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Substance use disorder

Substance abuse; Chemical use; Chemical abuse; Drug addiction; Addiction - drug; Dependence on drugs; Illicit drug use; Narcotic use; Hallucinogen use

Substance use disorder occurs when a person's use of alcohol or another substance (drug) leads to health issues or problems at work, school, or home.

This disorder is also called substance abuse.

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Depression and men

Causes

The exact cause of substance use disorder is not known. A person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors.

Many who develop a substance use problem have depression, attention deficit disorder, post-traumatic stress disorder, or another mental problem. A stressful or chaotic lifestyle and low self-esteem are also common.

Children who grow up seeing their parents using drugs may have a high risk of developing substance use problem later in life for both environmental and genetic reasons.

Commonly used substances include:

There are several stages of drug use that may lead to addiction. Young people seem to move more quickly through the stages than do adults. Stages are:

Symptoms

Symptoms and behaviors of drug use may include:

Exams and Tests

Drug tests (toxicology screens) on blood and urine samples can show many chemicals and drugs in the body. How sensitive the test is depends on the drug itself, when the drug was taken, and the testing laboratory. Blood tests are more likely to find a drug than urine tests, though urine drug screens are done more often.

Treatment

Substance use disorder is a serious condition and not easy to treat. The best care and treatment involves 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The substance may either be slowly withdrawn or stopped abruptly.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 drug free (abstinence) are also key to treatment.

Residential treatment 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 disorder, it should be treated. In many cases, a person starts using drugs to try to self-treat mental illness.

Support Groups

Many support groups are available in the community. They include:

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:

When to Contact a Medical Professional

Call for an appointment with your health care provider if you or a family member is using a substance and wants to stop. Also call 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.

Prevention

Drug education programs can be helpful. Parents can have a strong influence on their children by teaching them about the harm of using substances.

Related Information

Substance use
Drug use first aid
Stress and your health
Depression
Unconsciousness - first aid
Toxicology screen
Central nervous system
Hepatitis
Thrombophlebitis
Pulmonary embolus

References

American Psychiatric Association website. Substance-related and addictive disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:481-590.

Breuner CC. Substance abuse. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 140.

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.

National Institute on Drug Abuse website. Drugs, brains, and behavior: the science of addiction. How science has revolutionized the understanding of drug addiction. www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface. Updated July 2020. Accessed October 13, 2020.

Weiss RD. Drugs of abuse. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 31.

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Review Date: 5/10/2020  

Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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