Substance use disorder occurs when a person needs alcohol or another substance (drug) to function normally. Abruptly stopping the substance leads to withdrawal symptoms.
Addiction means that a person has a strong urge to use the substance and cannot stop, even if they want to. Tolerance to a substance (needing a higher dose to get the same effect) is usually part of addiction.
This disorder is also called substance abuse.
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.
At least half of those who become addicted 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 an addiction later in life for both environmental and genetic reasons.
Commonly abused 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 and behaviors of drug use include:
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.
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The substance may either be slowly withdrawn or stopped abruptly.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.
Many support groups are available in the community. They include Narcotics Anonymous (NA), Alateen, and Al-Anon. Most of these groups follow the 12-Step program used in Alcoholics Anonymous (AA). SMART Recovery and LifeRing are programs that do not use the 12-step approach. You can find other support groups on the internet.
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:
Call for an appointment with your health care provider if you or a family member is addicted to drugs and would like to get off of them. Also call if you have been cut off from your drug supply and are at risk of withdrawal. Most employers also offer referral services for their employees with substance use problems.
Drug education programs can be helpful. Parents can have a strong influence on their children by teaching them about the harms of using substances.
Kowalchuk A, Reed BC. Drug abuse. Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 51.
National Institute on Drug Abuse. Drugs, brains, and behavior: the science of addiction. Revised August 2010. Available at: http://www.drugabuse.gov/publications/science-addiction. Accessed on: February 24, 2014.
Stager MM. Substance abuse. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 108.
Weiss RD. Drug abuse and dependence. In: Goldman L, Shafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 33.
Review Date: 2/24/2014
Reviewed By: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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