Substance Use Disorder (SUD): Signs, Causes, & Treatment

What Is Substance Use Disorder (SUD)?

Substance use disorder (SUD), commonly known as drug addiction, is a mental health condition marked by substance misuse that impairs functionality or causes significant distress. SUD is a spectrum of disorders and may be mild, moderate, or severe.¹

Individuals may begin experimenting with substances for various reasons, but misuse can quickly escalate into addiction. The risk of developing SUD depends on the individual, type of substance, amount consumed, and duration of abuse.

Substances such as heroin, cocaine, and methamphetamine cause a release of dopamine and a rush of euphoria. These pleasurable hormones allow individuals to ‘feel alive’ or ‘normal,’ possibly resulting in prolonged misuse to continue experiencing a constant high. Over time, individuals may develop a tolerance or dependence on the substance and experience withdrawal symptoms when abuse ceases.

How Common Is Substance Use Disorder?

Determining the true extent of substance use disorder is challenging as many individuals do not seek treatment or admit to substance abuse. However, data indicates that roughly 17% of individuals aged 12 and older in the US reported drug misuse within the past year.² Additionally, death rates from opiate overdose have increased from 10,000 in 2002 to nearly 50,000 in 2017.³

What Are Substances of Abuse?

Psychoactive drugs are substances with addictive potential. Individuals may be prescribed substances by a medical professional, use drugs recreationally, or illegally purchase and misuse substances. The effects of psychoactive drugs differ but result in similar brain changes that may contribute to a substance use disorder.

Psychoactive drugs with addictive qualities include:

• Depressants
• Stimulants
• Psychedelics
• Opiates
• Cannabinoids
• Alcohol
• Caffeine
• Nicotine
• Inhalants
• Synthetic drugs

Substance Use Disorder Symptoms

Symptoms of SUD vary but often include similar behavioral or psychological manifestations. Individuals struggling with drug addictions may exhibit increased mood swings, confusion, and intense cravings.

According to the DSM, symptoms of substance use disorder include:¹

• Taking substances in higher amounts or for longer periods than intended
• Unsuccessful efforts to control the substance use
• Spending excessive time getting, using, and recovering from substances
• Cravings to use the substance
• Inability to meet work, school, or household responsibilities as a direct result of substance use
• Continued use despite adverse consequences of substance use
• Reducing or eliminating normal social, occupational, or recreational activities
• Repeatedly using the substance in hazardous environments or activities (e.g., driving a motor vehicle)
• Continued substance use despite ongoing physical or psychological ailments
• Tolerance for the substance
• Withdrawal symptoms associated with the substance
• Using substances to manage or relieve withdrawal symptoms

Signs of Drug Addiction & SUD

Signs of substance abuse may be unnoticeable when individuals begin misusing drugs. However, individuals may exhibit appetite, sleep, and behavioral changes otherwise out of the ordinary. Recognizing these early warning signs can help you or a loved one seek necessary preventative substance abuse treatment.

General signs of substance use disorder include:

• Pupil dilation: ‘Uppers’ cause pupils to dilate or grow, while ‘downers and opiates shrink pupils to a pinpoint, even in dim light.
• Hands sweating/shaking: Using drugs, such as cocaine or amphetamines, will cause shaky and sweaty hands. Coming down from alcohol will result in similar symptoms.
• Rapid speech: Recent use of uppers will cause rapid speech. Individuals may repeat the same idea or gesture dramatically. What they say will likely make little sense.
• Loss of appetite: Uppers often cause loss of appetite.
• Insomnia: Uppers can also result in insomnia or changes in sleep routine.
• Hallucinations: Prolonged use of uppers can cause hallucinations, like the sensation of insects or worms crawling on or under the skin.
• Intense relaxation: Someone on opiates will be very relaxed. Their face may be flushed, and they may nod off, close their eyes, or droop their heads.
• Neglect of appearance: Prolonged misuse of almost any substance may result in gradual neglect of appearance and hygiene.

What Causes Drug Addiction & SUD?

The causes of SUD are not definitive, but experts believe that a combination of genetic and environmental factors increases the risk of developing addiction. For example, some individuals have a genetic or hereditary predisposition to substance abuse due to familial patterns of drug addiction.

Possible causes of substance use disorder include:

Brain Chemistry

Reward pathways in the brain are responsible for reinforcing pleasurable and rewarding behaviors.⁴ Drugs can hijack this system, leading to brain chemistry and neurotransmitter changes. These chemicals transmit signals between brain cells, and many substances can either mimic their effects or interfere with normal functioning.

Over time, repeated drug use can disrupt homeostasis (the natural balance of neurotransmitters in the brain). The brain adapts to drugs by reducing sensitivity to dopamine or other neurotransmitters, leading to tolerance (a decreased response to natural rewards). This desensitization can result in needing higher doses to achieve the same pleasurable effects, sometimes intensifying withdrawal symptoms that further reinforce the cycle and ultimately lead to drug addiction.

Adverse Childhood Experiences

Adverse childhood experiences (ACEs) can significantly contribute to drug addiction and substance use disorder. ACEs refer to traumatic events during childhood, such as abuse, neglect, household dysfunction, or witnessing violence. These experiences can have long-lasting effects on physical, emotional, and psychological well-being, increasing vulnerability to substance abuse.

ACEs can also significantly disrupt normal brain development and affect the stress response system. Chronic exposure to stress during childhood can lead to dysregulation of hormones, such as cortisol, and alter reward and pleasure pathways. Individuals may find themselves stuck in “survival mode” or a state of “fight, flight, or freeze.” This dysregulation compromises sound judgment and can make individuals more susceptible to seeking relief or escape through drug use. Moreover, ACEs can contribute to maladaptive coping mechanisms and poor emotional regulation skills—exacerbating the symptoms of low affect or diagnosable mental health disorders.

Co-Occurring Conditions

Co-occurring conditions refer to dually diagnosed mental health and addictive disorders. These can contribute to drug addiction and substance use disorder in many ways. For example, individuals may experience substance use disorder symptoms because they use drugs to cope with mental health disorders.

Furthermore, co-occurring conditions can exacerbate substance-related disorders by interacting with the effects of drugs on the brain. Substance use can worsen symptoms of mental health disorders, making them more severe and persistent (e.g., intensify anxiety or trigger psychotic episodes). This interaction between substance use and mental health disorders creates a complex interplay that can perpetuate the cycle of addiction.

Environmental Factors

The environment in which an individual lives, works, and socializes can influence their access to drugs, social norms surrounding substance use, and the availability of supportive or risk-inducing factors. Individuals in environments where drugs are readily available or drug use is prevalent are more likely to be exposed to and experiment with substances. This easier access increases the risk of initiation and subsequent addiction.

Social norms also play a crucial role. A social environment that normalizes or encourages substance use can influence attitudes and behaviors about drugs. Additionally, environmental stressors, such as poverty, unemployment, or exposure to violence, can increase the vulnerability to drug addiction. These stressors can lead individuals to seek escape or relief through substance use to cope with challenging circumstances.

Genetic Factors

Genes can influence various aspects of substance addiction, including how the body metabolizes and how the brain responds to drugs. Genetic variations can affect the functioning of neurotransmitters, receptors, and other components of the reward system directly involved in the pleasurable effects of drugs. These genetic variations can influence sensitivity to the reinforcing properties of substances, making some individuals more susceptible to developing addiction.

Furthermore, research has shown that individuals with family histories of addiction are at a higher risk of developing a substance-related disorder.⁵ However, genetics are not the sole predictor and those with a predisposition can mitigate this risk by abstaining from substance use.

Effects of Substance Use Disorder

A substance use disorder can have wide-ranging and detrimental effects on physical, mental, and social well-being. SUD is a chronic condition characterized by compulsive and harmful drug or alcohol use, leading to deteriorating physical health, mental health problems, strained relationships, financial difficulties, legal issues, and a decline in overall quality of life.⁶ The impact can be profound, affecting both afflicted individuals and their family, friends, and community.

Effects of drug addiction may include:

Physical & Mental Health Complications

Drug addiction can lead to various health complications and conditions. For instance, individuals who abuse drugs may experience cardiovascular problems such as heart disease, heart attacks, or irregular heart rhythms.⁷ Other health complications may include respiratory issues, liver damage, kidney dysfunction, weakened immune system, and increased risk of HIV/AIDS or hepatitis.

Furthermore, drug abuse can also have severe mental health consequences. Substance abuse can exacerbate or influence mental health disorders like depression, anxiety, bipolar disorder, or psychosis. Additionally, drug addiction can impair cognitive functions, memory, and decision-making abilities.

Relationship Problems

Drug addiction often leads to significant relationship problems that can strain and disrupt social dynamics. Individuals may prioritize obtaining and using drugs over maintaining healthy relationships, leading to neglect, mistrust, and conflict within families, friendships, and romantic partnerships. Hence, we see that “addiction is a family disease.”

Substance abuse can erode trust as individuals may engage in secretive behaviors, lie, or manipulate loved ones to support their addiction. Friends and family may feel betrayed, resentful, and angry. In some cases, loved ones may seek substance abuse interventions for these individuals.

Moreover, substance abuse can lead to emotional and behavioral changes in individuals, impacting their ability to communicate effectively, regulate emotions, and fulfill their responsibilities. This behavior can increase arguments, unpredictable behavior, and a breakdown of emotional connection within relationships.

Financial Strain

Drug addiction can result in significant financial strain for individuals, their families, and the economy. To put this into perspective, the cost of obtaining drugs can quickly escalate, draining financial resources and causing severe economic consequences.⁸ Individuals with drug addiction often prioritize acquiring drugs over meeting their financial obligations, like paying bills, rent, or mortgage. As a result, they may accumulate debt, experience utility shut-offs, or face eviction, leading to a downward spiral of financial instability.

Moreover, drug addiction can hinder the ability to maintain employment or contribute productively to the workforce. The effects of substance abuse can lead to frequent absences or tardiness, often resulting in job loss or difficulty finding and retaining employment. Unemployment or underemployment further exacerbates financial strain, making covering basic living expenses and maintaining a stable lifestyle challenging.

Legal & Criminal Implications

Substance abuse often contributes to risky behaviors like driving under the influence. These behaviors can lead to accidents, injuries, or fatalities. Involvement in such incidents can result in severe legal consequences, including license suspension, fines, and mandatory substance abuse education or treatment. Engaging in illegal drug use and related activities can also lead to encounters with the criminal justice system. Possession, distribution, or manufacturing of illicit drugs can result in arrests, charges, and potential convictions.

These consequences not only have immediate effects but can also have long-term impacts on personal and professional lives. A criminal record can limit employment opportunities, housing options, and educational prospects, creating barriers to successful reintegration into society.

How Is SUD Diagnosed?

A mental or health care professional can diagnose a substance use disorder. Physicians will use various tests and interviews to determine if present symptoms or behaviors warrant a SUD diagnosis.

Diagnosis of substance use disorder may include:

• Open-ended interview: Clinicians will interview individuals to assess their medical history, substance use, treatment history, and substance misuse frequency.
• Observation: Physicians may sometimes request observational tests to assess for behavioral indications of drug addiction.
• Interviews with loved ones: With the patients’ permission, clinicians may interview spouses, family members, or friends to retrieve information about current and past substance abuse.
• Toxicology screens: Urine toxicology tests can help determine if someone has recently abused substances.
• Additional tests: Individuals may complete questionnaires in-person or online during a SUD diagnosis exam. Examples include the CAGE questionnaire, Michigan Alcohol Screening Test, Comprehensive Opiate Withdrawal Scale, and Alcohol Withdrawal Scale.⁹

Symptoms of a Drug Overdose

Living with a substance use disorder may result in uncomfortable symptoms, but an overdose from drug addiction is also possible. An overdose can be life-threatening and fatal. If someone is experiencing symptoms, individuals or loved ones should seek immediate medical attention or call 9-1-1.

Symptoms of a drug overdose may include:

• Slowed heart rate
• Short, shallow breaths
• Loss of consciousness
• Seizure
• Dizziness
• Nausea
• Loss of coordination
• Drowsiness
• Slow pulse
• Confusion

Substance Abuse Treatment Options

Substance use disorder treatment may include inpatient care, intensive outpatient therapy, medication, or lifestyle combinations. The goals of drug and alcohol addiction treatment are sobriety, improving quality of life, developing communication and problem-solving skills, and fostering healthy relationships.

However, the best treatment for substance abuse depends on the individual and their needs. Therefore, treating addiction starts with self-reflection, research, and motivation to obtain appropriate care. Treatment and recovery meet a standstill if substance-related mindsets, outlooks, attitudes, behaviors, and habits do not change.

Substance abuse treatment options may include:

Inpatient & Rehab

Rehab for drug addiction and substance use disorder typically lasts between 30 and 60 days, depending on the extent of substance misuse. In the initial stage of drug addiction treatment, detox occurs under medical supervision.

Once detox is complete, patients transfer to a rehabilitation facility where they receive 24/7 care and engage in various activities, therapies, and routines. Patients learn about proper nutrition, coping skills, and addiction to help them maintain sobriety.

Therapy

Intensive outpatient or traditional therapy can help individuals stay clean and sober. Many substance abuse treatments build on cognitive behavioral therapy (CBT) or rational emotive behavioral therapy (REBT), and individuals may pursue group or individual therapy options.

CBT and REBT involve learning to identify counterproductive thinking, discarding unproductive thoughts, and replacing negative beliefs about addiction or substance use with new, positive concepts. Individuals struggling with drug addiction learn to manage stress, develop problem-solving skills, and adopt sober activities.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a substance abuse treatment approach that combines the use of FDA-approved medications with counseling and behavioral therapies to address addiction.¹⁰ MAT is primarily used for opioid and alcohol use disorders, although some professionals utilize these practices for other substance addictions. Medications for substance abuse help reduce withdrawal symptoms, cravings, and the euphoric effects of drugs, allowing individuals to focus on their recovery and engage more effectively in counseling and therapy.

Alongside medication, MAT incorporates counseling and behavioral therapies to address the psychosocial aspects of addiction. These may include treatment approaches such as cognitive behavioral therapy (CBT) for addiction, dialectical behavioral therapy (DBT), rational emotive behavioral therapy (REBT), mindfulness-based therapies, interpersonal psychotherapy (ITP), and others.

This comprehensive approach aims to provide a holistic treatment experience, addressing both physiological and psychological aspects of addiction. Research shows that MAT increases treatment retention, reduces illicit drug use and overdose risk, improves social functioning, and supports long-term recovery.⁶

How to Find Help for a Loved One With SUD

Finding drug and alcohol addiction treatment for a loved one is gradual. The person with SUD may react with denial, rationalizing, and anger, so remain patient and persistent. Still, you cannot force someone to change–allow your loved one to seek treatment themselves. Provide encouragement and support as they manage their addiction, but take care of yourself and recognize your limits. If your loved one has expressed interest in receiving substance abuse treatment, consider contacting their primary doctor or using an online therapist directory to determine the next steps.

How to Cope with a Substance Use Disorder

Remaining sober comes with numerous challenges. Maintaining recovery starts with changing with whom you associate and disconnecting from substance-related environments. Avoid known triggers to help prevent relapse. Recovery is possible with time, effort, adequate treatment, and dedication.

Below are ways to cope with a drug addiction throughout treatment:

• Prepare for withdrawal symptoms: Understand that withdrawal symptoms are a normal part of recovery and work with healthcare professionals to develop strategies to manage them effectively. Symptoms are uncomfortable but will pass with time (and potentially some assistance via a medical detox process).
• Maintain treatment: Stay committed to your treatment plan, attend therapy sessions, and follow medication schedules as prescribed to optimize your chances of successful recovery. Intentionality and consistency are key here.
• Practice stress management skills: Learn and utilize healthy coping mechanisms, such as deep breathing exercises, mindfulness techniques, or engaging in hobbies, to manage stress without resorting to substance use. Like preparing for a marathon, this requires focus and time.
• Stay active: Engage in regular physical activity to promote physical and mental well-being, as exercise can help reduce cravings, improve mood, and provide a healthy outlet for stress. Remember, exercise boosts naturally euphoric neurotransmitters and hormones like dopamine and endorphins.
• Engage your mind in healthy activities: Incorporate positive activities, like meditation, yoga, or other mindfulness, to promote relaxation, self-awareness, and emotional stability. With a healthy mindset, one is more inclined to continue making healthy decisions while avoiding unhealthy ones.
• Be patient: Remaining patient cannot be overstated. Understand that recovery takes time and progress may not be linear. Practice self-compassion, celebrate small victories, and remain committed to the long-term goal of sustained recovery.
• Distance yourself from triggers: Avoid people, places, or situations that may trigger cravings or temptations to use drugs. Create a supportive and drug-free environment that promotes your recovery.
• Ask for social support: Seek support from friends, family, or support groups who can provide understanding, encouragement, and accountability throughout your recovery journey. “Drug buddies” who jump ship after you announce your recovery effort are not the supportive type you need.

Final Thoughts

Substance use disorders (SUDs) are complex conditions that can devastate individuals, their loved ones, and society. Recognizing the signs of SUD, such as compulsive drug use (despite desires or attempts to stop), tolerance, withdrawal symptoms, and negative consequences on one’s life is crucial for early intervention and treatment. With a comprehensive and individualized approach, individuals can navigate the challenges of SUD, regain control over their lives, and find a path toward sustained sobriety and improved well-being. Help is out there, but the onus is on you to seek out and commit to it.