What is substance use disorder?

People who have substance use disorder keep using alcohol or other substances even though it causes harm to themselves or others. People of all ages can have this disorder. They may misuse prescription or over-the-counter medicines, use marijuana or other drugs, drink too much alcohol, or mix alcohol and medicines. This can cause serious health problems and problems with money or the law. It also can harm their relationships.

Substance use disorder in older adults may be overlooked, because:

• Older adults are more likely to drink or use substances at home rather than in public.
• Older adults may not have duties that are affected by substance use, such as going to school or work.
• Symptoms of this disorder are similar to symptoms of health conditions that many older adults have, such as depression and dementia.
• Caregivers of older adults may be aware of the substance use but may not want to talk about it.

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).

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.

The goal of treatment is to safely reduce or quit substance use. You may need medical care at first to manage withdrawal symptoms. Some people call this detox.

Most people get some type of counseling, such as group therapy. Medicines are often used to help control cravings, ease withdrawal symptoms, and prevent relapse.

Treatment can also 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.

Getting support from others can help. Many people find support by going to group meetings. Examples are Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery.

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.