Substance Use Disorders

Alcohol and other drug use represents one of the most serious health problems in the United States. Although substance use disorders are classified as psychiatric disorders, problem drinking and drug use can lead to other life problems as well. Individuals who have alcohol or other drug problems have higher rates of depression, anxiety, and personality disorders than people in the general population. A person with a substance use disorder faces a number of possible difficulties, ranging from relationship problems, to brain damage, imprisonment, and death.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies substance use disorders on a spectrum, ranging from mild to severe depending on the number of symptoms present.

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The DSM-5 identifies 10 classes of drugs:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives, hypnotics, and anxiolytics
  • Stimulants (amphetamine-type substances, cocaine, and other stimulants)
  • Tobacco
  • Other (or unknown) substances

Substance Use Disorders involve use that leads to problems in everyday life. The diagnosis is determined by the presence of two or more of the following issues, taking place at any time in the same one year period:

  • Using more and more or over a longer period than was intended.
  • A strong desire, or ineffective efforts, to cut down or control substance use.
  • A lot of time spent finding a substance, using the substance, or recovering from use.
  • Craving or a strong urge to use the substance.
  • Repeated substance use that leads to problems at work, home, or school.
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  • Continued use even though it leads to social or interpersonal issues that either cause problems or make problems worse.
  • Avoiding or quitting important social, work, or recreational activities because of use.
  • Repeated substance use in situations in which it is physically dangerous.
  • Substance use continues despite knowing that it is causing problems.
  • Increased tolerance where one either needs more of the drug to achieve the same effect – or – not achieving the same effect using the same amount.
  • Withdrawal – physical or psychological symptoms happen when not using, or the substance is used in order to avoid these symptoms.

Alcohol

According to the 2015 National Survey on Drug Use and Health (NSDUH), as many as 86.4% of Americans adults reported that they drank alcohol at some point in their lifetime. Around 70% reported that they drank at least once in the past year, and 56% reported that they drank in the past month. Over 15 million adults in the US met criteria for alcohol use disorder in the US.

Data from the same survey suggest that nearly 27 percent of Americans ages 18 or older reported that they engaged in binge drinking in the past month. About 7 percent reported that they engaged in heavy alcohol use in the past month.

To learn more about the symptoms, consequences, and treatment of alcohol abuse see : National Institute on Alcohol Abuse and Alcoholism.

Drug Use

Marijuana use has been on the rise in recent years. In a New York State survey in 2018, over two million people reported using marijuana in the past year and over 1.5 million people reported using it in the past month. Over 100,000 people began using marijuana last year in New York State alone. Effects of use range from short term memory loss to cognitive impairments in heavy users.

Prescription drug use has also become more and more of a problem in the past two decades. Estimates suggest that 2.1 million Americans have a substance use disorder due to opioid pain reliever use. Rates of prescription for pain killers have more than doubled in the last 20 years. The number of unintentional overdoses had increased 400% since 1999. Other prescription medications have a potential for abuse, including anti-anxiety medications (Xanax, Valium, Ativan) and psychostimulants (Adderall, Ritalin), which are commonly prescribed for ADHD treatment.

Cocaine and amphetamines are stimulant drugs that lead to a sense of euphoria in the user. However, withdrawal symptoms include difficulty concentrating and feelings of depression and anxiety. Use is associated with increased risk for stroke and seizures.

Even drugs that are perceived to be relatively harmless (for example, over the counter cold medications, drugs sold in convenience stores) carry potential risks when abused. OTC medications like Coriciden Cold and Cough can cause hallucinations in high doses. Meanwhile, drugs that are marketed and sold in shops as “synthetic marijuana” or other legal alternatives increase risk of psychotic symptoms and the start of disorders like schizophrenia.

For more information on alcoholism and substance abuse see the following:
James O. Prochaska, John Norcross, and Carlo DiClemente
Changing for Good

To learn more about various drugs that are abused please see the National Institute on Drug Abuse website at http://www.drugabuse.gov/NIDAHome.html

Para información en español haz clic aquí.

Substance Use Treatment

There is a significant gap in the Unites States for those who need treatment vs. those who are getting treatment. In 2013, around 22.7 million Americans needed treatment for a problem related to substance use issues, but only about 2.5 million people received treatment at a specialty facility. People with substance use disorders can be difficult to assess and treat for a variety of reasons. They may be difficult to motivate to pursue treatment, especially during active addiction. For some people with substance use problems, the shame associated with addictive behaviors may discourage them from seeking help. In other cases, medical and psychological problems may hide the presence of a substance use disorder. Effective treatment plans must take into account social, psychological, interpersonal, and physical issues. Healthcare professionals should tailor a treatment approach to each individual. Involvement in self-help or 12-step recovery groups, medication compliance, and behavioral skills training are all part of a comprehensive plan in treating a person with a substance use disorder. Cognitive Behavior Therapy (CBT) for substance use disorders focuses on addressing dysfunctional thoughts, problematic behaviors, and negative coping strategies. While CBT can be the primary source of treatment, it is often used at the same time as medication, group therapies, and 12-Step programs. Cognitive behavior therapists believe that substance abuse is learned, and, therefore, it can be “unlearned” and stopped through the use of cognitive-behavioral techniques. Understandably, a person with a substance use disorder faces many challenges. In doing CBT, a person can take part in an effective, flexible, and evidence based therapy to help achieve their goals. Miniseries on Substance Use Disorders by Dr. Graham Reynolds: Blog Posts on Substance Abuse:
The AICT
Cognitive Therapy
Podcast
Substance Abuse Miniseries by
Dr. Graham Reynolds
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