Substance Use Disorder

Alcohol has become a ubiquitous presence in our daily lives –  marking its appearance in social gatherings, vacations, family and work events, nightclubs, and even in some cultural ceremonies. Similar to the prevalent use of alcohol, nicotine consumption has also become a part of the everyday routine of many individuals, which often manifests through smoking or other forms of tobacco.

A majority of individuals have tried alcohol at least once in their lives, and many others have also sampled other substances such as tobacco, cannabis, or cocaine (Degenhardt et al., 2008). Consumption of these substances is statistically common and not inherently pathological. Nevertheless, their usage is deemed to be disordered when taken excessively, resulting in impairment and adverse consequences.

In recent years, the increasing prevalence of substance use disorder (SUD) has emerged as a significant societal challenge, casting a widespread shadow over communities globally. Now let’s take a moment to understand what substance use disorder exactly is

Before we get started, some of the basic concepts related to “Substance Use” that we should know are

• Substance Abuse: This usually involves using a substance excessively, which can lead to either (1) risky behaviour such as driving while intoxicated, or (2) persistent use despite consistent social, psychological, occupational, or health problems. According to the American Psychological Association, “Substance abuse is a pattern of compulsive substance use marked by recurrent significant social, occupational, legal, or interpersonal adverse consequences, such as repeated absences from work or school, arrests, and marital difficulties.”
• Substance Dependence: This consists of severe forms of substance use disorders, that are marked by a significant physiological need for increasing amounts of a substance to achieve desired effects. In these cases, the dependence eventually manifests into a tolerance of the substance and the occurrence of withdrawal symptoms whenever the substance isn’t available when desired (Hooley, Butcher, Nock, Mineka, 2017). 

The historical distinctions between substance use, abuse, and dependence have been consolidated under the comprehensive term “Substance Use Disorder” in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), which signifies an enhanced comprehension of varying degrees of severity in such conditions.

Various substances fall under the umbrella of “substance use”

• Alcohol

  Alcohol abuse and dependence are significant problems all around the world. They are ranked among the most destructive of psychiatric disorders due to the profound impact excessive alcohol use can have on the lives of alcohol consumers and those of their families and friends (Hooley, Butcher, Nock, Mineka, 2017). 

  The potential harm from excessive alcohol use is enormous! Heavy drinking is associated with vulnerability to injury, marital discord, and becoming involved in intimate partner violence just to name a few issues that may disrupt one’s life (Cherpitel, 1997; Hornish & Leonard, 2007; Eckhardt, 2007). 

It is also of utmost importance to note that intoxication is determined by the amount of alcohol that is actually concentrated in the bodily fluids, not the amount consumed. The effects of alcohol vary for different drinkers, based on their physical condition, the amount of food or drink in their stomach, and the duration of their drinking. Additionally, alcohol users may also gradually build a tolerance to the substance, leading to it being consumed in higher amounts to produce the desired effects (Gordis, et al., 1995). 

• Drugs

  Following alcohol, the psychoactive drugs that are commonly associated with substance abuse and dependence are:

• Opium and its derivatives

  Opium and its derivatives have been used for centuries for medicinal and recreational purposes and were found to have pain-relieving properties. Opium is a mixture of around 18 chemical substances that are known as alkaloids. In 1905 the predominant alkaloid, consisting of 10-15% of the total, was identified as a bitter-tasting powder that could serve as a powerful sedative and pain reliever, subsequently named morphine. It was later found out that if morphine was treated with an affordable and easily accessible chemical – acetic anhydride – it would turn into another powerful pain suppressant known as heroin, which proved to be an even more hazardous substance compared to morphine. The life of an individual addicted to opiates becomes increasingly focused on acquiring, and using drugs, which usually results in dysfunctional social behavior. Sometimes in extreme cases, individuals addicted to these substances may even resort to theft to support their dangerous habits.

• Stimulants such as cocaine, and amphetamines along with caffeine and nicotine

Cocaine

Cocaine is a substance that is obtained from plants and gained popularity in the 1880s when Sigmund Freud, viewed it as an excellent treatment for certain disorders. Cocaine can be ingested by sniffing, injecting, or swallowing, and it has a different effect on the brain as compared to other substances such as alcohol or opioids. 

Cocaine primarily works by blocking the presynaptic dopamine transporter, which leads to an increased availability of dopamine in the synapse and a heightened activation of the receiving cells, which results in the reward and pleasure effects that are experienced (Berridge & Kringelbach, 2015).

Amphetamines

Amphetamines are known for boosting activity in neurotransmitters and are commonly prescribed for conditions such as ADHD. However, just as the other substances we’ve discussed before, amphetamines carry heavy risks, which include addiction and with excessive misuse, can also lead to cognitive damage. (Hooley, Butcher, Nock, Mineka, 2017).

Caffeine

Most of us start our day with a steaming hot cup of coffee, before heading out the door to begin our routine. This dosage of caffeine provides us with a jolt of energy we need to be productive, and numerous researches have proven that caffeine is associated with higher levels of alertness, enhanced focus, greater energy levels, and a positive impact on our mood (Nehlig, 2016). 

However, an excessive and harmful use of caffeine over a period of time can lead to a caffeine addiction, leading to negative effects on one’s health, social relations, and all other aspects of life. 

As most of us know, caffeine consumption can disturb sleep patterns and is often consumed when one has to stay up late or delay sleep. This in turn results in dysfunctional performance during the day. Excessive consumption of caffeine is also associated with increased blood pressure and changes in the heart rhythm, along with increased chances of anxiety (Bodar, Chen, Gaziano, Albert & Djoussé, 2019).

Thus, it is best to consume caffeine in moderate amounts and avoid excessive intake as it may lead to numerous issues and challenges. 

Nicotine

The main psychoactive ingredient in tobacco – nicotine – is a stimulant drug that speeds up the process of exchanging messages between the brain and the body. This is a highly addictive substance found in the tobacco plant, however, it can also be synthetically produced in labs. 

This drug creates a temporary feeling of relaxation, along with increasing the heart rate, and creates a surge of endorphins in the body. Eventually, this feeling wears off and leads to the feeling of “wanting more”. Excessive consumption of tobacco also changes the brain functioning in relation to self-control, stress, learning, etc. 

According to research conducted by Chadda and Sengupta in 2003, Young Indian adolescents have become major targets for the tobacco industry, with an estimated 20 million becoming addicted, adding 5500 new consumers every day. Although many of these users attempt to quit annually, very few – only about 20% succeed in this endeavor. 

Hence, nicotine is detrimental to one’s overall health and well-being. 

Apart from these substances, there are a variety of non-substance-related addictions which we will take a brief look at

Non-substance addictions often referred to as “behavioural addictions” encompass compulsive behaviours rather than the use of a particular substance. Some examples of these are:

• Gambling addiction

  A gambling addiction is characterized by a severe and uncontrollable urge to engage in gambling, despite being well aware of the negative consequences. It can lead to maladaptive behaviours and clinically significant distress in individuals. This condition can lead to severe financial, emotional, and social repercussions, negatively impacting one’s quality of life (Esparza-Reig et al., 2023). 

• Internet addiction

  The internet has become an integral aspect of our lives, and most of us cannot even begin to imagine our lives without the indispensable being – that is the internet. However, just like everything else we’ve seen before, excessive and inappropriate use of the internet can once again, lead to an addiction, subsequently resulting in tolerance, withdrawal symptoms, and difficulties with attempts to quit. 

Cybersexual addiction is also a part of internet addiction and can be described as viewing pornographic content excessively, or over engaging in online sexual communication. 

Various virtual social relationships are also facilitated through the internet via social networking sites, which may contribute to the development of a cyber-relationship addiction. This condition can lead to decreased real-life social interactions. Social interactions that take place on the internet allow for anonymity and allow more time to create and edit messages to make the desired impression. This condition has been witnessed in many individuals having social anxiety, as the internet not only provides comfort but can lead to a troublesome use of the internet, which in turn could negatively impact the user’s life. Many employers have reported that this addiction has become a big concern, especially for the youth. 

Online gaming has significantly developed in recent years, leading to the creation of a complex graphical virtual world, massively known as “multiplayer online games.” This component can lead to many players becoming increasingly involved in participating in these games, perhaps having higher levels of interaction online, through the mode of these games, compared to real-life social interactions. This contributes to the development of an online gaming addiction. 

(Kurniasanti, Assandi, Ismail, Nasrun & Wiguna, 2019). 

• Work Addiction

  Work addiction, commonly known as “workaholism,” is a behaviour al pattern characterized by being unable to disconnect oneself from the work they do, putting in long hours in the office, and being obsessed with work-related success. It is a complex condition, and often difficult to identify. Employees are expected to show initiative and go above and beyond in their work performance –  therefore we can say that there is a very fine line between work commitment and work addiction. This is considered a real mental health condition affecting one’s personal and social life, along with creating great levels of distress in their overall well-being. (Mohan & Lone, 2021).

Now it is important to understand the difference between the recreational use of substances and when it is considered to be an addiction

Many people experiment with alcohol and drugs for a variety of different reasons – sometimes out of peer pressure, sometimes to alleviate problems such as anxiety and stress, and other times simply out of curiosity. The sole purpose for consuming these substances can simply be as a means of enjoyment, or as an escape from the reality of life. 

In the beginning, taking these substances is a choice, and consumption is done as a recreation. However, as consumption carries on, self-control can become increasingly difficult, and recreational use can become a slippery slope towards addiction. Once an individual develops a dependence on these substances and depends on them to carry out basic everyday functions, it becomes an addiction. 

(National Institute on Drug Abuse, 2022)

According to a study conducted by David, Kaku, Daniel & Lowenstein in 1990, recreational drug was found to be a prominent and increasing risk factor that contributed to strokes in young adults. So, although it may not have the same effects as addiction, it was still found to be detrimental to one’s overall health. 

Signs and Symptoms of dependence

According to the DSM-V, the signs and symptoms of dependence may vary according to individuals and the type of addiction they suffer from, however, some of the most common warning signs are

• Social Impairment and change in social behaviour.
• Neglected appearance, body odor, red eyes, large pupils, decreased coordination, and slowed reaction time.
• Irritability, anxiety, paranoia, confusion, and hallucinations.
• Problems at school or work.
• Financial issues include spending excessive money on acquiring the substance, despite being well aware that it isn’t affordable.
• Insomnia.
• Feeling the need to have the substance regularly, perhaps even several times a day.
• Requiring higher levels of the substance to achieve the desired effects.
• Experiencing withdrawal symptoms when attempting to stop taking the substance.
• Failed attempts to quit the substance.

The prevalence for developing a substance use disorder is

• Genetics: We all have different bodies that react differently to different substances. For some people consuming a drug once may not have any severe effects on their body, in fact, they may even hate how the substance feels and never consume it ever again! But for many others, since the first trial, they may get hooked on to the substance and want more. Heredity also plays a very significant role in the development of an addiction. Children whose biological parents battled an addiction are more likely to develop the same (Hooley, Butcher, Nock, Mineka, 2017).
• Trouble at Home: If someone grows up and lives in a troubled home environment, with constant fights, being ignored, and one or both of the parents consuming drugs or excessive alcohol, then they may be more likely to develop a substance use disorder. 
• Trouble at school/work: Failure to succeed at school, work, or in any other social setting can increase the prevalence of developing a substance use disorder, as one might resort to these substances as an “escape” from these problems. 
• Peer Pressure: Hanging out and spending time with friends/ colleagues who regularly consume drugs/alcohol may lead to increased chances of an individual “trying out” the substance at first and then regularly consuming it to “fit in” with their peers.
• Exposure through medical treatment: Another very important causal factor to the development of substance addiction is being exposed to these substances through medical treatment. In some conditions, opium and its derivatives are used as a pain reliever in medical treatments. Being exposed to this drug even once can lead to an individual wanting more, and eventually becoming addicted (Hooley, Butcher, Nock, Mineka, 2017). 

These are just some of the possible contributing factors. Other factors include having mental health problems, beginning to consume drugs from a young age, stress, and troubled marital and intimate relationships.

(National Institute on Drug Abuse, 2022)

Impact of substance use and addiction on the quality of life of an individual

As seen before, substance use and addiction can impact the overall well-being of an individual in numerous different ways. It can affect their social interactions, and performance at school and work, create financial difficulties, impact their physical health contributing to various physiological issues, and also lead to an inability to function daily without the consumption of a specific substance. The experience of withdrawal symptoms can also generate great levels of distress in the individual, and the overall signs and symptoms presented due to addiction can also generate great levels of distress within the individual’s family members.  

How to manage and treat substance use disorder?

• Rehabilitation

  According to the World Health Organization, rehabilitation is a “set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”. This intervention method helps a person become independent in their everyday activities and helps them live a meaningful life. 

  Personalized rehabilitation is delivered through various settings, including hospitals and communities, by a diverse workforce comprising of occupational therapists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses. 
  Locate the best clinical psychologist in india 

• Pharmacotherapy

  Pharmacotherapy is the use of prescribed medication to help the treatment of addiction. The FDA has sanctioned numerous different medications to treat alcohol and opioid use disorders such as disulfiram, acamprosate, and naltrexone. These medications alleviate withdrawal symptoms and the psychological craving that causes chemical imbalances within our bodies. These medications are evidence-based treatment options and are not merely substitutes for different drugs (National Library of Medication, 2013).  Please remember that medication should not taken without consulting a medical professional.

Biomedical therapies include the use of drugs, surgical methods, electric shock treatments, and non-invasive stimulation techniques. It is important to understand that biomedical therapies often eliminate or alleviate the symptoms of a disorder, while psychotherapy addresses issues associated with the disorder, and when used together, these two types of therapy facilitate each other (Maxmen et al., 2009; Ciccarelli & White, 2018). 

• Psychotherapy

  Psychotherapy typically involves an individual, couple, or small group of individuals working directly with a  therapist in India or other qualified mental health professionals around the world, and discussing their concerns or problems.
  Common psychotherapies used to reduce the frequency of undesirable behaviours such as smoking, or drinking alcohol, are Motivation Enhancement Therapy, Cognitive Behaviour Therapy, Dialectal Behaviour Therapy and Family Therapy.

• Support from family

  The family of the individual addicted to a substance can get involved and play a healthy role in decreasing their undesired behaviours. The family can reward positive behaviours, while holding their loved one accountable for negative actions. The family members can also attend support groups with the individual, or even attend their own support groups with the family members of other individuals having substance use disorders. 

• Motivational Interviewing

  Motivational Interviewing is a brief, client-centered, intervention technique, where the primary aim is to strengthen a person’s motivation and commitment to change (Frenske & Peterson, 2015)

  Thus to conclude, a substance use disorder is a serious and debilitating condition that affects an individual in numerous aspects of their lives. As we navigate through the complex landscape of substance use, we understand that there are various contributing factors in the development of a substance use disorder and that an individual can get addicted not only to different substances but also experience various behavioural addictions as well. It is crucial to seek help immediately if you or your loved ones are battling addiction or excessive and uncontrollable levels of substance use. 

  Connect with the best online psychiatrist in India and prioritize your mental well-being today.

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