Substance Abuse Disorders

A problematic pattern of substance use that affects one's health and well-being.

Alcohol Use Disorder (AUD)

     Alcohol use disorder (also known as alcohol abuse, alcohol dependence, alcohol addiction, or alcoholism) is a brain disorder that makes it difficult to stop or moderate usage of alcohol, even when it negatively affects work, health, and social life. It can be classified as mild, moderate, or severe. Alcohol’s effect on the brain typically makes individuals more susceptible to relapse. Millions of adults in the US have AUD, and 1 in 10 children live with a parent who has AUD.
     AUD is diagnosed using the DSM-5, which classifies the disorder as mild, moderate, or severe based on the number of positive responses in the past year to certain questions, such as "had times when you ended up drinking more, or longer, than you intended?" or "continued to drink even though it was causing trouble with family or friends?". If you are interested in learning more about this condition or think you or someone you know may have this condition, contact a local mental health professional.
     Any amount of alcohol can negatively impact your health. It can be consumed in moderation with few adverse effects, but it will never benefit a user medically. There is no medical reason to consume alcohol.  Alcoholism frequently becomes a problem for people after retirement, when individuals no longer have other responsibilities preventing them from drinking. Increased exposure to alcohol increases likelihood of addiction, meaning if you have been drinking for years, even responsibly, you still have a higher chance of developing an addiction.  Individuals who can drink a lot while experiencing few effects may drink excessively to feel a buzz. If anything, being able to hold your liquor is a reason to be more cautious of your drinking habits.
     Risk factors for AUD include, but are not limited to drinking at an early age, family history of alcohol problems, and other mental health conditions or trauma. People frequently get help through medications approved by the FDA to treat AUD such as naltrexone, acamprosate, and disulfiram. Help can also be found through behavioral treatments like interventions, counseling, or mutual support groups. 
     Support should be sought out for individuals who meet any of the criteria for the DSM-5 diagnosis. If you respond yes to any of these criteria, you should speak with a health provider who can determine the best course of action based on your symptoms.

Cocaine Use Disorder (CUD)

     Cocaine use disorder, or CUD, is the compulsive use of cocaine despite adverse medical, psychological, and behavioral consequences. About 2.2 million people in the US use cocaine, 1.5 million of which meet the criteria for the DSM-5 diagnosis of CUD.
     CUD is characterized by significant impairment or distress in daily life as a result of cocaine usage. Repeated exposure to cocaine can cause more sensitivity to stress, displeasure, or mood swings, all of which are symptoms of withdrawal that occur as the high wears off. As usage increases, tolerance does, as well, meaning users will take increasingly high doses that cause increasingly concerning effects such as panic attacks, paranoia, restlessness, or even hallucinations. It can be diagnosed using 11 DSM-5 criteria, which can be organized into the following categories: physiologic (craving, tolerance, withdrawal), loss of control of cocaine use, cocaine taking precedence over other activities, and other negative consequences from cocaine use. CUD is classified as mild (2-3 criteria met), moderate (4-5 criteria met), or severe (6 or more criteria met) based on the amount of criteria met for diagnosis in the DSM-5.

Common misconceptions:
- Cocaine addiction takes time to develop or is safe in moderation.
     First-time users experience a dopamine overload that results in loss of control and compulsive behavior. This means that just trying it once, or only using a little bit, is still dangerous and puts you at risk for addiction.
- Cocaine improves sex, socialization, or work skills.
     On the contrary, cocaine adversely affects physical and mental skills. Usage in social settings often leads to social dependence on cocaine to feel included, which can result in riskier behaviors in any context.
- Cocaine is safe if you snort it.
Cocaine is not safe to ingest in any manner and has no positive medical effects. 

     Cocaine addiction is common in individuals with a family history of usage or who live in unstable home environments, the two of which are not mutually exclusive. Other mental illnesses can increase risk for cocaine addiction, along with a generally stressful life or peer pressure that could motivate an individual to seek out cocaine. 

How people get help
     Rehabilitation therapy: Counseling from a licensed therapist is an important method of recognizing addiction, becoming motivated to overcome it, and having guidance throughout the recovery process. Group therapy is similarly guided by a therapist but has the added benefit of support from peers undergoing the same process.
     Intensive outpatient programs: Intensive outpatient programs, or IOPs, are programs in which a patient visits a facility regularly to receive treatment during the day and return home at night.
     Residential treatment: For patients who cannot live on their own without reverting to substance abuse, there are residential facilities monitored at all hours of the day by medical staff which provide more intensive support.
     Transitional living/sober housing programs: These programs typically serve patients who have completed residential treatment or an outpatient program and provide a sober environment for recovering individuals while also providing resources such as job opportunities to help with the reintegration process. 

     If you or anyone you know experience any symptoms of cocaine use disorder, you should seek professional help. Cocaine is a highly addictive drug that requires continued support to quit and is extremely difficult to manage individually.

Cannabis Use Disorder (CUD)

     Cannabis is a term that encompasses all parts of the cannabis sativa plant, including its dried flowers, leaves, stems, and seeds. Marijuana is the most common form of cannabis and contains a significant amount of tetrahydrocannabinol, or THC, the chemical that makes you feel “high”. Cannabis disorder involves an overpowering, compulsive desire to use cannabis, increased tolerance to it, and/or increased withdrawal symptoms. It can be classified as mild, moderate, or severe. Cannabis use disorder and cannabis addiction are not necessarily the same thing. Cannabis addiction is the most severe form of the disorder and entails continued substance abuse despite adverse effects.

Common Signs
Signs of cannabis use disorder can include, but are not limited to:
- Using more cannabis for a longer time than intended
- Having a strong desire to use cannabis
- Failing to cut down on cannabis usage
- Spending a lot of time obtaining or using cannabis or recovering from usage
- Experiencing difficulties in work, school, or at home because of cannabis
- Using cannabis even when it strains relationships Giving up activities because of cannabis use
- Continuing to use cannabis even when it puts you in danger, such as while driving
- Continuing to use cannabis despite ongoing physical or psychological problems which can be related to cannabis use
- Developing tolerance for cannabis, requiring larger doses to get high
- Experiencing withdrawal symptoms 
*If you or someone you know is exhibiting any of these signs, its important to reach out to a mental health professional.*

     Cannabis use is related to family history of usage, prior mental health conditions, and access to the drug. Oftentimes use disorder develops from experimental usage of the drug, which can spark addiction. Cannabis use disorder is difficult to treat because of its prevalence and reputation as a safer alternative to harder drugs such as cocaine or opioids. There is no medication at this time for cannabis use disorder. The most effective proven treatment is cognitive behavioral therapy, which is frequently used in tandem with other methods such as motivational enhancement therapy. Meeting any of the criteria for cannabis use disorder is cause for concern and warrants a discussion with a health professional. Even if it doesn’t feel serious, it’s beneficial to discuss it with a doctor who can help.

Tobacco Use Disorder (TUD)

     Tobacco use disorder is defined by the DSM-5 as a problematic pattern of tobacco use leading to clinically significant impairment or distress. It is highly prevalent and over a billion people use tobacco globally. Tobacco use is typically performed socially and is trivialized as a minor substance in comparison to harder drugs, but its effects are profoundly morbid and should not be understated. Tobacco use is diagnosed with the DSM-5 using the same criteria as any substance abuse disorder, including experiencing withdrawal or craving. 

Common misconceptions
- People have free will.
     This sounds like an overstatement, but it really isn’t. Tobacco companies spend exorbitant amounts on advertising, tobacco is glamorized in the media, and each cigarette contains enough nicotine to get people addicted and keep them hooked.
- Everyone knows how bad smoking is.
     Not necessarily. While most people generally know that smoking is bad for you, many may not recognize specific risks for individuals or understand the dangers of smoking at all. Most women are unaware of tobacco’s disproportionate negative effects on them, such as cervical cancer, osteoporosis, early menopause, miscarriage, ectopic pregnancy, and infertility. Smoking is much more common in rural areas where health knowledge is not as widely disseminated.
- Secondhand smoke isn’t deadly.
     While its effects may be less concentrated, individuals living in environments where they experience prolonged exposure to environmental tobacco, even if they don’t smoke, are still very much at risk of all the health consequences a smoker may face. 

     As tobacco is such a readily available drug, it’s easy to become addicted regardless of personal circumstances. However, conditions such as family history of smoking or stress can be risk factors for smoking. Nicotine quickly addicts users, and once they are addicted, it’s easy to trigger the urge to smoke. Such situations may include taking breaks at work, drinking coffee, talking on the phone, drinking, driving, or spending time with friends. Making a plan for rehabilitation requires recognizing your triggers and making a plan to overcome them. 
     Behavioral treatments such as cognitive behavioral therapy, motivational interviewing, and telephone supports or quit lines are some of the most effective methods of overcoming addiction. Medication is also available, the most common of which is nicotine replacement therapies such as patches, sprays, gum, and lozenges. The FDA has also approved bupropion and varenicline. It is recommended that adolescent smokers avoid medication. If you or someone you know exhibits the substance abuse symptoms listed in the DSM-5, it is important to seek out a doctor and mental health professional, especially if it is impossible to quit smoking. It usually takes several attempts to stop smoking before individuals can quit long-term.

Methamphetamine Use Disorder (MUD)

     Methamphetamine, or meth, use disorder is the compulsive use of methamphetamine, in spite of adverse physical, emotional, and psychological effects. Meth usage has increased by 195% since its usage low from 2010 to 2018, and 1.86 million Americans used meth in 2018. It has the potential to become the next substance abuse crisis.
     Methamphetamine use disorder is diagnosed using the DSM-5 criteria for a substance abuse disorder. It is diagnosed if at least two of the DSM-5 criteria are met in a twelve month period. Examples of criteria include, "the stimulant is often taken in larger amounts or over a longer period than was intended" or "craving, or a strong desire or urge to use the stimulant". If you or someone you know exhibits these criteria, you should seek professional help.

Common Misconceptions
- Meth isn’t as dangerous as other drugs.
Meth is commonly made from household chemicals such as battery acid, drain cleaner, lye, and antifreeze, which means it’s easily accessible but more toxic than most drugs. First time usage has a greater risk of a hospital visit for meth than for any other drug.
- Meth isn’t a problem because pseudoephedrine is so tightly regulated.
Wrong. Meth is very accessible because it can be made with household products and recipes are readily available online, making its production difficult to monitor.
- Meth is only a problem in large cities.
Meth usage in rural communities is significant and has increased while usage in cities has gone down. 

     Meth usage has been tied to many factors such as family history of usage, unstable home environment and lack of parental supervision, accessibility, and low socioeconomic status. There is currently no medication to support rehabilitation from methamphetamine use disorder, despite it being one of the leading causes of death in the country (USA). The most effective treatment at the moment is behavioral therapy such as contingency management, cognitive behavioral therapy, the Matrix Model, and 12-step facilitation therapy. Meeting any of the DSM-5 criteria for substance abuse disorder is cause for concern and warrants discussion with a health professional.

Opioid Use Disorder (OUD)

     Cleveland Clinic defines opioid use disorder as a mental health condition where an ongoing pattern of opioid use affects your health and quality of life. Opioids are addictive drugs that are sometimes prescribed by healthcare providers to treat pain. It is a chronic condition that can affect anybody. OUD is diagnosed using the same DSM-5 criteria for any substance abuse disorder. If you or someone you know exhibits these symptoms, it is important to reach out for support.

Common misconceptions
- Prescribed opioids are safe.
     All opioids have the risk of becoming addictive, even if they are prescribed. To minimize risk for addiction or overdose, follow these guidelines: Take the medicine as prescribed – do not take extra doses. Check the instructions every time a dose is taken. Do not break, chew, crush, or dissolve opioid pills. Opioids can cause drowsiness. Do not drive or use any machinery that may cause injury, especially when first starting the medicine. Contact the provider if experiencing side effects. If possible, use the same pharmacy for all of medicines. The pharmacy’s computer system will alert the pharmacist if someone is taking two or more medicines that could cause a dangerous interaction.
- Going cold turkey is the best way to cure opioid addiction. Going cold turkey causes individuals to experience withdrawal symptoms, which can be severe and carry a high risk of relapse. It is recommended that individuals seek medical help to get over opioid addiction, as it is a process that requires a lot of support and attention. People can stop being addicted to opioids if they try hard enough. Opioid addiction is a disease, not a choice. Opioids alter your brain chemistry in such a way that it is extremely difficult to stop using the drug in spite of its negative consequences. It is treatable, but, like diabetes, there is no cure. 

     Risk for addiction is higher in younger people, those with a family history of opioid abuse, those experiencing significant stress, have other mental health conditions, or who use tobacco heavily. Women in particular have their own set of risk factors due to an increased likelihood of experiencing long-term pain, which can warrant opioid prescription. It is in this way that women are more likely than men to become dependent on pain relievers such as opioids and possibly become addicted. Opioid addiction is more likely in those who have been using for longer periods of time, whether it is prescribed or not. It is also more likely in those who inject or crush it first, because the dose becomes more concentrated and thus more addictive. 
     There are medications available to assist with recovery from opioid addiction. These include buprenorphine, methadone, and naltrexone. Behavioral therapies such as outpatient counseling and inpatient rehabilitation are also effective methods of treatment. Meeting any of the DSM-5 criteria for a substance abuse disorder is cause for concern. Especially in the case of opioids (because they are so addictive) it is important to discuss treatment plans with a health professional.