Drug use disorder

What is Drug Use Disorder?

Drug use disorder, also known as substance use disorder (SUD), is a mental health condition where you experience a problematic pattern of substance use that affects your health and well-being12. It is considered a chronic brain disease that causes a person to take drugs repeatedly, despite the harm they cause1.

Substances change how your brain works over time. They release dopamine, a chemical in your brain that makes you feel good until the substance wears off2. Your brain and body want to continue this good feeling, even if it's unhealthy. This condition can significantly impact your emotional well-being, relationships, education, and career. In many cases, it's life-threatening2.

The disorder exists on a spectrum and may be mild, moderate, or severe. The most important thing to know is that this condition is treatable and help is available when you're ready23.

Types of Substances

Drug use includes using illegal substances, misusing prescription medicines, and misusing over-the-counter medicines1. Some of the most common substances involved in drug use disorder include alcohol, opioids, and marijuana2.

Illegal substances include anabolic steroids, club drugs, cocaine, heroin, inhalants, marijuana, and methamphetamines1. Misusing prescription medicines means taking them in a different way than your health care provider prescribed. This includes taking a medicine prescribed for someone else, taking a larger dose than prescribed, using the medicine in a different way such as crushing and snorting tablets instead of swallowing them, or using the medicine for another purpose such as getting high1.

A substance use disorder can involve alcohol, cannabis, hallucinogens, inhalants, opioids (both prescription and illegal), sedatives, hypnotics or anxiolytics, stimulants and psychostimulants, tobacco (nicotine), or other unknown substances3. Alcohol use disorder is the most common type of substance use disorder in the United States2.

It's common to have more than one substance use disorder at a time, like alcohol use disorder and tobacco use disorder. This is known as a polysubstance use disorder2.

How Drug Use Becomes a Disorder

Drug use is dangerous because it can harm your brain and body, sometimes permanently. It can hurt the people around you, including friends, families, and children. If you are pregnant, it can harm your fetus. Drug use can also lead to mild, moderate, or severe substance use disorders1.

Not everyone who uses drugs becomes addicted. Everyone's bodies and brains are different, so their reactions to drugs can also be different. Some people may become addicted quickly, or it may happen over time. Other people never become addicted. Whether or not someone becomes addicted depends on many factors, including genetic, environmental, and developmental factors1.

Repeated drug use can change the brain and lead to addiction. The brain changes from addiction can be lasting, so drug addiction is considered a "relapsing" disease. This means that people in recovery are at risk for taking drugs again, even after years of not taking them1.

Some substances are more addictive than others. Drugs like crack or heroin are so addictive that they might only be used once or twice before the user loses control4. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others5.

Recognizing the Signs

There are many signs that someone may have a drug problem. These signs include changing friends a lot, spending a lot of time alone, losing interest in favorite things, not taking care of themselves such as not taking showers, changing clothes, or brushing their teeth, and being very energetic, talking fast, or saying things that don't make sense1.

Other behavioral changes to look for include changed personality, isolating themselves from friends and family, extreme changes in their behavior and mood like arguing and fighting more with family and friends, being sad, angry, or anxious whenever they are not using drugs or alcohol, and trouble remembering things or staying alert6.

People with drug use disorder may take risks to get and use drugs or alcohol, lose interest in activities they once enjoyed, and have changes in their habits around their drug or alcohol use. They may use drugs or alcohol first thing in the morning or while at school or work, use more drugs or alcohol to get the same effect, use more often, use alone, and spend more money on drugs or alcohol6.

The disorder can make it difficult to manage basic parts of life. This includes getting lower grades at school or lower productivity at work, missing school or work, decreased health, unstable finances, strained or tense relationships, and lower self-esteem6.

Symptoms of the 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 body2.

Intoxication is the immediate and short-term effect of a substance in your body. Symptoms include feeling sleepy, calm, excited, or experiencing intense emotions. The substance can also affect your judgment and decision-making or physical and mental functioning2.

Withdrawal symptoms 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 changes2.

According to medical guidelines, the signs of substance use disorder include taking the substance in larger amounts and for a longer amount of time than prescribed, having a strong desire or urge to use the substance, and having unsuccessful efforts to cut down on or manage substance use2.

Additional signs include 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, and giving up social, occupational, or recreational activities because of substance use2.

People may use substances again and again even when it puts them in danger, continue substance use despite an ongoing physical or psychological problem that's likely caused or worsened by the substance, develop tolerance (needing increased amounts to get the same effect), and experience withdrawal symptoms which can be relieved by taking more of the substance2.

Who is at Risk?

No single factor can predict whether you'll develop an addiction. A combination of factors influence your risk, including your individual biology, social environment, and age or stage of development. The more risk factors you have, the greater your chance of addiction4.

Your biology plays an important role. People can react to drugs differently. Some people like the feeling the first time they try a drug and want more. Others hate how it feels and never try it again1. Your genes and environmental influences account for about half of your addiction risk. Sex, ethnicity, and mental disorders also contribute to your risk4.

People who have untreated mental health problems, such as depression, anxiety, or attention deficit/hyperactivity disorder (ADHD) are more likely to become addicted. This can happen because drug use and mental health problems affect the same parts of the brain. Also, people with these problems may use drugs to try to feel better1.

Trouble at home can make you more likely to have a drug problem. If your home is an unhappy place or was when you were growing up, you might be more likely to develop substance use disorder1. Trouble in school, at work, or with making friends might lead you to use drugs to get your mind off these problems1.

Hanging around other people who use drugs can increase your risk. They might encourage you to try drugs1. Starting drug use when you're young is particularly risky. When kids use drugs, it affects how their bodies and brains finish growing. This increases your chances of becoming addicted when you're an adult1.

Getting a Diagnosis

Diagnosing drug addiction (substance use disorder) requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor7.

Blood, urine, or other lab tests are used to assess drug use, but they're not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery7.

For diagnosis of a substance use disorder, most mental health professionals use criteria published by the American Psychiatric Association. Seeking medical care as soon as you have signs of substance use disorder is essential27.

Treatment and Recovery Options

Although there's no cure for drug addiction, treatment options can help you overcome an addiction and stay drug-free. Your treatment depends on the drug used and any related medical or mental health disorders you may have. Long-term follow-up is important to prevent relapse7.

Treatment programs for substance use disorder usually offer individual, group, or family therapy sessions, a focus on understanding the nature of addiction, becoming drug-free and preventing relapse, and levels of care and settings that vary depending on your needs, such as outpatient, residential, and inpatient programs7.

The goal of detoxification, also called "detox" or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center7.

There are safe and effective ways to recover from substance use disorders. Finding the right treatment option can be the key to a successful recovery journey. Recovery options include outpatient counseling, which helps people understand addiction, their triggers, and their reasons for using drugs3.

Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy. It may even require checking into a rehabilitation facility3. While no single treatment method is right for everyone, recovery is possible, and help is available for patients with substance use disorders3.

Like many other chronic conditions, treatment is available for substance use disorders. Evidence-based guidelines can assist doctors with choosing the right treatment options. These guidelines help evaluate a patient's clinical needs and situation to match them with the right level of care in the most appropriate available setting3.

It's important to remember that addiction is a disease, not a character flaw. People experiencing substance use disorders have trouble controlling their drug use even though they know drugs are harmful. Overcoming a substance use disorder is not as simple as resisting the temptation to take drugs3.