Substance use disorder
Substance misuse; Chemical use; Chemical misuse; Drug addiction; Addiction - drug; Dependence on drugs; Illicit drug use; Narcotic use; Hallucinogen useSubstance use disorder occurs when a person's use of alcohol or another substance (prescribed medicine or illegal drug) leads to health issues or problems at work, school, or home.
This disorder is also called substance misuse.
Causes
The exact cause of substance use disorder is not known. A person's genes, the action of the prescribed medicine or illegal drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors.
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark ArticleDepression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
Read Article Now Book Mark ArticleStress
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark ArticleMany who develop a substance use problem have depression, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), or another mental health issue. A stressful or chaotic lifestyle and low self-esteem are also common.
Depression
Depression is feeling sad, blue, unhappy, or down in the dumps. Most people feel this way once in a while. Major depression is a mood disorder. It...
Read Article Now Book Mark ArticleAttention deficit hyperactivity disorde
Attention deficit hyperactivity disorder (ADHD) is a problem caused by the presence of one or more of these findings:Not being able to focusBeing ove...
Read Article Now Book Mark ArticlePost-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a type of anxiety disorder. It can occur after you have gone through an extreme emotional trauma that invol...
Read Article Now Book Mark ArticleChildren who grow up seeing their parents misuse substances may have a high risk of developing substance use problem later in life for both environmental and genetic reasons.
Commonly used substances include:
- Opiates and other narcotics are powerful painkillers that can cause drowsiness, and sometimes intense feelings of well-being, elation, happiness, excitement, and joy. These include heroin, opium, codeine, and narcotic pain medicines that may be prescribed by a health care provider or acquired illegally.
Narcotic pain medicines
Narcotics are also called opioid pain relievers. They are only used for pain that is severe and is not helped by other types of painkillers. When u...
Read Article Now Book Mark Article - Stimulants are substances that stimulate the brain and nervous system. They include cocaine, amphetamines, and some medicines used to treat ADHD (such as methylphenidate, or Ritalin). A person can start needing higher amounts of these substances over time to feel the same effect.
Cocaine
Cocaine is made from the leaves of the coca plant. Cocaine comes as a white powder, which can be dissolved in water. It is available as a powder or...
Read Article Now Book Mark ArticleAmphetamines
Amphetamines are drugs. They can be legal or illegal. They are legal when they are prescribed by a health care provider and used to treat health pr...
Read Article Now Book Mark Article - Depressants cause drowsiness and reduce anxiety. They include alcohol, barbiturates, benzodiazepines (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. Using these substances can lead to addiction.
Depressants
When a medicine is not taken in the way it is meant to be used and a person is addicted to it, the problem is called prescription drug use disorder. ...
Read Article Now Book Mark ArticleAlcohol
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to f...
Read Article Now Book Mark Article - LSD, mescaline, psilocybin ("mushrooms"), and phencyclidine (PCP, or "angel dust") can cause a person to see things that are not there (hallucinations) and can lead to psychological addiction.
LSD
LSD stands for lysergic acid diethylamide. It is an illegal street drug that comes as a white powder or clear colorless liquid. It is available in ...
Read Article Now Book Mark ArticlePCP
Phencyclidine (PCP) is an illegal street drug that usually comes as a white powder, which can be dissolved in alcohol or water. It can be bought as ...
Read Article Now Book Mark ArticleHallucinations
Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.
Read Article Now Book Mark Article - Marijuana (cannabis, or hashish).
Marijuana
Marijuana comes from a plant called hemp. Its scientific name is Cannabis sativa. The main active ingredient in marijuana is THC (short for delta-9...
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There are several stages of substance use that may lead to addiction. Young people seem to move more quickly through the stages than do adults. Stages are:
- Experimental use -- Typically involves peers, done for recreational use; the user may enjoy defying parents or other authority figures.
- Regular use -- The user misses more and more at school or work; worries about losing substance supplier; uses substances to fix negative feelings; begins to stay away from friends and family; may change friends to those who are regular users; shows increased tolerance and ability to handle the substance.
- Problem or risky use -- The user loses any motivation; does not care about school and work; has obvious behavior changes; thinking about substance use is more important than all other interests, including relationships; the user becomes secretive; may begin dealing substances to help support habit; use of other, harder substances may increase; legal problems may increase.
- Addiction -- Cannot face daily life without substance; denies problem; physical condition gets worse; loss of control over use; may become suicidal; financial and legal problems get worse; may have broken ties with family members or friends.
Symptoms
Symptoms and behaviors of substance use may include:
- Confusion
Confusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark Article - Continuing to use substances, even when health, work, or family are being harmed
- Episodes of violence
- Hostility when confronted about substance dependence
- Lack of control over substance misuse, being unable to stop or reduce alcohol intake
- Making excuses to use substances
- Missing work or school, or a decrease in performance
- Need for daily or regular substance use to function
- Neglecting to eat
- Not caring about physical appearance
- No longer taking part in activities because of substance misuse
- Secretive behavior to hide substance use
- Using substances even when alone
Exams and Tests
Drug tests (toxicology screens) on blood and urine samples can show many chemicals and substances in the body. How sensitive the test is depends on the substance itself, when the substance was used, and the testing laboratory. Blood tests are more likely to find a substance than urine tests, though urine substance screens are done more often.
Treatment
Substance use disorder is a serious condition and not easy to treat. The best care and treatment involve trained professionals.
Treatment begins with recognizing the problem. Though denial is a common symptom of addiction, people who are addicted have far less denial if they are treated with empathy and respect, rather than told what to do or being confronted.
The substance may either be slowly withdrawn or stopped abruptly. Support for physical and emotional symptoms, as well as staying substance free (abstinence) are also key to treatment.
- People with substance overdose may need emergency treatment in the hospital. The exact treatment depends on the drug used.
- Detoxification (detox) is the withdrawal of the substance abruptly in an environment where there is good support. Detoxification can be done on an inpatient or outpatient basis.
- At times, another substance with a similar action or effect on the body is taken, as the dose is slowly decreased to reduce the side effects and risks of withdrawal. For example, for narcotic addiction, methadone or similar medicines may be used to prevent withdrawal and continued use.
Residential treatment programs and intensive outpatient programs monitor and address possible withdrawal symptoms and behaviors. These programs use techniques to get users to recognize their behaviors and learn how not to go back to using (relapse).
If the person also has depression or another mental health issues, it should be treated. In many cases, a person starts using substances to try to self-treat mental health illness.
Support Groups
Many support groups are available in the community. They include:
- Narcotics Anonymous (NA) -- www.na.org
- Alateen -- al-anon.org/for-members/group-resources/alateen/
- Al-Anon -- al-anon.org
Most of these groups follow the 12-Step program used in Alcoholics Anonymous (AA) www.aa.org.
SMART Recovery www.smartrecovery.org and Life Ring Secular Recovery www.lifering.org are programs that do not use the 12-step approach. You can find other support groups on the Internet.
Outlook (Prognosis)
Substance use may lead to a fatal overdose. Some people start taking the substances again (relapse) after they have stopped.
Complications of substance use include:
- Depression
- Cancer, for example, mouth and stomach cancer are linked to alcohol use and dependence
- Infection with HIV, or hepatitis B or C through shared needles
- Loss of job
- Problems with memory and concentration, for example, hallucinogen use, including marijuana (THC)
- Problems with the law
- Relationship breakup
- Unsafe sexual practices, which may result in unwanted pregnancies, sexually transmitted diseases, HIV, or viral hepatitis
When to Contact a Medical Professional
Make an appointment with your provider if you or a family member is using a substance and wants to stop. Also contact your provider if you have been cut off from your drug supply and are at risk of withdrawal. Most employers offer referral services for their employees with substance use problems.
If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
Prevention
Substance education programs can be helpful. Parents can have a strong influence on their children by teaching them about the harm of using substances.
References
American Psychiatric Association website. Substance-related and additive disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.
Breuner CC. Substance use disorder. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 157.
Kowalchuk A, Reed BC. Substance use disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 50.
Weiss RD, Liebschutz JM. Drug use disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 365.
Depression and men - illustration
Depression is less reported in the male population, but this may be caused by male tendency to mask emotional disorders with behavior such as alcohol abuse.
Depression and men
illustration
Review Date: 5/4/2024
Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.