What is substance use disorder?

You can improve your life and health by stopping your use of alcohol or drugs. When you don't drink or use drugs, you may feel and sleep better. You may get along better with your family, friends, and coworkers. There are medicines and programs that can help with substance use disorder.

The more symptoms of substance use disorder you have, the more severe it may be. Symptoms include:

• Using more of the substance or using it for a longer time than you ever meant to.
• Not being able to cut down or control your use.
• Spending a lot of time getting or using the substance or recovering from the effects.
• Having a strong need, or craving, for the substance.
• Not being able to do your main jobs at work, school, or home.
• Continuing to use, even though the substance use hurts your relationships.
• Not doing important activities because of your substance use.
• Using substances in situations where doing so is dangerous, such as driving.
• Using the substance even though it's causing health problems.
• Needing more of the substance to get the same effect, or getting less effect from the same amount over time (tolerance).
• Having uncomfortable symptoms when you stop using the substance or use less (withdrawal).

In addition to alcohol, almost any type of substance can lead to substance use disorder. Common ones include:

• Prescription medicines such as diazepam (Valium), methylphenidate (Ritalin), and opioids like hydrocodone (Norco) and oxycodone (OxyContin).
• Marijuana and other drugs such as heroin, meth, and cocaine.
• Over-the-counter medicines, such as cough syrups and cold pills.
• Hallucinogens, such as LSD, mescaline, psilocybin, and ketamine.
• Anabolic steroids.
• Household products that can be inhaled (inhalants). These include glues, aerosol sprays, and paint thinners.

You and your doctor can decide what type of treatment might help you. If you are physically dependent on the substance, you may need to stay in a hospital at first. There you can be treated for withdrawal symptoms. Medicines are often used to help control cravings, ease withdrawal symptoms, and prevent relapse.

One of the goals of treatment is to help you reduce problems associated with substance use. This may include getting used to life without the substance. Counseling can help you prepare for people or situations that might tempt you to start using again. You can practice these skills through one-on-one counseling, family therapy, or group therapy.

Therapy may be part of inpatient treatment, where you stay in a treatment center. Or it may be part of outpatient treatment. This lets you fit therapy around your job or other duties. You might talk to your doctor or do an online search for local treatment programs.

Another goal of treatment is to help you find ongoing support for your sober life. Many people find support by going to group meetings. Examples include Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery. This type of support can help you feel less alone and more motivated to stay sober. Or you might tell a friend or loved one that you need help.

Treatment programs for substance use disorder may be outpatient, inpatient, or residential. They offer similar therapies. Your treatment team can help you decide which type of program is best for you.

• Outpatient treatment.

  You regularly go to a mental health clinic, a counselor's office, a hospital clinic, or a local health department for treatment.

• Inpatient treatment.

  You stay at a hospital and have counseling during the day or evening. You probably will then go to outpatient treatment.

• Residential treatment.

  This provides you with treatment and a place to live while you recover. You get counseling and 24-hour care.

Some treatment programs give rewards, called vouchers, when you stay off substances. The rewards may get bigger when you go for a long time without using.

Many programs give regular drug tests while you go through treatment. Knowing that you will be tested may help you feel more motivated to resist your cravings.

Substance use disorder may be diagnosed during a routine doctor visit. Or you may see your doctor for a health or other problem linked to substance use, such as anxiety, depression, or family conflict.

Diagnosing substance use disorder

Your doctor will ask questions about your symptoms and past health and do a physical exam. If your doctor thinks you have substance use disorder, your doctor may ask about current and past substance use and your family history of substance use.

Your doctor may ask you to have:

• A test to check for substance use, such as a urine or blood test.
• Tests to look for health problems related to substance use. These may include tests for hepatitis B, hepatitis C, or HIV.

If you and your doctor agree that you have substance use disorder, your doctor probably will refer you to a specialist who treats substance use.

Checking for a dual diagnosis

Many people who have substance use disorder also have a mental health condition, such as depression or an anxiety disorder. This is called a dual diagnosis. If this may be true for you, your doctor may do a mental health assessment.

If you have a dual diagnosis, you'll need treatment for both conditions. This gives you a better chance of a full recovery and less chance of using substances again.

Health professionals who can diagnose and treat substance use disorder include a:

• Medical doctor such as a family physician, general practitioner, psychiatrist, or pediatrician.
• Physician assistant.
• Nurse practitioner.

Professionals who can diagnose and provide counseling for substance use disorder include a:

• Psychiatrist.
• Psychologist.
• Social worker.
• Licensed mental health counselor.

Here are some ways to help you stay sober and prevent relapse.

• If you have been given medicine to help keep you sober or reduce your cravings, be sure to take it exactly as prescribed.
• Talk to your doctor about programs that can help you stop using drugs or drinking alcohol.
• Do not keep alcohol or drugs in your home.
• Plan ahead. Think about what you'll say if other people ask you to drink or use drugs. Try not to spend time with people who drink or use drugs.
• Use the time and money spent on drinking or drugs to do something that's important to you.

Preventing a relapse

• Have a plan to deal with relapse. Learn to recognize changes in your thinking that lead you to drink or use drugs. Get help before you start to drink or use drugs again.
• Try to stay away from situations, friends, or places that may lead you to drink or use drugs.
• If you feel the need to drink alcohol or use drugs again, seek help right away. Call a trusted friend or family member. Some people get support from organizations such as Narcotics Anonymous or SMART Recovery or from treatment facilities.
• If you relapse, get help as soon as you can. Some people make a plan with another person that outlines what they want that person to do for them if they relapse. The plan usually includes how to handle the relapse and who to notify in case of relapse.
• Don't give up. Remember that a relapse doesn't mean that you have failed. Use the experience to learn the triggers that lead you to drink or use drugs. Then quit again. Recovery is a lifelong process. Many people have several relapses before they are able to quit for good.

Certain things make you more likely to develop substance use disorder. These risk factors include:

• Genes.

  Genes play an important role in personality. As a result, substance use disorder often runs in families.

• Mental health.

  You're more likely to have substance use disorder if you have a mental health condition, such as depression or an anxiety disorder.

• Early use.

  The earlier you start to use substances, the more likely you are to develop substance use disorder.

• Environment.

  You're more likely to use substances if you live in an area where they're easy to get and substance use is common.

• Family and friends.

  You're more likely to use substances if your family members or friends use them.

Treatment for substance use disorder usually involves one or more types of counseling, such as:

• Group therapy.

  With this treatment, you talk about your recovery with other people who are trying to quit.

• Cognitive behavioral therapy (CBT).

  In CBT, you learn to change the thoughts and actions that make you more likely to use substances.

• Motivational interviewing (MI) or motivational enhancement therapy (MET).

  MI or MET helps you find your reasons for quitting and build on your personal strengths to help you succeed.

• Couples therapy or family therapy.

  Couples or family therapy can help you to stop using substances, stay substance-free, and improve your relationships with your partner and family.

If there's a chance you may have substance use disorder, it's important to find out. Ask yourself the following questions. You may have substance use disorder if your answer is "yes" to two or more questions, and these symptoms cause you harm or distress.

• Do you use larger amounts of the substance than you ever meant to? Or have you been using it for a longer time than you ever meant to?
• Are you not able to cut down or control your use? Or do you constantly wish you could cut down?
• Do you spend a lot of time getting or using the substance or recovering from the effects?
• Do you have strong cravings for the substance?
• Do you find that you can no longer do your main jobs at work, at school, or at home?
• Do you keep using, even though your substance use hurts your relationships?
• Have you stopped doing important activities because of your substance use?
• Do you use substances in situations where doing so is dangerous?
• Do you keep using the substance even though you know it's causing health problems?
• Do you need more and more of the substance to get the same effect, or do you get less effect from the same amount over time? This is called tolerance.
• Do you have uncomfortable symptoms when you stop using the substance or use less (withdrawal)?

Substance use disorder can range from mild to severe. The more signs of this disorder you have, the more severe it may be.

Do you think you might have substance use disorder? If you do, being aware of it is an important first step.

Many people have overcome this disorder. And most of them started by reaching out to others, like caring friends or family, their doctor, or a support group.

Substance use can cause many problems. These may include:

Health problems.

• Substance use can cause health problems such as heart disease, stroke, depression, or even overdose and death.
• You're more likely to have unsafe sex when you're using substances. And you may get and spread sexually transmitted infections (STIs).
• If you're pregnant, drugs can pass through your bloodstream to the placenta and harm your baby.

Problems with thinking and remembering.

Substance use can affect judgment, decision-making, emotions, and learning.

Personal problems.

• Substance use may cause you to do poorly at work or in school.
• You may have legal problems, like being arrested for driving under the influence (DUI).
• Your partner, family, or friends may be angry or upset with you.

Substance use disorder means that a person uses substances even though it causes harm to themself or others. This disorder can range from mild to severe. It can develop from the use of almost any type of substance. This includes:

• Alcohol.
• Marijuana and other drugs.
• Prescription medicines.
• Over-the-counter medicines.