What Are Substance-Related And Addictive Disorders?

Introduction

Alcohol and controlled substances can cause addictive disorders. But did you know they are not the only source of addiction and dependence? Have you ever wondered how to prevent or get rid of addictive disorders?

In addition to prescription medication, nonprescription or over-the-counter (OTC) medications can also cause addictive disorders if they are taken more often or in larger doses than they are advised by your physician.

In this article, you will find the information required to identify and tackle these disorders and behaviours and gradually return towards a healthy lifestyle.

What is addiction?

Addiction is characterised by compulsive behaviour or a need to consume or use something, or perform a certain activity that you are aware is damaging to your health.

The mechanism by which addiction develops in humans is, in summary, described by the fact that the body becomes used to the substances being consumed, and then, as time passes, the user requires the continuous administration of these substances. Otherwise, adverse effects (withdrawal symptoms) occur that differ for each substance addiction. This may also be referred to as physical dependence.

What is substance use disorder?

Medications for different diseases are classified under controlled and non-controlled substances. Controlled substances are drugs that act directly on the brain and if abused, may lead to mental as well as physical dependence, giving way to addiction. These drugs always require a prescription.¹

Substance use disorder (SUD) is defined as a condition in which the individual becomes unable to control their consumption of controlled substances, even though they are aware of the detrimental outcomes of this consumption.

Addiction due to the misuse of controlled drugs comes under the category of substance addiction or SUD. Drug misuse is defined as taking the drug more frequently, in larger doses than prescribed by the physician, or taking the drug when there is no need for its consumption (no indication of disease).

Types of substances

Drugs that are commonly abused and cause SUD include:

• Ethanol (alcohol)
• Opioids (e.g. heroin)
• Marijuana (cannabis)
• Cocaine
• Nicotine (tobacco)
• Amphetamine

Drugs taken for managing anxiety and insomnia can also cause addiction, such as benzodiazepines (e.g. alprazolam) and barbiturates (e.g. amobarbital).

Alcohol

Alcohol use disorders (AUDs) are reported to be one of the major predisposing factors towards disability and early death in individuals who are 15 to 49 years old. Excessive use of alcohol leads to about 3.3 million deaths every year.² A survey conducted in 2018 showed that over the previous year, 20.3 million individuals were found to have SUDs, and out of all these, 14.8 million cases were associated with alcohol use.³ Substance use during pregnancy can lead to a variety of debilitating disorders in the offspring, including foetal alcohol spectrum disorder.⁴

Alcohol advertisements, or, for example, the glorification of alcohol in media, are risk factors and provide a route to normalising the use of alcohol. This leads the youth to underestimate the hazards associated with alcohol consumption.²

Individuals with AUD tend to neglect their responsibilities or social activities and spend their entire time either drinking alcohol or recovering from its effects.

Opioids

Opioids are a group of medications that are taken to relieve pain and are very addictive, therefore requiring a prescription. The commonly abused opioids include both prescription opioids (over-prescription) and non-prescription opioids (illegal use). People with opioid use disorder (OUD) are more liable to committing felonies, traffic accidents, attempting suicide, and engaging in violent activities.

Moreover, a study reported that individuals with opioid use disorder have a 6.9 times higher probability of causing accident-related trauma than individuals without any OUDs. The same study also showed that people with OUD possess a 7.9 times higher likelihood of attempting suicide.⁵

Central nervous system stimulants

Central nervous system (CNS) stimulants are highly addictive, as they provide a boost to our brains, causing euphoria (extreme state of happiness) and excitement and also reducing exhaustion. The commonly abused stimulants that also cause SUDs include amphetamine, methamphetamine, ecstasy (MDMA) and cocaine. 

According to a study carried out by Ronsley et al. in 2020, 17.8% of the users seeking medical treatment in the United States suffer from an SUD, including cocaine.⁶ The consequences of long-term stimulant use incorporate the following:

• Sleep disorder
• Psychosis (hallucination)
• Aggression
• Anxiety/stress
• Malnourishment⁷

Cannabis

Cannabis is the third most abused substance after nicotine and alcohol. According to an estimate in 2016, 22.1 million people were found to have a cannabis use disorder (CUD).⁸ CUD leads to health complications, including bronchitis, poor mental health, and psychosis.

Nicotine (tobacco)

Nicotine is a substance found in cigarettes, and smoking can lead to nicotine use disorder (NUD). Smoking can be abolished through cessation therapy, which includes the regular administration of small doses of nicotine to fulfil the craving of users. NUD may lead to severe health consequences, such as chronic obstructive pulmonary disorder (COPD) and lung cancer.

Symptoms of substance use disorder

The symptoms of SUD are allocated by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If an individual is found to have two or more of the symptoms below, they can be diagnosed with SUD. These symptoms are:

1. Severe craving or need for the substance
2. Wanting to abolish substance use but not being able to
3. Using the substance in higher quantities or for a longer time than planned
4. Abandoning home, work, or school duties
5. Wasting time in acquiring the substance, using it, and recovering from its use
6. Carrying on the substance use despite its effect on the user’s relationships
7. Higher uptake of the substance to get the originally intended effect (tolerance)
8. Experiencing withdrawal effects and taking higher amounts of the substance to relieve them
9. Carrying on substance use despite its effects on both mental and physical health
10. Continuing substance use despite it resulting in harmful circumstances
11. Abandoning essential social and fun activities.⁹

Risk factors of substance use disorder

Risk factors can be described as the elements that make an individual more susceptible to a certain condition. Substance use is considered to be typical in young people. Not everyone develops an addictive disorder, but the presence of risk factors tends to make young people more susceptible to developing SUDs when compared to older individuals.

The risk factors for developing an SUD include:

• Genetic factors
• Peer pressure
• Over-prescribing
• Abuse or trauma
• Parental conflict
• Other mental disorders
• Drug availability
• Alcohol advertising

Consequences of substance use disorder

According to a study by Ignaszewski in 2021, 55% of the detained individuals report that they were intoxicated at the time of the felony they committed, while almost 20% of them say that they committed the crime to obtain money for buying substances. 1 out of 5 deaths happen due to drug abuse or substance use.¹⁰ Substance use has various detrimental effects on the user, some of which are the following:

• Impaired mental and physical health 
• Reduced lifespan 
• Fewer employment prospects
• Affected education
• Social isolation
• Increased traffic accident rates

SUD or related disorders also encourage the surfacing of negative traits in an individual, such as exhibiting violent tendencies and carrying out illegal activities. SUD may also encourage suicidal thoughts if the user is suffering from mental disorders, including depression or severe anxiety.

Diagnosis of substance use disorder

A healthcare professional will analyse the patient’s medical history and conduct a physical examination. The psychiatric history of the individual is also analysed by a clinician to exclude any other comorbid mental disorders. Blood and urine tests are also conducted.

The practitioner will typically ask certain questions regarding substance use history, such as the frequency, quantity, and duration of substance use, motivation for use, use of substance combination, and the source of substances. 

If the patient has two or more of the symptoms (criteria) allocated by the DSM-5, then they are diagnosed with SUD.¹¹

Being aware of the diagnostic criteria of SUD may assist you in detecting whether you or people close to you may have SUD; therefore, seek medical help before the symptoms worsen.

Treatment of substance use disorder

The three main models of SUD treatment include the following:¹²

• Withdrawal management
• Behavioural therapy
• Medication therapy

Withdrawal management

During this treatment phase, the individual stops the use of substances by gradually reducing the amount of substance intake to minimise the severity of withdrawal symptoms. 

Behavioural therapy

Behavioural therapy is a mode of treatment that is  under the umbrella of psychotherapy and consists of

• Cognitive behavioural therapy (CBT): a form of psychotherapy that causes individuals to reflect on their thoughts and how they affect their behaviour.
• Assertive community treatment (ACT): this form of therapy is a community-based treatment model involving various specialists, including licenced medical professionals, therapists, peer support specialists, and nurses. ACT caters for a specific treatment approach for each individual (individualised therapy).
• Dialectical behaviour therapy (DBT): DBT focuses on the individual’s recognition of their own intense emotions and helps them to lessen their self-destructive behaviours and habits.
• Therapeutic communities (TCs): TCs describe a residential-setting treatment approach that encourages healthier behaviour and values.
• Contingency management (CM): CM focuses on offering rewards as a result of achieving healthy behaviour.

Medication-assisted treatment (MAT)

Medications help combat withdrawal symptoms and reduce the craving for substances. Below are some of the SUDs that have evidence-based medication treatments:

• Alcohol use disorder: Disulfiram, naltrexone, acamprosate 
• Opioid use disorder: Naltrexone, buprenorphine, methadone
• Tobacco use disorder: Bupropion, varenicline, nicotine (patch, gum, lozenge, spray)

A study by Petersen et al. in 2019 has suggested that having sufficient social support and being involved in society is extremely important for getting rid of SUDs. The study was conducted to assess how much social relationships affect the recovery of individuals with SUD, showing that the initiation of sobriety was greatly influenced by the loved ones' acknowledgement and support.¹³

FAQs

How can I help a loved one with a substance use disorder?

Communicate with them about your concerns, offer support and encourage them to visit a healthcare provider. Although they may deny your support and provide excuses, be patient and remember that denial and not admitting the issue is a common characteristic of SUDs. Remain involved throughout their treatment progress and help them to stay away from risk factors that are involved in the development of SUD.

Can substance use disorders be treated?

Yes, SUDs can be treated with the combination of proper medications, health advice from a physician, and psychotherapy.

What is drug addiction?

SUD is also referred to as a drug addiction. The terms are used interchangeably as they mean the same thing.

What causes someone to become addicted to drugs?

Risk factors of drug addiction or SUD are the factors that drive someone to become addicted to drugs. These factors are discussed in the article above and include childhood neglect, genetic factors, easy availability of drugs, and peer pressure, among others.

Summary

SUDs are mental disorders that can be caused by genetic, psychological, and environmental factors and can be treated with proper medication, psychotherapy, and social support. They can also be prevented through proper education and appropriate adherence to prescription. Although substance use does not lead to SUD, the presence of several risk factors increases the chances of an individual developing SUD. If you believe that you or a loved one has SUD, reach out to a healthcare provider.