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Addiction and Substance Use Disorders

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Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person's ability to function in day to day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems. The most severe SUDs are sometimes called addictions.

People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain's structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavioral control.

Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate effects of the substance wears off, or in other words, after the period of intoxication. Intoxication is the intense pleasure, euphoria, calm, increased perception and sense, and other feelings that are caused by the substance. Intoxication symptoms are different for each substance.

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Expert Q&A: Addiction and Substance Use Disorders

Preventing relapse to substance use is mainly a matter of becoming aware of the triggers to relapse and either finding ways to avoid or cope with them. Triggers can be external, for example being in places where substances are being used. Stress of any kind (job stress, financial stress, arguments with important people) can also be an external trigger. Triggers can also be internal such as craving, depressed mood, anxiety, hunger or fatigue. The key is, whenever possible, to anticipate triggers ahead of time so they don't come as a surprise and have a plan or coping strategy to deal with the triggers. Usually professional help can be helpful in gain awareness of triggers and developing plans to deal with triggers to relapse. There are also very good medications for alcohol, opioid and tobacco use disorders that effectively reduce craving and can help prevent relapse.

Opioid type medications that have potential to lead to addiction are only one way, and probably not the best way, to help manage chronic pain. So the best plan is to try all the alternatives first.

Non-medication interventions such as graded exercise programs, physical therapy, mindfulness meditation, yoga, tai-chi and a form of psychotherapy called cognitive-behavioral therapy (CBT) all take some effort but often work very well. Acupuncture may benefit some people living with pain. Many medications that do not have addiction potential can also be helpful for chronic pain. These include anti-inflammatory medications like aspirin, ibuprofen or naproxen; antidepressants like nortriptyline or duoloxetine; or medications often used for seizures like gabapentin or pregabalin.

If you or someone you know does require opioid pain medications to help manage chronic pain, it is reassuring to know that the majority of people who take these medications for chronic pain do not become addicted to them, although anyone who takes these type of medications for more than a few weeks is likely to have some tolerance (less effect of the medication over time) and withdrawal symptoms if the medications are stopped abruptly.

Al-Anon and Alateen are widely available and free resources for family members. These organizations offer mutual help groups. Members do not give direction or advice to other members. Instead, they share their personal experiences and stories, and invite other members to "take what they like and leave the rest" — that is, to determine for themselves what lesson they could apply to their own lives. The best place to learn how Al-Anon and Alateen work is at a meeting in your local community. Most professional treatment programs also offer family groups to help families support their loved ones struggling with addiction.

Yes. Overall, men are about one and a half to two times more likely to have a substance use disorder (SUD) than women. Data from the National Survey on Drug Use and Health indicate that in 2019, approximately 10.7% of males 12 years of age and older and 6.3% of females met criteria for an SUD in the prior year. It is important to note, however, that when children 12 to 17 were examined apart from adults, the rates for boys and girls were much closer and even slightly higher for girls (5.7%) than for boys (4.8%).

Similarly, epidemiological research has found that among younger women and men in the U.S., the gender differences in rates of binge and heavy drinking are smaller than are seen for older adults. This suggests that women are essentially catching up to men in unsafe use of alcohol, and this has significant implications for their health and safety and that of their children, both unborn and born.

Children in families with a lot of drug or alcohol addiction among the members are at high risk. It is very clear from studies of twins that 50% of the risk for developing addiction is determined by genetics. Among identical twins who share all their genes, if one twin has addiction, the other twin has a 50% chance of having it as well. Among fraternal twins who, just like any other siblings share about half their genes, if one twin has addiction, the other twin has about 25% chance of having the disorder. The good news here is that half the risk for developing addiction is environmental so that effective interventions can probably prevent it in many genetically susceptible individuals.

We also know that, regardless of genetics, the earlier a child starts using substances, the higher the risk of later developing addiction. Children at high risk should be told of their risk at the earliest age when they can begin to understand the meaning, generally between ages 10 and 12 depending upon the child's maturity.

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Andrew Saxon, M.D.

Andrew Saxon, M.D.

Professor and Director, Addiction Psychiatry Residency Program
University of Washington
Director, Center of Excellence in Substance Abuse Treatment and Education (CESATE)
VA Puget Sound Health Care System

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