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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--sometimes called an addiction--on using a certain substance(s) such as alcohol, tobacco, or other psychoactive substances, to the point where their 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. 

Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate intoxication wears off. Intoxication is the intense pleasure, euphoria and calm that are caused by the substance; these symptoms are different for each substance. With continued use of a substance, tolerance can develop, where someone may require larger amounts in order to fell these effects. Additionally, discontinuing use can lead to symptoms of withdrawal and intense cravings to return to use, often experienced as anxiety.

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.

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Expert Q&A: Addiction and Substance Use Disorders

One way to prevent returning to use, is to become aware of an individual’s personal triggers and find ways to avoid or cope with them. These can be external, such as environments where others are using or offering substances, or they can be internal, such as anxiety, hunger, or fatigue. The key is to do your best to anticipate triggers, and have a plan or coping strategy to deal with them. Mental health professionals can help you to gain awareness of triggers and to develop coping plans. There are also very good medications for most use disorders that effectively reduce cravings.

Medications that have potential to lead to addiction are only one way to help manage chronic pain.

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, including anti-inflammatory medications like aspirin, ibuprofen or naproxen; antidepressants like nortriptyline or duloxetine; or medications often used for seizures like gabapentin or pregabalin. Speak with your doctor to come up with a plan that works for you.


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. 

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 an addiction, the other twin has about 25% chance of having the disorder. This does not mean that a young person with a family history is predetermined to develop a substance use disorder. It does, though, mean that they are particularly susceptible to the disease.

Regardless of genetics, the earlier a child starts using substances, the higher the risk of later developing addiction. Children and adolescents are at a stage of life defined by their curiosity and growing independence, but they are also still maturing into their ability for judgement and self-inhibition. Because their brains are still growing, they are also more susceptible to being modified by substance use in a lasting way.

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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Brigette Torrise, M.D.


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