Substance use disorder (SUD) is a complex condition involving the uncontrolled use of a substance, despite harmful consequences. Learn more about substance use disorders including the symptoms, and how they can be managed and treated.
A substance use disorder (SUD) occurs when someone loses the ability to control their use of a substance such as drugs, medication, alcohol or tobacco, causing harm to themselves or others. These substances activate the brain’s reward system, producing pleasurable feelings, which can lead to intense cravings. A substance use disorder can result in a person being unable to function normally day-to-day.
Substance use disorders are diagnosed based on the primary substance being misused. There are two main types of substance use disorder:
Alcohol consumption is responsible for three million deaths each year globally, according to the World Health Organization. Overall, alcohol use disorders are responsible for 5.1% of the global burden of disease. Alcohol is the main risk factor for premature mortality and disability among people aged 15-49, accounting for 10% of all deaths in this age group.
The World Health Organization reports that about 270 million people (or about 5.5% of the global population aged 15-64) used psychoactive drugs in the previous year and about 35 million people are estimated to have drug use disorders. It is estimated that about half a million deaths every year are due to drug use, equating to 350,000 male deaths and 150,000 female deaths.
The symptoms of substance use disorders vary from person to person and can also depend on the type of addiction.
There are several signs and symptoms of substance use disorder that are common to most types of addiction. These include:
Behavioural and social changes:
Psychological changes:
Physical changes:
It is important to spot the early warning signs of a substance use disorder in order to get help as soon as possible.
Alcohol abuse early signs may include:
Drug abuse early signs may include:
Like many mental health conditions, there are several factors that may lead to substance use disorders.
The exact cause of substance use disorders is not known. Instead, there may be many factors involved, including:
Substance use disorders are moderately to highly heritable. If someone has a blood relative, such as a parent or sibling, with an alcohol or drug addiction they have a greater risk of developing a substance use disorder. Genetic traits may speed up or delay the disorder’s progression.
People of any age, sex, background or economic status can become addicted to alcohol or drugs, although it is more common in people exposed to environmental, mental health or genetic risk factors.
Although people can live with a substance use disorder, it is known to be a risk factor for premature death. These deaths can be caused by diseases and injury, including suicide, liver disease, hepatitis, cancer and HIV brought on as a result of excessive substance use.
Globally, illicit drug use is responsible for over 585,000 premature indirect and direct deaths each year and 42% of all deaths are in people younger than 50 years.
It is estimated that 2.84 million people die prematurely around the world every year as a result of alcohol consumption. Europe has the highest proportion in the world of total ill health and premature death due to alcohol and in Eastern Europe nearly one-third of deaths are attributed to alcohol consumption.4
Globally, almost three quarters of those dying from premature deaths due to alcohol are younger than 70 years and 28% are younger than 50 years.
Substance use disorders are usually diagnosed through a doctor’s evaluation, but some people will also self-report their problem if they are looking for help.
Substance use disorder is diagnosed with a thorough evaluation, which usually includes an assessment by a mental health professional. Substance use can be checked using blood or urine testing, but the outcomes of these tests are not an indication of addiction.
There are a variety of questionnaires that mental health professionals can use to undertake their clinical evaluation to assess problematic alcohol and substance use.
These include the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) developed for the World Health Organization to assist with early identification of substance use disorders, the Alcohol Use Disorders Identification Test (AUDIT) to identify the early signs of harmful drinking and mild dependence, the Drug Use Disorders Identification Test for self-administered screening for drug-related problems, and the CRAFFT Screening Test designed to assess substance-related risks in adolescents.
Treatment and medication for substance use disorders can be used to help people withdraw from the substance they are addicted to and help to prevent relapse.
Treatment for substance use disorder depends on personal circumstances and what substances someone is addicted to. A treatment plan may include a number of different treatments and strategies.
The field of addiction medicine in Europe continues to progress, particularly in the development of new treatment interventions, which help to provide a wide range of options for people with substance use disorder.
Medication can be used to help re-establish normal brain function and decrease cravings. It is available for treating addiction to opioids (including heroin and prescription pain relievers), nicotine and alcohol.
There are no specific approved medications to treat stimulant addiction (cocaine, methamphetamine, and cannabis dependence), but advances are being made in the development of medication to treat these disorders.
If people use more than one drug, they will need treatment for each substance they use.
Medication used to treat substance use disorders includes:
Many behavioural or talking therapies can be used to help patients with substance use disorder alongside other interventions. These help people to modify their attitudes and behaviours to drug use, increase healthy life skills and continue with other additional treatment. These therapies include:
People with substance use disorder typically suffer from nutrient deficiencies because they tend to eat less nutrient-rich food and their body has a lower capacity to absorb nutrients because of the effects of drugs or alcohol.
Substance users in recovery should increase their intake of nutrients to help their body build and maintain healthy organs and fight off infection. They are advised to maintain regular mealtimes, eat foods low in fat, and eat more protein, complex carbohydrates and fibre, as well as reducing caffeine intake and stopping smoking if possible. In addition, dehydration is common during recovery from substance use so it is important to drink plenty of fluids during and in between meals.
Improving and maintaining good eating habits is also important because people in recovery may not recognise the difference between hunger and substance craving, which can lead to a high chance of relapse.
People with substance use disorders can find that exercise is helpful as a distraction from cravings. Taking part in physical exercise can also help people affected by substance use to develop a healthier lifestyle, which has been shown to improve their mental and physical health.
Moderate and high-intensity aerobic exercise such as brisk walking, playing tennis, running or skipping and mind-body exercise like yoga can be an effective part of a combined treatment plan for people with substance use disorders.
In addition, exercise regimes can add structure to a day and help people form positive social connections that can improve their recovery and overall wellbeing.
For substance use disorders, the main goal of prevention is to delay the first use of drugs or alcohol during adolescence.
It is important to address multiple risk factors which can be common in many areas of adolescent life, such as peer pressure, as well as focus on increasing protective factors, such as school support, to help young people resist the temptation to try drugs or alcohol.
Prevention interventions are also necessary to prevent people who already use some drugs from moving onto other drugs, and to prevent people who use drugs on an occasional basis from using them excessively.
The international classification of prevention interventions used in the United Nations Office on Drugs and Crime standards includes the following prevention strategies:
Targeting each population group with relevant resources and messages can help prevent substance use and associated problems from starting or escalating.
Research into substance use continues to progress in a number of key areas including evidence-based treatment practices, addiction treatment outcomes, addiction, psychiatry and the brain, addictive substances such as prescription opioids and heroin, and substance abuse in adolescents and other groups, as well as recovery management looking at how earlier detection and re-intervention can improve long-term outcomes.
Researchers are also looking at personalising treatment of substance use disorders, while noting that for meaningful recovery to occur, a substance user will need to integrate into a socially meaningful environment. With the understanding that addiction is influenced by genes, development, and social factors, treatment could in the future be personalised to accommodate each individual’s situation.
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