Substance Use Disorders

The DSM-5 diagnostic criteria based an SUD diagnosis on evidence of diminished control, social impairment, and problematic use of alcohol and/or illicit drugs (American Psychiatric Association, 2013).  The diagnosis of an SUD is also based on a pathological pattern of behaviors that are directly related to SU (Messinger, 2015).  According to the Substance Abuse and Mental Health Services Administration (SAMHSA) (2014), SUDs develop when the regular use of alcohol or drugs causes clinical impairment, which can result in health problems and the failure to meet major responsibilities at work, home, or school.  Individuals with SUDs use alcohol and/or illicit drugs with impaired control, usually at the expense of other aspects of their lives; eventually, destructive consequences arise due to this compulsive behavior (Fletcher et al., 2015).  Due to diminished control, SUDs, especially alcohol, can result in changes in brain circuits, which can persist even beyond detoxification, after the substance is no longer in the body (Messinger, 2015).  These changes in brain circuitry are considered to be prominent in individuals with severe cerebral disorders but can also occur at mild and moderate levels (Messinger, 2015). 

Alcohol consumption is considered to be among the top 10 leading causes of ill-health and is the fourth leading cause of preventable loss of life, right behind smoking, poor diet, and physical inactivity (Anton, 2010).  The identification of the devastating nature of this substance-induced illness has resulted in almost every major medical society and federal government agency defining alcohol and other SUDs as a disease (Anton, 2010). 

The most common SUD in the United States consists of an alcohol use disorder (AUD), which results when the excessive use of alcohol increases an individual’s risk of developing serious physical problems and issues related to intoxication and symptoms of alcohol withdrawal (APA, 2013).  Data collected by SAMHSA (2014) for the National Survey on Drug Use and Health (NSDUH) indicated that in the year 2014 more than half (52.7%) of Americans 12 years and older reported that they currently consume alcoholic beverages.  Most individuals consume alcohol in moderation; however, according to SAMHSA (2014), an estimated 17 million out 176.6 million have an AUD.

Marijuana (cannabis) is considered to be the most used drug after alcohol and tobacco in the United States, according to SAMHSA (2014).  The use of marijuana can result in distorted perception: difficulty in thinking, recalling information, and problem solving, in addition to the loss of motor skill coordination (SAMHSA, 2014).  According to SAMHSA (2014), the long-term use of marijuana can cause respiratory infection, diminished memory, and exposure to cancer-causing compounds.  In 2013, 4.2 million Americans ages 12 and older met the criteria for an SUD based on their use of marijuana (SAMHSA, 2014).

Stimulants increase an individual’s energy level, attention, alertness; and they also increase blood pressure, heart rate, and respiration (APA, 2013).  The stimulants that are reportedly most commonly abused are amphetamines, methamphetamines, and cocaine (SAMHSA, 2014).  According to SAMHSA (2014), an estimated 913,000 individuals ages 12 years and older had a diagnosed stimulant use disorder. 

Illegal opioid drugs such as heroin and legally available prescription pain- relieving medications such as oxycodone and hydrocodone can result in serious health conditions (SAMHSA, 2014).  Opioids can reduce feelings of pain, produce drowsiness, mental confusion, euphoria, nausea, constipation, and can also depress respiration, which can result in death (SAMHSA, 2014).  According to SAMHSA (2014), an estimated 1.9 million Americans had an opioid use disorder related to prescription pain medications, and an estimated 586,000 individuals had an opioid use disorder related to the use of heroin.  “Overdoses related to opioid medications resulted in almost 17,000 deaths in 2011 and since 1999, opioid overdose deaths have increased 265% among men and 400% among women” (SAMHSA, 2014, p. 35).

Hallucinogens can produce visual and auditory hallucinations and feelings of detachment from oneself and one’s environment (SAMHSA, 2014).  According to SAMHSA (2014), hallucinogens can be synthesized chemically or derived naturally from psilocybin mushrooms or peyote.  In the year 2014, an estimated 246,000 Americans had a diagnosed hallucinogen use disorder (SAMHSA, 2014).

Because SUDs are so devastating, it is crucial to understand the phenomenon of SUDs in order to provide effective prevention and treatment.  One step of assessment is to obtain a better understanding as to why an individual might use alcohol or illicit drugs.  The second step is to understand why the use of substances might transition into an SUD.

There have been many theories about the reasons individuals use intoxicating substances that are not good for them or for the people around them.  According to Anton (2010), the two most modern biological theories are the reward and reinforcement theory and the stress reduction theory:

The theory that alcohol and illegal substances are reinforcing, is a behavioral concept that essentially argues that illegal drugs and alcohol tend to make some individuals feel good, and those susceptible individuals want more of it regardless of the negative consequences that might result. (Anton, 2010, p. 735) 

The stress reduction theory maintains that individuals use substances in an effort to escape from their personal problems (Anton, 2010).  For example, the stress of everyday life (e.g., job, relationships/marriage, financial), in addition to the abnormal stress of severe traumatic events (e.g., abuse, assault, war, accidents), can be suppressed by the use of intoxicating substances (Arndt & Fujiwara, 2014).  This sense of suppression can be rewarding, resulting in an individual continuously seeking out the substance in an effort of attempting to get a sense of relief from the source of stress (Anton, 2010).  Additionally, the use of intoxicating substances can be associated with an attempt or hope of normalization which can eventually lead to increasing cycles of use, dysphoria, social stress, isolation, increased tolerance, and ultimately physical and psychological dependence (Anton, 2010).  The power of SUDs resides within the interaction of the drug and/or the alcohol and the internal terrain of the individual who uses it and ultimately discovers its pain-relieving effects (Khantzian, 2012).  The pain-relieving effects of the substance of choice strongly alter and ameliorate dysphoria by promoting a sense of well-being, which essentially is what is experienced as pleasure and reward (Khantzian, 2012).

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