Alcohol & substance use disorder

Substance use disorder means that a person uses substances even though it causes harm to themself or others. Substances include alcohol, marijuana or other drugs, inhalants, prescription medicines, and over-the-counter medicines. Substance use disorder can range from mild to severe. The more symptoms of this disorder you have, the more severe it may be.

Symptoms of substance use disorder include:

• Using more of the substance over longer periods of time or needing more of it to feel high.
• Continuing to use the substance even though it harms your relationships, causes physical problems, or causes problems at home, school, or work.
• Trying to quit using the substance but not being able to.
• Using substances in situations where doing so is dangerous, such as driving.
• Feeling sick if you stop using the substance (withdrawal).

Many factors can lead to substance use disorder. It's not due to weakness or a lack of willpower.

Certain things make it more likely that you will develop a substance use disorder. These are called risk factors.

Genetic and health risk factors

These include:

• Genes.

  Genes play an important role in personality. As a result, substance use disorder often runs in families. Genes may influence whether you use substances and whether your substance use becomes substance use disorder.

• Mental health.

  You're more likely to develop substance use disorder if you have a mental health condition, such as depression, post-traumatic stress disorder (PTSD), or an anxiety disorder. Treating mental health conditions makes substance use less likely. And if you have substance use disorder, treating mental health conditions makes recovery more likely.

Social and other risk factors

These include:

• Early use.

  The earlier you start to use substances, the more likely you are to develop substance use disorder. This may be because early substance use changes the developing brain.

• How you use.

  If you smoke a drug or inject it into a vein, you are more likely to develop substance use disorder. These methods give you a fast and intense high, but you lose the high quickly and then feel low. This may cause you to use the substance more often.

• Environment.

  You're more likely to use substances if you live in an area where they're easy to get and substance use is common.

• Family and friends.

  You are more likely to use substances if your family members or friends use them.

• Problems with others.

  You may be more likely to use substances when you are having problems in your family or with friends.

• Lack of purpose or satisfaction.

  If you have no activities that give you a sense of purpose, you may be more likely to use substances.

The more symptoms of substance use disorder you have, the more severe it may be. Symptoms include:

• Using more of the substance or using it for a longer time than you ever meant to.
• Not being able to cut down or control your use.
• Spending a lot of time getting or using the substance or recovering from the effects.
• Having a strong need, or craving, for the substance.
• Not being able to do your main jobs at work, school, or home.
• Continuing to use, even though the substance use hurts your relationships.
• Not doing important activities because of your substance use.
• Using substances in situations where doing so is dangerous, such as driving.
• Using the substance even though it's causing health problems.
• Needing more of the substance to get the same effect, or getting less effect from the same amount over time (tolerance).
• Having uncomfortable symptoms when you stop using the substance or use less (withdrawal).

Substance use disorder may be diagnosed during a routine doctor visit. Or you may see your doctor for a health or other problem linked to substance use, such as anxiety, depression, or family conflict.

Diagnosing substance use disorder

Your doctor will ask questions about your symptoms and past health and do a physical exam. If your doctor thinks you have substance use disorder, your doctor may ask about current and past substance use and your family history of substance use.

Your doctor may ask you to have:

• A test to check for substance use, such as a urine or blood test.
• Tests to look for health problems related to substance use. These may include tests for hepatitis B, hepatitis C, or HIV.

If you and your doctor agree that you have substance use disorder, your doctor probably will refer you to a specialist who treats substance use.

Checking for a dual diagnosis

Many people who have substance use disorder also have a mental health condition, such as depression or an anxiety disorder. This is called a dual diagnosis. If this may be true for you, your doctor may do a mental health assessment.

If you have a dual diagnosis, you'll need treatment for both conditions. This gives you a better chance of a full recovery and less chance of using substances again.

The first step to treat substance use disorder is to seek help from your family doctor or treatment program in your area. Treatment usually includes group therapy, other types of counseling, and substance use education. You may need medicine to help you move toward staying substance-free. Attending a 12-step program, such as Narcotics Anonymous (NA), is often part of treatment and continues afterward as part of your recovery. Your family members might also want to attend a support group such as Nar-Anon.

When you have stopped using substances, you have taken the first step toward recovery. To gain full recovery, you need to take steps to improve other areas of your life, such as learning to deal with your work, family, and living situation in healthy ways. This makes it easier to stay substance-free.

Starting treatment

You might start with your family doctor. Or your doctor may recommend that you enter a treatment program. You might go to a clinic that deals with substance use.

You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.

You may be asked questions about your drug use, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your team may write a plan that includes your treatment goals and ways to reach those goals. This helps you stay on track.

Treatment options

Treatment for substance use disorder may include:

Detox.

You may need medical care to manage withdrawal symptoms when you first quit. Some people call this detoxification, or detox. Detox usually is done under the care of a doctor. Withdrawal can be dangerous without medical care.

Treatment programs.

Treatment programs can be outpatient, inpatient, or residential. They offer similar therapies. Your treatment team can help you decide which type of program is best for you.

Counseling.

Treatment for substance use disorder usually involves one or more types of counseling. These may include cognitive-behavioral therapy (CBT), motivational interviewing (MI), or family therapy.

Medicines.

Medicines are often used to treat substance use disorder. You may take medicines to help you quit using opioids or to help you overcome withdrawal symptoms. Medicines that can help you include methadone and naltrexone.