What is substance use disorder? | Whiteriver Recovery

What is the difference between substance use disorder and addiction?

They are the same. Substance use disorder was adopted to recognise the condition as a mental health disorder and ditch labels such as abuse and dependency. In the past, substance abuse was viewed as a mild form of addiction, and substance dependency was a moderate to severe addiction.

The National Institute of Drug Abuse defines addiction – substance use disorder – as:

“a relapsing, chronic disorder characterised by compulsive drug (and alcohol) seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances.”

Substance use disorder relates to the effect of drugs and alcohol on the form and function of the brain, not on people’s life choices and behaviour.

What factors cause substance use disorder?

Substance use disorder is a complex medical condition influenced by genetics, environmental factors and past experiences. Genetics Genetics refers to physical and mental traits that are passed from parents to children at birth. It’s a misconception that people are born with an addiction gene, but research shows that addictions are moderate to highly heritable (transmissible from parent to offspring). Addiction scientists estimate that genetics account for between 40 to 60 percent of a person’s vulnerability to developing an addiction.

These stats mean if one or more of your parents have struggled with an addiction, the risk of developing an addiction yourself is higher than someone who has no direct family link to the disorder.
Environmental factors
A person’s environment plays a significant role in how substance use disorder develops. Environmental factors are activities, places and people you are exposed to from childhood to adulthood.
Environmental factors that have the most considerable influence include growing up in a low-income community, peer pressure, absent father, poor discipline and structure in the home, parents or relatives abusing substances or being involved in criminal activity, and early exposure to alcohol or drugs.
Past experiences
Childhood experiences shape your physical and mental wellbeing. Early exposure to trauma, violence and stress can have a long-term adverse effect on your mental wellbeing, affecting your behavioural and emotional development in adulthood.

Examples of adverse past experiences include:

sexual, physical or verbal abuse
witnessing violence in the home or community
financial difficulties, living in poverty
parents’ divorce or separated, marital conflict
physical or emotional neglect
abandonment
growing up with a parent or family member with a mental health disorder
parent in prison

How does substance use disorder develop?

Substance use disorder follows a path from drug and alcohol tolerance to dependency and substance use disorder (addiction). Let’s look at the difference between the three to help you understand how the condition evolves.

Tolerance
Tolerance occurs when you no longer respond to alcohol or drugs the way you did in the beginning. You need larger doses more often to feel the same way you did when you first used them. This conditioning happens because your brain adapts to the repeated surge of dopamine (triggered by alcohol and drug use) by reducing or shutting down chemical receptors.

Enzymes that metabolise harmful substances speed up, and the number of cell receptors that dopamine attaches to decreases. Your central nervous system gets used to the level of drugs or alcohol, leading to substance tolerance and increasing the risk of permanent changes to brain chemistry and developing an addiction.

Dependency
Dependency means you experience physical and mental withdrawal symptoms if you reduce or stop using alcohol or drugs. Symptoms can be mild, like quitting coffee or cigarettes; or they can be severe and life-threatening, like when you stop using street drugs or prescription opioids.

Having a substance dependency does not mean you have an addiction. However, if you don’t seek help and deal with your reliance on harmful substances, it won’t be long before you develop a substance use disorder.

Substance use disorder
Substance use disorder – addiction – is a chronic brain disease caused by repeated, compulsive drug or alcohol use. By this stage, chemical brain changes have become permanent, your physical and mental wellbeing is compromised, you struggle to function normally at school, home or work, and you experience severe withdrawal symptoms if you try to stop using alcohol or drugs.

What are the common signs and symptoms of substance use disorder?

Substance use disorder – addiction – causes a range of uncomfortable, distressing and life-threatening symptoms that affect your physical and mental health. The need to consume drugs or alcohol is overwhelming, despite dire consequences. Your behaviour and poor mental health also have a knock-on effect on family members and friends, devastating relationships, finances and daily life.

Relationships are damaged or destroyed, your work performance suffers, you fail your school year or lose your job, and you develop serious medical complications. The tragic consequence of substance use disorder is an overdose and death.

Warning signs of addiction

defensive, hostile when questioned about using drugs or drinking too much
mood changes; anxious, depressed, irritable, manic
changes in physical appearance; unkempt, unwashed, dishevelled
poor school or work performance, fail school or fired from a job
mysterious, secretive, increased need for privacy
dishonest, manipulative
hiding drug paraphernalia; syringes, needles, spoons, empty bottles
lose interest in family, friends and activities
financial difficulties, constantly borrowing money
wear long-sleeved shirts on warm days (hiding track marks)
skipping meals, not eating at regular times
reduced sex drive, impotence
engage in risky behaviour, run-ins with the law

Physical signs of addiction

poor hygiene, lack of self-care
poor quality sleep, insomnia
slurred, forced speech
persistent itching
frequent sniffling
weight loss or gain
bloodshot eyes, pinpoint pupils
shallow, deep or rapid breathing
hyperpigmentation, dark patches around injection sites
pale, clammy, dry skin
acne breakouts
open, pus-filled sores
inflamed, swollen, cracked lips
shaking, trembling
constipation or diarrhea
nausea or vomiting
convulsions, seizures

Emotional signs of addiction

anxiety, depression
mood swings, mood changes rapidly
volatile temper, quick to anger
defensive, argumentative
agitated, irritable, restless
low self-esteem, sense of self-worth
feeling hopeless, helpless, discontent
paranoia
hallucinations
anti-social traits

What are the different types of substance use disorders?

Substance use disorder is a broad umbrella term that covers several types of addictions. Polysubstance use disorder is the medical term for people diagnosed with substance use disorder who misuse more than one type of drug or a combination of drugs and alcohol.

There are seven types of substance use disorders:

alcohol use disorder (beer, wine, spirits)
opioid use disorder (heroin, fentanyl, OxyContin, Vicodin)
stimulant use disorder (cocaine, crack, meth, crystal meth, study drugs)
nicotine use disorder (tobacco cigarettes, e-cigarettes)
marijuana use disorder (weed, cannabis)
sedative use disorder (tranquilisers, hypnotics)
hallucinogen use disorder (LSD, psilocybin, peyote)

How is substance use disorder treated?

An effective addiction treatment programme combines a medical detox, medication to treat physical and emotional symptoms, various psychotherapy techniques, group support, regular exercise and a healthy, balanced die
Inpatient addiction programmes tends to deliver better outcomes than outpatient rehab centres because the care and support are intensive; you can distance yourself from addiction triggers and focus on your recovery.

A comprehensive three-month (90-day) treatment programme at Recovery Centre at White River is recommended for people who have struggled with addiction for a long time and relapsed often.

Medication used for addiction treatment

antidepressants
antipsychotics
agonists (drug replacements)
antagonists (Narcan)
anti-craving (Naltrexone)
anti-drinking (Disulfiram)

Psychotherapy used for addiction treatment

cognitive behavioural therapy
dialectal behaviour therapy
humanistic therapy
interpersonal therapy
rational emotive behaviour therapy

Holistic therapy used for addiction treatment

mindfulness meditation
massage
acupuncture
art and music therapy
equine therapy
yoga
nutritional therapy
physical therapy
biofeedback and neurofeedback
reiki, qigong, healing touch

Why should you seek help for substance use disorder?

Substance use disorder affects your physical and mental wellbeing and can be life-threatening. It results in chronic illnesses cardiovascular distress, liver and kidney damage, gastrointestinal and respiratory problems, brain damage, cirrhosis, reduced immunity, infections, and impaired brain function.

According to the Centers for Disease Control and Prevention (CDC), the number of deaths linked to opioid overdoses in the United States has quadrupled in ten years. Heroin is the most challenging drug to quit; every year, it is responsible for over 70 000 overdose deaths in the United States alone. Currently, no robust data on drug overdose deaths exists in South Africa, but the numbers are climbing at an alarming rate.

You suffer an overdose when drug toxicity overwhelms your central nervous system, causing organs like your heart, lung and kidneys to shut down. The primary cause of drug overdose deaths is respiratory failure.
Alcohol poisoning can be fatal without emergency medical treatment. It is caused by drinking a large amount of alcohol in a short space of time. High alcohol levels shut down critical parts of your brain that control your breathing, body temperature and heart rate.

The sooner you seek help and receive comprehensive treatment for alcohol or drug addiction, the better. An integrated addiction treatment programme can save your life and lead to a full recovery.

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