharing your prescription medication with someone else or selling your medication. Always store it in a safe place away from children.
• If you have leftover prescription medications (like opioids) at the end of your treatment, find a community drug take-back program or pharmacy mail-back program to safely dispose of them.

The risk of substance use increases during times of stress and change. For an adult, a divorce, loss of a job or death of a loved one may increase the risk of substance use. For a teenager, moving, family divorce or changing schools can increase their risk. It’s important to turn to healthy coping mechanisms during these times of change, like exercising, meditating or learning a new hobby. Consider seeing a mental health professional if you’re having difficulty managing stress.

What’s the outlook for substance use disorder?

The prognosis (outlook) for this condition varies based on several factors, including:

• The type and severity of the SUD.
• The level of commitment to treatment and recovery.
• Genetics.
• How you cope during stressful situations.

Substance use disorder is a lifelong disease. But recovery is possible. Different tools work for different people. Many find success through support groups (like Narcotics Anonymous) and ongoing therapy.

Relapses are common with SUD. A relapse is returning to a substance after stopping it for a period of time. You’ll need to detox again and restart your treatment cycle from the beginning. This can be a frustrating process. Relapses can happen years after you last took a substance. It helps to have a strong support system to rely on if you may be at risk of relapse.

Your healthcare provider should review your treatment plan regularly. It’s normal for your goals or lifestyle to change. This may mean you try a different type of therapy or a new medication. A provider can help you make adjustments throughout your life as needed. 

When should I see a healthcare provider?

If you’re currently using a substance regularly and are concerned it’s turning into a habit you’re unable to stop on your own, talk to a healthcare provider. A provider can also give you guidance on how to have a conversation with your children about SUD and get them help if you think they’re at risk.