Substance use disorder (SUD) is a mental health condition in which a person has a problematic pattern of substance use that causes distress and/or impairs their life.
SUD exists on a spectrum and may be mild, moderate or severe. It typically involves an overpowering desire to use the substance, increased tolerance to the substance and/or withdrawal symptoms when you stop taking the substance.
A person can have more than one substance use disorder at a time, such as alcohol use disorder and cocaine use disorder.
Substance use disorder can significantly impact your health, relationships and overall quality of life. It can also be life-threatening. It’s crucial to seek help as soon as you develop signs of SUD.
Substances are drugs that have addiction potential. They can be prescription drugs or non- medical drugs and include:
While these substances are very different from each other, they all strongly activate the reward center of your brain and produce feelings of pleasure.
These substances vary in how likely they are to lead to SUD. The likelihood is called “addiction liability,” and it depends on multiple factors, including:
Substance use/misuse refers to occasional episodes of substance use rather than chronic, habitual or patterned use.
People can use substances occasionally without developing SUD, but even a few episodes of taking certain substances can lead to tolerance and dependence. Tobacco, heroin, cocaine, alcohol, cannabis and benzodiazepines are all substances that you can develop tolerance and dependence to.
Substance use disorder can be mild, moderate or severe. Addiction is the most severe form of SUD. It involves continued substance use despite negative consequences. Addiction to
substances happens when the reward system in your brain “takes over” and amplifies compulsive substance-seeking.
Both involve the development of physical dependence and psychological dependence.
People are psychologically dependent when a drug is so central to their thoughts, emotions and activities that the need to continue its use becomes a craving or compulsion despite negative consequences.
With physical dependence, your body has adapted to the presence of the substance, and withdrawal symptoms happen if you suddenly stop taking the drug or you take a reduced dosage.
In the past, healthcare providers, organizations and members of the public often used the
terms “addiction/addict,” “abuse/abuser” and “dependence” when referring to substance use.
Mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM), have become more sophisticated over time. The term “substance use disorder” allows for more clarity in diagnosis. SUD also recognizes a spectrum of problematic substance use, not just physiologic addiction.
In addition, there’s a lot of stigma and negativity associated with the terms “addiction/addict” and “abuse/abuser.” Similarly, people often use the terms “addiction” and “addict” casually to describe an affinity for a thing, place or hobby. This downplays the seriousness and complexity of true addiction and substance use disorder.
Substance use disorder affects people of all ages, races, genders and socioeconomic levels.
In general, people assigned male at birth (AMAB) are more likely to develop SUD. Substance use/misuse is highest among people aged 18 to 25.
Tobacco use disorder is the most common substance use disorder worldwide
What are the signs and symptoms of substance use disorder?
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the signs of substance use disorder include:
likely caused or worsened by the substance.
Other symptoms and behaviors of substance use may include:
The progression to a substance use disorder often follows this pattern:
This progression is complex, and several complex factors contribute to the development of substance use disorder, including:
Substances affect your brain, especially the reward center of your brain.
Humans are biologically motivated to seek rewards. Often, these rewards come from healthy behaviors. When you spend time with a loved one or eat a delicious meal, your body releases a chemical called dopamine, which makes you feel pleasure. It becomes a cycle; you seek out these experiences because they reward you with good feelings.
Substances send massive surges of dopamine through your brain, too. But instead of feeling motivated to do the things you need to survive (eat, work and spend time with loved ones), such massive dopamine levels can lead to damaging changes that affect your thoughts, feelings and behavior.
This can create an unhealthy drive to seek more pleasure from the substance and less from more healthy experiences.
Over time, the substances change your brain chemistry, and you become desensitized to their effects. You then need more to produce the same effect.
For some substances, such as opioids, the withdrawal symptoms are so severe that they create significant motivation to continue using them.
Studies show that genetic factors are responsible for 40% to 60% of the vulnerability to any substance use disorder. If you have a first-degree relative (biological sibling or parent) with SUD, you’re more likely to develop it.
Scientists are working to locate specific genes that may contribute to this vulnerability. For example, they’ve found that a change in the CHRNA2 gene on chromosome 8 is associated with cannabis use disorder, including diagnosis at an earlier age.
About half of people who experience a mental health condition will also experience a substance use disorder and vice versa. This is known as a dual diagnosis. In 2020, 17 million U.S. adults had a co-occurring mental health disorder and SUD.
SUDs and other mental health conditions are caused by overlapping factors such as genetic vulnerabilities, issues with similar areas of your brain and environmental influences.
Research shows that mental illness may contribute to SUD, and SUD can contribute to the development of mental illness.
Having any of the following mental health conditions can contribute to the development of SUD:
Access to substances is a particularly significant environmental risk factor. Factors that increase the extent of exposure and the opportunity for substance use include:
Adolescents are especially at risk for developing SUD due to exposure. Adolescents who start using substances early are more likely to develop an SUD. About 70% percent of people who began using at age 13 have an SUD compared to 27% who started at age 17.
In addition, it’s more likely that someone will use substances that are legally and/or readily available (like alcohol and tobacco). This increases the risk of progression to problematic use. Opioids are another example of this — the availability and volume of prescription opioids make them easier to access.
Adverse childhood experiences (ACEs) are stressful or traumatic events during childhood. They can include:
ACEs are strongly related to the development of a wide range of health problems throughout a person’s lifespan, including SUD. The more ACEs a child experiences, the more at risk they are for developing SUD at some point in their life.
How is substance use disorder diagnosed?
A single test can’t 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 and evaluate prescription drug monitoring program reports.
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 SUD exists on a spectrum of severity:
What is the treatment for substance use disorder?
Effective treatments are available for substance use disorder. Treatment is highly individualized
— one person may need different types of treatment at different times.
Treatment for SUD often requires continuing care to be effective, as SUD is a chronic condition with the potential for both recovery and relapse.
As people with SUD often have co-occurring mental health conditions, treating them together rather than separately is generally better.
The three main forms of treatment include:
There are also several different types of treatment settings, including:
In detoxification, you stop taking the substance(s), allowing them to leave your body. Depending on the severity of the SUD, the substance or an alternative may be tapered off to lessen the effects of withdrawal. It’s the first major step of treatment for SUD. You can go through detoxification in both inpatient and outpatient settings.
Psychotherapy (talk therapy) can help treat SUD and any other co-occurring mental health conditions. Therapy also teaches healthy coping mechanisms.
Healthcare providers may recommend cognitive and behavioral therapies alone or in combination with medications.
Some examples of effective therapies for adults with SUDs include the following:
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. The underlying principle of these programs is that people with SUD must understand that they have a chronic condition that will never go away. Group therapy supports people with SUD in maintaining self-control and restraint.
Medication may be part of your treatment plan. Medications can help modify your brain chemistry to help treat certain SUDs. They can also relieve cravings and withdrawal symptoms.
Medication-assisted treatments are available for:
How can I prevent substance use disorder?
Preventing substance use and SUD starts with education. Education in schools, communities and families helps prevent using a substance or misusing a prescription medication for the first time. Other ways to prevent SUD include:
instructed. Opioid use disorder, for instance, can start after just five days of misuse.
The risk of substance use increases greatly 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, such as exercising, meditating or learning a new hobby. Consider seeing a mental health professional if you’re having issues managing your stress.
What is the prognosis for substance use disorder?
The prognosis (outlook) for substance use disorder varies based on several factors, including:
Substance use disorder is a lifelong disease. But people can recover from it and lead full lives. Getting help is essential to recovery. Different tools work for different people, but ongoing therapy and self-help groups such as Narcotics Anonymous help many.
SUD is a relapsing disease. People who are in recovery have a higher chance of using substances again. Recurrence can happen even years after you last took the substance.
Because of the possibility of relapse, you need ongoing treatment. Your healthcare provider should review your treatment plan with you and change it based on your changing needs.
The complications of substance use disorder are broad and may depend on the type of substance use.
Substance use disorder can impact multiple systems of your body, including your:
Specific chronic and acute complications can include:
How can I help a loved one with substance use disorder?
It can be very challenging and stressful to learn that someone you love may have substance use disorder. Here are some tips to help your loved one and yourself:
Suggest calling a helpline, talking to a healthcare provider or mental health professional, entering a treatment program or going to a 12-step program. Offer your help and support without being judgmental.
experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms. Consider joining a support group or organization in your community.
If you’re currently taking a prescription drug and are concerned you may be developing a
dependence, talk to your healthcare provider immediately.
If you think your child may be using substances, get them help as soon as possible.