Substance Use Disorder
What is it?
Drug addiction, also referred to as substance use disorder, is a medical condition that impacts a person’s brain and behaviour, resulting in an inability to control the use of legal or illegal drugs or medications. Substances such as alcohol, marijuana, and nicotine are classified as drugs.
Despite the harm it causes, individuals with addiction continue to use these substances. Addiction can begin with experimental use of recreational drugs in social settings, and for some, it progresses to more frequent use. In the case of opioids, addiction can start with the use of prescribed medications or obtaining them from others with prescriptions.
Over time, individuals may develop tolerance, requiring larger drug doses to achieve the desired high or simply to feel normal. Attempts to quit drug use can lead to intense cravings and physical illness known as withdrawal symptoms.
People with substance use disorder may experience distorted thinking and behaviours. Changes in brain structure and function contribute to intense cravings, alterations in personality, abnormal movements, and other behavioural changes. Brain imaging studies reveal modifications in areas of the brain involved in judgement, decision-making, learning, memory, and behavioural control.
Causes
The causes of SUD are multifaceted and can vary from person to person. Here are some common factors that can contribute to the development of Substance Use Disorder :
- Biological Factors : Genetic predisposition can play a role in the development of SUD. Some individuals may have a higher risk due to specific genetic variations that affect how their bodies respond to substances, including how quickly they metabolise drugs or alcohol. Additionally, certain brain chemistry imbalances or abnormalities in reward pathways may increase susceptibility to addiction.
- Environmental Factors : Environmental influences significantly impact the development of SUD. Factors such as exposure to substance use at an early age, peer pressure, family history of addiction, lack of parental guidance, childhood trauma or abuse, and chaotic home environments can contribute to the likelihood of developing a substance use problem.
- Psychological Factors : Certain psychological factors can make individuals more vulnerable to SUD. Co-occurring mental health disorders, such as depression, anxiety, or trauma-related disorders, can increase the risk of substance abuse as individuals may turn to substances as a way to self-medicate or alleviate distressing symptoms. Additionally, personality traits like impulsivity, sensation-seeking, low self-esteem, or a history of poor coping skills can also contribute to the development of addiction.
- Social and Cultural Factors : Social and cultural influences play a significant role in SUD. Factors such as societal attitudes towards substance use, cultural norms around drinking or drug use, availability of substances, and social acceptance of substance use can influence an individual’s perception and patterns of substance use.
- Developmental Factors : The stage of life can impact the development of SUD. Adolescents and young adults are particularly vulnerable due to ongoing brain development, peer pressure, and experimentation. Early exposure to substances during critical periods of brain development can increase the risk of addiction later in life.
Symptoms of substance use disorders include
- Feeling the need to use the drug regularly, even multiple times a day.
- Experiencing intense cravings for the drug to achieve the desired effect.
- Developing tolerance over time, requiring increasing amounts of the drug for the same effect.
- Taking larger quantities of the drug over longer periods than intended.
- Ensuring a consistent supply of the drug.
- Spending money on the drug despite financial difficulties.
- Neglecting obligations, work responsibilities, or reducing social and recreational activities due to drug use.
- Continuing to use the drug despite awareness of its negative impact on life and physical or psychological well-being.
- Engaging in atypical behaviours, such as theft, to obtain the drug.
- Engaging in risky activities, including driving, while under the influence of the drug.
- Spending significant time acquiring, using, or recovering from the effects of the drug.
- Failing in attempts to quit using the drug.
- Experiencing withdrawal symptoms when attempting to stop taking the drug.
Treatment
Treatment for Substance Use Disorders (SUD) typically involves a comprehensive and individualised approach that addresses both the physical and psychological aspects of addiction. Here are some common treatment modalities and interventions used in the management of SUD :
- Detoxification : The initial step in treating SUD is often detoxification, which focuses on safely managing withdrawal symptoms when discontinuing substance use. Medical supervision and support may be necessary during this process to ensure safety and comfort.
- Behavioural Therapies : Various evidence-based behavioural therapies are used to address the psychological and behavioural aspects of addiction. These therapies help individuals identify and change unhealthy patterns of thinking and behaviour associated with substance use. Examples include Cognitive-Behavioral Therapy (CBT), Motivational Interviewing (MI), Contingency Management (CM), and Dialectical Behavior Therapy (DBT).
- Medication-Assisted Treatment (MAT) : For certain substance addictions, medications may be prescribed to help manage cravings, reduce withdrawal symptoms, and support long-term recovery. Medications like methadone, buprenorphine, naltrexone, or acamprosate can be used in combination with behavioural therapies for opioids, alcohol, or nicotine addiction.
- Support Groups : Participating in support groups, such as 12-step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can provide peer support, accountability, and guidance throughout the recovery journey. Non-12-step support groups, such as SMART Recovery, are also available as alternatives.
- Individual and Family Counseling : Individual counselling sessions provide a private and supportive environment to explore personal triggers, underlying issues, and develop coping skills to maintain sobriety. Family counselling is beneficial for repairing relationships, improving communication, and addressing the impact of addiction on the family system.
- Dual Diagnosis Treatment : For individuals with co-occurring mental health disorders alongside SUD, integrated treatment that addresses both conditions simultaneously is essential. This may involve collaboration between addiction specialists and mental health professionals to provide comprehensive care.
- Aftercare and Relapse Prevention : Continuing care and support after initial treatment are crucial for long-term recovery. Aftercare programs may include ongoing counselling, support group participation, sober living arrangements, vocational training, and assistance with reintegration into society.
It’s important to note that treatment plans should be tailored to the individual’s specific needs, taking into account the substance of abuse, severity of addiction, mental health status, and personal circumstances. Seeking professional help from addiction specialists, counsellors, or treatment centres is essential to receive an accurate assessment and appropriate treatment recommendations.
