Substance Use Disorder
What is Substance Use Disorder?
Drug abuse and addiction are a growing health crisis around the world. According to the World Health Organization, 31 million people worldwide have a substance use disorder. Drug addiction and substance abuse severely impact a person’s well being and can even lead to premature death. Substance abuse also negatively impacts the person’s family, friends, and the wider community. Drunk driving accounts for 65% of all traffic fatalities in South Africa and recent surveys have uncovered that an estimated 4% of the South African population abuses drugs. The most commonly abused substances in South Africa are alcohol, cannabis, sedatives, and amphetamines.
In general, a person’s appearance will not always indicate they are abusing drugs or alcohol. It’s relatively easy for someone to hide substance abuse and addiction, especially in the early phases of the disorder. For concerned family and friends, understanding the difference between abuse, substance use disorder, and addiction can help loved ones intervene, and support someone in recovery.
What is drug abuse?
When a substance is used in a way that it was not intended, or taken in excess, it is considered abuse. Some examples of substance abuse include:
- Taking a larger dose of a prescription than a doctor ordered
- Taking medicine more frequently than was prescribed
- Mixing different substances to get high (i.e., drinking alcohol while taking opioids)
- Binge drinking
- Stealing another person’s prescription
- “Doctor shopping.”
- Using medicines in ways they were not intended (i.e., crushing and snorting prescription pills)
- Using any illicit substance to get high
Drug abuse does not always mean a person is addicted to drugs or alcohol. People may abuse drugs for different reasons; that doesn’t always indicate an addiction disorder. For example, young people may abuse drugs to experiment or alleviate boredom. Young people are also at risk of abusing drugs and getting high because they feel pressured into it by their peers.
People will also abuse drugs to alleviate mental health disorder symptoms. When someone is experiencing the pain of depression, or panic attacks and excessive worry, they can be tempted to turn to drugs and alcohol for quick relief. While substances may give them some reprieve from their symptoms for a short while, they do not solve the underlying cause of a person’s drug or alcohol abuse. People who are addicted to substances and are also diagnosed with a mental health condition have a condition called dual diagnosis. People who are using drugs or alcohol to alleviate either mental health distress or physical distress are often self-medicating their pain. Self-medication is typically a warning sign of an impending addiction disorder, and unfortunately, repeatedly abusing drugs or alcohol can lead to addiction.
It is a myth that a legal medication can’t be addictive. Many prescription and over-the-counter medications come with a risk of addiction and possess addictive chemicals. This is one of the reasons why certain prescription drugs, such as benzodiazepines and sleeping pills, must be taken under strict guidelines and for short periods. An individual can develop a physical dependency on a legal, prescription medication, but this doesn’t necessarily mean they are addicted.
When someone takes a drug or drinks alcohol, the chemicals in the substance impact the brain’s risk and reward neural pathways. Compounds in the substances bind to and activate certain receptors in the brain that induce a high or euphoric feeling. These feelings can be psychologically addictive. The body can also develop a physical tolerance to the substance, and a person will need to take more and more of it to get the same desired effect. Then, the body and brain start to need the substance to function “normally.” Once this occurs, a person is, in fact, addicted. When the user is unable to obtain and use a steady supply of drugs or alcohol, they will experience painful and distressing withdrawal symptoms.
Are substance use disorder and drug addiction the same thing?
Drug addiction is frequently referred to as substance use disorder in clinical settings. Substance use disorder is a chronic, lifelong condition that requires medical intervention and participation in ongoing maintenance programs so the patient can avoid a relapse of symptoms.
What is substance use disorder?
When someone is unable to control their use of legal or illegal drugs or substances, they are addicted and have a substance use disorder. Any time a person’s misuse or abuse of a substance leads to negative consequences, it is indicative of substance use disorder. People who are severely addicted to drugs or alcohol will not be able to stop using, regardless of the consequences. Severe addiction impacts the way a person thinks, feels and behaves. Even losing their job or home because of drug abuse is unable to deter their behavior. In these instances, it is imperative that medical professionals intervene to end the cycle of addiction.
How is substance use disorder treated?
Substance use disorder is a chronic condition, but it is treatable. Patients can benefit the most from having a highly customised recovery plan that is crafted around their unique medical needs and medical histories. The first step in addiction recovery and rehabilitation is to detox the patient from drugs or alcohol safely.
When someone is addicted and chemically dependent, their body and brain are unable to function without the drugs in their system. The drug detoxification and drug withdrawal process refers to the time it takes for the body to clear itself of toxic chemicals. This process begins after cessation. However, the process can be painful and in some cases, potentially deadly. For example, people who are in recovery for alcohol addiction can experience a condition called delirium tremens, a seizure disorder. Up to 25% of people who develop delirium tremens will die without medical intervention.
For many patients undergoing detox, a partial hospitalisation program is recommended. In these settings, patients can safely detox under the care and supervision of trained medical staff. Doctors can also put patients under a replacement drug schedule, where the patients are given safe, legal medications to help lessen the severity and duration of drug withdrawal symptoms.
After safely detoxing from drugs, patients can either participate in an inpatient drug rehabilitation centre or attend intensive outpatient programs. The goal of rehab is to uncover the root of the patient’s drug abuse and addiction. Drug rehabilitation programs give patients the chance to receive care for a dual diagnosis, attend talk therapy, and re-learn how to live life outside the facility without using drugs or alcohol to cope. Peer support from other patients in recovery and sober loved ones is critical to preventing relapse and helping patients heal from drug abuse and addiction. The goal of inpatient or outpatient rehab is to transition the patient to sober and independent living.
In some cases, patients may not be able to go straight from the structured, 100% drug-free environment of inpatient rehab to living independently. Some patients may benefit from a transitional period where they can live in a sober living house or a halfway house. These arrangements give patients the chance to transition slowly to independent living, while still being able to live in a more structured, drug-free environment while receiving care for substance use disorder.
Once patients have completed detox, rehab, and have moved on to independent living, that’s not the end of their recovery. Substance use disorder is similar to physical conditions such as heart disease or diabetes. It’s imperative that patients continue to participate in relapse prevention programs designed to help them maintain sobriety. Also, relapse prevention will look different for each patient. Ongoing talk therapy, twelve step program participation, meeting with a sober companion, and recovery coaching may all have a place in an individual patient’s relapse prevention plans.