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Expert Q&A: Addiction and Substance Use Disorders

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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.

If your child is using heroin, you are absolutely correct that they are in a life-threatening situation. The very best way to address this problem is to get them into medication  treatment with one of the three medications that are approved by the FDA for treatment of opioid use disorder (buprenorphine, methadone or naltrexone). Treatment without medications does not work for most people. If you can contact a local addiction psychiatrist, that physician would know how to help you. If there is no doctor with that specialty in your area, take your child to their or your regular physician and ask for help arranging medication treatment with one of those medications.

In the instance of an acute overdose, addition, there is an available antidote: a medication called naloxone. It is used in emergency rooms to reverse an overdose and is available without a prescription to patients with opioid use disorder and their friends or family members. This medicateion must be given as a nasal spray or by injection. Since someone who has overdosed on heroin or another opioid cannot give himself or herself the naloxone, friends or family members need to be trained to respond to an overdose and give the naloxone. It is important to also call 911 as even with naloxone, someone experiencing an overdose with require medical attention.

The cost will obviously depend upon the severity of your spouse's problem and what components of treatment your health insurance covers. Many of the costs mentioned below should be covered by insurance.Aburpt discontinuation of alcohol can be dangerous. Symptoms of withdrawal could include sweating, rapid heartbeat, tremor, difficulty sleeping, hallucinations or even seizures. If these types of symptoms are present, your spouse will need medical attention to help reduce or stop their alcohol use. If they do not have these symptoms, it is very likely that they could get the help they need at no cost by attending Alcoholics Anonymous meetings (AA), getting an AA sponsor, and engaging seriously in the AA 12-step program (called “working the steps.”)

Medical attention for symptoms of withdrawal should not cost any more than a routine doctor's appointment. Many people can have withdrawal treated on an outpatient basis with three or four brief doctor's appointments. If outpatient treatment for withdrawal does not work or if alcohol withdrawal is severe with a risk of seizures or delirium (extreme mental confusion), inpatient treatment would be needed. Inpatient withdrawal treatment usually lasts five to seven days and, depending upon how much is covered by insurance, might cost several thousand dollars. Many communities do have public “detox” programs which can provide a similar service for much less cost. 

It is common for people with alcohol use disorder to have other psychiatric disorders. It is often difficult to determine if the other psychiatric disorder is caused or worsened by the alcohol use or even whether the other disorder exists without the alcohol use. If possible, it is ideal to be able to stop the alcohol use totally for a period of three to six weeks to help determine how much the alcohol might be contributing to the psychiatric symptoms. 

In many cases, symptoms will substantially improve after stopping the alcohol. If the psychiatric symptoms do not improve with stopping alcohol, they will need specific treatment with medication and psychotherapy. It sometimes makes sense to go ahead and try treating the other psychiatric symptoms with medication and psychotherapy even while some alcohol use is still occurring, with the hope that treating the psychiatric symptoms will make it easier to cut down on or completely stop alcohol use.

Content Author

Brigette Torrise, M.D.


Medical leadership for mind, brain and body.

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