Substance Use Disorder: Your GoodRx Guide

What is a substance use disorder?

A substance use disorder is a condition where a person continues to use drugs and/or alcohol despite experiencing significant problems. These problems can include physical and mental health issues, relationship conflict, and/or failure to keep up with responsibilities at home, work, or school. A person must have at least two symptoms of a substance use disorder in order to receive a diagnosis.

Many Americans experience a substance use disorder each year. According to a 2019 national survey, about 14.5 million (5.3%) people ages 12 and over in the United States had an alcohol use disorder and 8.3 million (3%) people had a substance use disorder within the past year.

What falls under a substance use disorder?

• Drug addiction is a condition where a person continues to use drugs despite negative consequences. Over time, addiction can cause changes to the parts of the brain involved in pleasure, stress, and impulse control. The terms addiction and substance use disorder are often used interchangeably, although addiction is known to be a more severe form of substance use disorder.

• Alcohol addiction refers to a condition where a person continues to drink alcohol despite harmful consequences and has difficulty controlling alcohol use.

• Physical dependence happens when the body becomes reliant on a drug, alcohol, or prescription medication over a period of time. When the substance is not taken, the body can experience withdrawal symptoms. Certain substances cause physical dependence, such as alcohol, opioids, and benzodiazepines.

• Substance misuse refers to a person using illicit drugs, alcohol, or prescription medications in a way other than prescribed or recommended. Substance misuse may cause problems in a person’s life and lead to a substance use disorder and addiction.

Types of substance use disorders

A person may develop a substance use disorder to any of the following:

• Alcohol

• Caffeine

• Tobacco

• Cannabis/marijuana

• Stimulants, including cocaine, methamphetamine, and prescription medications like Adderall and Ritalin

• Opioids, including heroin and prescription painkillers like Oxycontin and Vicodin

• Sedatives, hypnotics, or anxiolytics, including benzodiazepines like Xanax and Ativan

• Hallucinogens

• Inhalants

How does a substance use disorder progress over time?

Often, substance use disorders begin during adolescence and become more severe over time. However, some people do develop substance use disorders later in life. Substance problems usually start off as experimentation and later progress to misuse, addiction, and a disorder.

In 2019, around 57 million Americans ages 12 and over used illicit substances within the past year.

A person’s prognosis is complex and will depend upon many different factors, including the number of risk and protective factors.

Early intervention and treatment can help prevent substance problems from progressing. People who receive treatment are more likely to achieve abstinence and experience improvements in other areas of their lives, like:

• Work

• Relationships

• Legal status

• Mental health

What’s the difference between misuse, addiction, and a clinical disorder?

A 2019 national survey revealed that about 57 million people ages 12 and over used illicit drugs within the past year. While a large number of people use substances, not all of them meet criteria for substance misuse, addiction, or a disorder.

Substance misuse

Signs of substance misuse include:

• Using large amounts of a substance, such as binge drinking alcohol

• Taking prescription medications in non-prescribed ways

• Using in dangerous or inappropriate settings

• Experiencing problems as a result of using substances

Substance misuse can lead to a substance use disorder or addiction, a severe form of substance use disorder. How quickly this process occurs can vary from person to person.

Addiction and substance use disorder

The terms addiction and substance use disorder are often used interchangeably. Addiction is a term that refers to continuing to engage in a behavior despite it being harmful. People can become addicted to drugs, alcohol, and medications, as well as behaviors like gambling and sex. A substance use disorder is a clinical diagnosis given when a person exhibits a certain number of symptoms. Many people with an addiction also meet criteria for a substance use disorder.

What causes a substance use disorder?

Substance use disorders typically develop because of a combination of biological, environmental, and developmental factors. Risk factors are experiences or traits that increase the chances of a person developing a condition. The greater the number of risk factors that a person has, the higher the likelihood of developing a substance use disorder.

Common risk factors

Some common risk factors for developing a substance use disorder include:

• Childhood aggression

• Poor parental supervision

• Peer substance use

• Poverty

• Availability of drugs in the community

Protective factors are experiences or traits that decrease the likelihood of developing a substance use disorder.

Common protective factors

Some common protective factors include:

• Self-control

• Adequate parental supervision

• Good academic performance

• Positive peer and family relationships

What are the symptoms of a substance use disorder?

Symptoms of a substance use disorder include:

• Taking more of a substance or taking it for a longer amount of time than intended

• Failed efforts in the past to cut down

• Spending long amounts of time acquiring, using, or recovering from the effects of a substance

• Cravings, or strong urges, to use drugs or alcohol

• Continued use despite failure to meet responsibilities at home, work, or school

• Continued use despite social/interpersonal problems that are caused or worsened by substance use

• Giving up important activities due to substance use

• Using drugs or alcohol in dangerous situations

• Continued use despite experiencing physical or psychological problems caused or worsened by substances

• Tolerance, which involves either: a need for more drugs or alcohol to experience the desired effects, or experiencing less of an effect with the same amount

• Withdrawal, which involves either: experiencing withdrawal symptoms as a result of stopping or reducing substance use, or using a substance in order to avoid or alleviate withdrawal.

How do you diagnose a substance use disorder?

A substance use disorder can be diagnosed by a medical, mental health, or addiction treatment professional. To arrive at a diagnosis, a healthcare provider will conduct a diagnostic evaluation, which involves a series of questions about a person’s past and present substance use and the impact of substances on a person’s life. A person must experience at least two symptoms of a substance use disorder in order to receive a diagnosis.

In 2019, around 20 millions Americans ages 12 and over experienced a substance use disorder within the past year.

The severity of a substance use disorder is distinguished by how many symptoms a person experiences:

• Two to three symptoms indicate a mild disorder.

• Four to five symptoms indicate a moderate disorder.

• Six or more symptoms indicate a severe disorder.

Why is it so difficult to diagnose substance abuse disorders?

Substance use disorders can be difficult to diagnose because people may be unaware that they are suffering from a disorder and in need of help. This may be due to poor insight or denial, which is a refusal to acknowledge something that is actually happening. Shame and fear of stigma can also prevent people from reaching out for help and can lead to minimizing drug and alcohol use. Without accurate information from an individual, professionals can have a hard time determining if a person has a problem with substances.

Medications for a substance use disorder

Medication-assisted treatment, also known as MAT, is available for the treatment of alcohol and opioid use disorders. These medications can help manage withdrawal symptoms and cravings in the early stages of recovery.

Medications for alcohol use disorder include:

• Acamprosate (Campral) helps reduce cravings for alcohol and increases abstinence.

• Disulfiram (Antabuse) deters people from drinking by causing unpleasant side effects if they drink alcohol while taking the medication.

• Naltrexone reduces the pleasurable effects of alcohol, which can help people maintain motivation for sobriety.

Medications for opioid use disorder include:

• Methadone reduces cravings and withdrawal symptoms.

• Buprenorphine helps decrease cravings. Some medications, like Suboxone and Zubsolv, combine buprenorphine with naloxone, which blocks the pleasurable effects of opioids if a person relapses.

• Naltrexone is also used to treat opioid addiction by preventing a person from experiencing euphoria when taking an opioid. Vivitrol is an injectable form of naltrexone.

How do you treat a substance use disorder?

Treatment options

Treatment for a substance use disorder can include medications, therapy, and social support. The specific treatment recommendations will depend upon the particular substance being used and the severity of the substance use disorder. Treatment is available at the following levels of care:

• Detoxification: Medications are given to help alleviate withdrawal symptoms and increase safety, given the potential for dangerous effects associated with stopping a substance. These medications are monitored by a physician in the inpatient or outpatient setting.

• Residential treatment: Care is provided 24 hours a day in a facility. This form of treatment can be long-term (6 to 12 months) or brief (typically less than 30 days).

• Partial hospitalization: This is a type of outpatient treatment that is offered a few hours per day, at least 5 days per week, but where the individual still lives at home.

• Intensive outpatient: This type of outpatient treatment is offered a few hours per day for 2 to 4 days per week.

• Standard outpatient: A person may attend individual or group therapy on a weekly basis.

Each level of care typically offers group, individual, and family therapy aimed at helping people recover from substance use problems.

Living and coping with a substance use disorder

Relapse prevention and recovery

For many people, relapse is a part of the recovery process. An estimate of 60% or greater of people with substance use disorders relapse within the first year after treatment. That’s why it’s necessary to create a relapse prevention plan.

Common aspects of relapse prevention include:

• Avoiding people, places, and things that trigger cravings

• Changing negative thought patterns that lead to substance use

• Increasing coping skills

• Practicing self-care

• Finding alternative sources of pleasure

• Reaching out for sober support

Recovery support groups can also help people recover from substance use problems. These groups are available in-person and online, are led by a peer in recovery, and are free. The most popular groups include:

• Alcoholics Anonymous (AA)

• Narcotics Anonymous (NA)

• SMART Recovery