substance abuse disorder essay

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• July 01, 2024 | VOL. 181, NO. 7 CURRENT ISSUE pp.565-686
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Substance Use Disorders and Addiction: Mechanisms, Trends, and Treatment Implications

• Ned H. Kalin , M.D.

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The numbers for substance use disorders are large, and we need to pay attention to them. Data from the 2018 National Survey on Drug Use and Health ( 1 ) suggest that, over the preceding year, 20.3 million people age 12 or older had substance use disorders, and 14.8 million of these cases were attributed to alcohol. When considering other substances, the report estimated that 4.4 million individuals had a marijuana use disorder and that 2 million people suffered from an opiate use disorder. It is well known that stress is associated with an increase in the use of alcohol and other substances, and this is particularly relevant today in relation to the chronic uncertainty and distress associated with the COVID-19 pandemic along with the traumatic effects of racism and social injustice. In part related to stress, substance use disorders are highly comorbid with other psychiatric illnesses: 9.2 million adults were estimated to have a 1-year prevalence of both a mental illness and at least one substance use disorder. Although they may not necessarily meet criteria for a substance use disorder, it is well known that psychiatric patients have increased usage of alcohol, cigarettes, and other illicit substances. As an example, the survey estimated that over the preceding month, 37.2% of individuals with serious mental illnesses were cigarette smokers, compared with 16.3% of individuals without mental illnesses. Substance use frequently accompanies suicide and suicide attempts, and substance use disorders are associated with a long-term increased risk of suicide.

Addiction is the key process that underlies substance use disorders, and research using animal models and humans has revealed important insights into the neural circuits and molecules that mediate addiction. More specifically, research has shed light onto mechanisms underlying the critical components of addiction and relapse: reinforcement and reward, tolerance, withdrawal, negative affect, craving, and stress sensitization. In addition, clinical research has been instrumental in developing an evidence base for the use of pharmacological agents in the treatment of substance use disorders, which, in combination with psychosocial approaches, can provide effective treatments. However, despite the existence of therapeutic tools, relapse is common, and substance use disorders remain grossly undertreated. For example, whether at an inpatient hospital treatment facility or at a drug or alcohol rehabilitation program, it was estimated that only 11% of individuals needing treatment for substance use received appropriate care in 2018. Additionally, it is worth emphasizing that current practice frequently does not effectively integrate dual diagnosis treatment approaches, which is important because psychiatric and substance use disorders are highly comorbid. The barriers to receiving treatment are numerous and directly interact with existing health care inequities. It is imperative that as a field we overcome the obstacles to treatment, including the lack of resources at the individual level, a dearth of trained providers and appropriate treatment facilities, racial biases, and the marked stigmatization that is focused on individuals with addictions.

This issue of the Journal is focused on understanding factors contributing to substance use disorders and their comorbidity with psychiatric disorders, the effects of prenatal alcohol use on preadolescents, and brain mechanisms that are associated with addiction and relapse. An important theme that emerges from this issue is the necessity for understanding maladaptive substance use and its treatment in relation to health care inequities. This highlights the imperative to focus resources and treatment efforts on underprivileged and marginalized populations. The centerpiece of this issue is an overview on addiction written by Dr. George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and coauthors Drs. Patricia Powell (NIAAA deputy director) and Aaron White ( 2 ). This outstanding article will serve as a foundational knowledge base for those interested in understanding the complex factors that mediate drug addiction. Of particular interest to the practice of psychiatry is the emphasis on the negative affect state “hyperkatifeia” as a major driver of addictive behavior and relapse. This places the dysphoria and psychological distress that are associated with prolonged withdrawal at the heart of treatment and underscores the importance of treating not only maladaptive drug-related behaviors but also the prolonged dysphoria and negative affect associated with addiction. It also speaks to why it is crucial to concurrently treat psychiatric comorbidities that commonly accompany substance use disorders.

Insights Into Mechanisms Related to Cocaine Addiction Using a Novel Imaging Method for Dopamine Neurons

Cassidy et al. ( 3 ) introduce a relatively new imaging technique that allows for an estimation of dopamine integrity and function in the substantia nigra, the site of origin of dopamine neurons that project to the striatum. Capitalizing on the high levels of neuromelanin that are found in substantia nigra dopamine neurons and the interaction between neuromelanin and intracellular iron, this MRI technique, termed neuromelanin-sensitive MRI (NM-MRI), shows promise in studying the involvement of substantia nigra dopamine neurons in neurodegenerative diseases and psychiatric illnesses. The authors used this technique to assess dopamine function in active cocaine users with the aim of exploring the hypothesis that cocaine use disorder is associated with blunted presynaptic striatal dopamine function that would be reflected in decreased “integrity” of the substantia nigra dopamine system. Surprisingly, NM-MRI revealed evidence for increased dopamine in the substantia nigra of individuals using cocaine. The authors suggest that this finding, in conjunction with prior work suggesting a blunted dopamine response, points to the possibility that cocaine use is associated with an altered intracellular distribution of dopamine. Specifically, the idea is that dopamine is shifted from being concentrated in releasable, functional vesicles at the synapse to a nonreleasable cytosolic pool. In addition to providing an intriguing alternative hypothesis underlying the cocaine-related alterations observed in substantia nigra dopamine function, this article highlights an innovative imaging method that can be used in further investigations involving the role of substantia nigra dopamine systems in neuropsychiatric disorders. Dr. Charles Bradberry, chief of the Preclinical Pharmacology Section at the National Institute on Drug Abuse, contributes an editorial that further explains the use of NM-MRI and discusses the theoretical implications of these unexpected findings in relation to cocaine use ( 4 ).

Treatment Implications of Understanding Brain Function During Early Abstinence in Patients With Alcohol Use Disorder

Developing a better understanding of the neural processes that are associated with substance use disorders is critical for conceptualizing improved treatment approaches. Blaine et al. ( 5 ) present neuroimaging data collected during early abstinence in patients with alcohol use disorder and link these data to relapses occurring during treatment. Of note, the findings from this study dovetail with the neural circuit schema Koob et al. provide in this issue’s overview on addiction ( 2 ). The first study in the Blaine et al. article uses 44 patients and 43 control subjects to demonstrate that patients with alcohol use disorder have a blunted neural response to the presentation of stress- and alcohol-related cues. This blunting was observed mainly in the ventromedial prefrontal cortex, a key prefrontal regulatory region, as well as in subcortical regions associated with reward processing, specifically the ventral striatum. Importantly, this finding was replicated in a second study in which 69 patients were studied in relation to their length of abstinence prior to treatment and treatment outcomes. The results demonstrated that individuals with the shortest abstinence times had greater alterations in neural responses to stress and alcohol cues. The authors also found that an individual’s length of abstinence prior to treatment, independent of the number of days of abstinence, was a predictor of relapse and that the magnitude of an individual’s neural alterations predicted the amount of heavy drinking occurring early in treatment. Although relapse is an all too common outcome in patients with substance use disorders, this study highlights an approach that has the potential to refine and develop new treatments that are based on addiction- and abstinence-related brain changes. In her thoughtful editorial, Dr. Edith Sullivan from Stanford University comments on the details of the study, the value of studying patients during early abstinence, and the implications of these findings for new treatment development ( 6 ).

Relatively Low Amounts of Alcohol Intake During Pregnancy Are Associated With Subtle Neurodevelopmental Effects in Preadolescent Offspring

Excessive substance use not only affects the user and their immediate family but also has transgenerational effects that can be mediated in utero. Lees et al. ( 7 ) present data suggesting that even the consumption of relatively low amounts of alcohol by expectant mothers can affect brain development, cognition, and emotion in their offspring. The researchers used data from the Adolescent Brain Cognitive Development Study, a large national community-based study, which allowed them to assess brain structure and function as well as behavioral, cognitive, and psychological outcomes in 9,719 preadolescents. The mothers of 2,518 of the subjects in this study reported some alcohol use during pregnancy, albeit at relatively low levels (0 to 80 drinks throughout pregnancy). Interestingly, and opposite of that expected in relation to data from individuals with fetal alcohol spectrum disorders, increases in brain volume and surface area were found in offspring of mothers who consumed the relatively low amounts of alcohol. Notably, any prenatal alcohol exposure was associated with small but significant increases in psychological problems that included increases in separation anxiety disorder and oppositional defiant disorder. Additionally, a dose-response effect was found for internalizing psychopathology, somatic complaints, and attentional deficits. While subtle, these findings point to neurodevelopmental alterations that may be mediated by even small amounts of prenatal alcohol consumption. Drs. Clare McCormack and Catherine Monk from Columbia University contribute an editorial that provides an in-depth assessment of these findings in relation to other studies, including those assessing severe deficits in individuals with fetal alcohol syndrome ( 8 ). McCormack and Monk emphasize that the behavioral and psychological effects reported in the Lees et al. article would not be clinically meaningful. However, it is feasible that the influences of these low amounts of alcohol could interact with other predisposing factors that might lead to more substantial negative outcomes.

Increased Comorbidity Between Substance Use and Psychiatric Disorders in Sexual Identity Minorities

There is no question that victims of societal marginalization experience disproportionate adversity and stress. Evans-Polce et al. ( 9 ) focus on this concern in relation to individuals who identify as sexual minorities by comparing their incidence of comorbid substance use and psychiatric disorders with that of individuals who identify as heterosexual. By using 2012−2013 data from 36,309 participants in the National Epidemiologic Study on Alcohol and Related Conditions–III, the authors examine the incidence of comorbid alcohol and tobacco use disorders with anxiety, mood disorders, and posttraumatic stress disorder (PTSD). The findings demonstrate increased incidences of substance use and psychiatric disorders in individuals who identified as bisexual or as gay or lesbian compared with those who identified as heterosexual. For example, a fourfold increase in the prevalence of PTSD was found in bisexual individuals compared with heterosexual individuals. In addition, the authors found an increased prevalence of substance use and psychiatric comorbidities in individuals who identified as bisexual and as gay or lesbian compared with individuals who identified as heterosexual. This was most prominent in women who identified as bisexual. For example, of the bisexual women who had an alcohol use disorder, 60.5% also had a psychiatric comorbidity, compared with 44.6% of heterosexual women. Additionally, the amount of reported sexual orientation discrimination and number of lifetime stressful events were associated with a greater likelihood of having comorbid substance use and psychiatric disorders. These findings are important but not surprising, as sexual minority individuals have a history of increased early-life trauma and throughout their lives may experience the painful and unwarranted consequences of bias and denigration. Nonetheless, these findings underscore the strong negative societal impacts experienced by minority groups and should sensitize providers to the additional needs of these individuals.

Trends in Nicotine Use and Dependence From 2001–2002 to 2012–2013

Although considerable efforts over earlier years have curbed the use of tobacco and nicotine, the use of these substances continues to be a significant public health problem. As noted above, individuals with psychiatric disorders are particularly vulnerable. Grant et al. ( 10 ) use data from the National Epidemiologic Survey on Alcohol and Related Conditions collected from a very large cohort to characterize trends in nicotine use and dependence over time. Results from their analysis support the so-called hardening hypothesis, which posits that although intervention-related reductions in nicotine use may have occurred over time, the impact of these interventions is less potent in individuals with more severe addictive behavior (i.e., nicotine dependence). When adjusted for sociodemographic factors, the results demonstrated a small but significant increase in nicotine use from 2001–2002 to 2012–2013. However, a much greater increase in nicotine dependence (46.1% to 52%) was observed over this time frame in individuals who had used nicotine during the preceding 12 months. The increases in nicotine use and dependence were associated with factors related to socioeconomic status, such as lower income and lower educational attainment. The authors interpret these findings as evidence for the hardening hypothesis, suggesting that despite the impression that nicotine use has plateaued, there is a growing number of highly dependent nicotine users who would benefit from nicotine dependence intervention programs. Dr. Kathleen Brady, from the Medical University of South Carolina, provides an editorial ( 11 ) that reviews the consequences of tobacco use and the history of the public measures that were initially taken to combat its use. Importantly, her editorial emphasizes the need to address health care inequity issues that affect individuals of lower socioeconomic status by devoting resources to develop and deploy effective smoking cessation interventions for at-risk and underresourced populations.

Conclusions

Maladaptive substance use and substance use disorders are highly prevalent and are among the most significant public health problems. Substance use is commonly comorbid with psychiatric disorders, and treatment efforts need to concurrently address both. The papers in this issue highlight new findings that are directly relevant to understanding, treating, and developing policies to better serve those afflicted with addictions. While treatments exist, the need for more effective treatments is clear, especially those focused on decreasing relapse rates. The negative affective state, hyperkatifeia, that accompanies longer-term abstinence is an important treatment target that should be emphasized in current practice as well as in new treatment development. In addition to developing a better understanding of the neurobiology of addictions and abstinence, it is necessary to ensure that there is equitable access to currently available treatments and treatment programs. Additional resources must be allocated to this cause. This depends on the recognition that health care inequities and societal barriers are major contributors to the continued high prevalence of substance use disorders, the individual suffering they inflict, and the huge toll that they incur at a societal level.

Disclosures of Editors’ financial relationships appear in the April 2020 issue of the Journal .

1 US Department of Health and Human Services: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality: National Survey on Drug Use and Health 2018. Rockville, Md, SAMHSA, 2019 ( https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2018-NSDUH ) Google Scholar

2 Koob GF, Powell P, White A : Addiction as a coping response: hyperkatifeia, deaths of despair, and COVID-19 . Am J Psychiatry 2020 ; 177:1031–1037 Link ,  Google Scholar

3 Cassidy CM, Carpenter KM, Konova AB, et al. : Evidence for dopamine abnormalities in the substantia nigra in cocaine addiction revealed by neuromelanin-sensitive MRI . Am J Psychiatry 2020 ; 177:1038–1047 Link ,  Google Scholar

4 Bradberry CW : Neuromelanin MRI: dark substance shines a light on dopamine dysfunction and cocaine use (editorial). Am J Psychiatry 2020 ; 177:1019–1021 Abstract ,  Google Scholar

5 Blaine SK, Wemm S, Fogelman N, et al. : Association of prefrontal-striatal functional pathology with alcohol abstinence days at treatment initiation and heavy drinking after treatment initiation . Am J Psychiatry 2020 ; 177:1048–1059 Link ,  Google Scholar

6 Sullivan EV : Why timing matters in alcohol use disorder recovery (editorial). Am J Psychiatry 2020 ; 177:1022–1024 Abstract ,  Google Scholar

7 Lees B, Mewton L, Jacobus J, et al. : Association of prenatal alcohol exposure with psychological, behavioral, and neurodevelopmental outcomes in children from the Adolescent Brain Cognitive Development Study . Am J Psychiatry 2020 ; 177:1060–1072 Link ,  Google Scholar

8 McCormack C, Monk C : Considering prenatal alcohol exposure in a developmental origins of health and disease framework (editorial). Am J Psychiatry 2020 ; 177:1025–1028 Abstract ,  Google Scholar

9 Evans-Polce RJ, Kcomt L, Veliz PT, et al. : Alcohol, tobacco, and comorbid psychiatric disorders and associations with sexual identity and stress-related correlates . Am J Psychiatry 2020 ; 177:1073–1081 Abstract ,  Google Scholar

10 Grant BF, Shmulewitz D, Compton WM : Nicotine use and DSM-IV nicotine dependence in the United States, 2001–2002 and 2012–2013 . Am J Psychiatry 2020 ; 177:1082–1090 Link ,  Google Scholar

11 Brady KT : Social determinants of health and smoking cessation: a challenge (editorial). Am J Psychiatry 2020 ; 177:1029–1030 Abstract ,  Google Scholar

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• Substance-Related and Addictive Disorders
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Substance Abuse - List of Essay Samples And Topic Ideas

Substance abuse and homelessness.

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Substance Abuse and Development

Substance abuse can be defined as the overindulgence in addictive substance or the reliance on an addictive substance, especially illicit drugs like crystal methamphetamine and others. Methamphetamine, or meth, as it is popularly called is a highly addictive stimulant that creates a feeling of energy, heightened alertness and euphoria. It is synthetically prepared, using toxic and flammable chemicals and side effects include irregular and rapid heartbeat, hyperthermia, convulsions, stroke, insomnia, high blood pressure, restlessness, and tremors . Meth can be […]

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NIH Principles of Substance Abuse Prevention for Early Childhood

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The Role of Social Workers: Counselors in Substance Abuse

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Nowadays, many people have thought that drugs are viable solution for personal problems or any other situations that affect the life of a person, but eventually, if a person reads the words drugs, it becomes a real problem in the current society. Therefore, there are factors that expose the drugs as an issue in the society. How can we understand this point? First, the abuse of different substances and drugs are one of the most common situations that teenagers and […]

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Alcohol and Substance Abuse

When adolescents begin experimenting with drugs and alcohol many parents believe their children are just going through a rebellious stage, but that is not always the case (11 Reasons Why Teenagers Experiment with Drugs, 2016). There are many reasons why adolescents begin experimenting with drugs and it may lead to a serious addiction. Boredom is the most common reason why adolescents begin experiment with drugs and alcohol. They have too much time on their hand, so they experiment as a […]

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One common disease that is prevalent throughout the country is drug and substance abuse. This particular impediment remains as difficult an issue to tackle as ever before with drug abuse statistics in Georgia increasing at a shocking rate. While these numbers alone are staggering, the issues that stem from drug abuse bring forward an increase in addiction to low-income communities making this an even more pressing issue to overcome. Drug abuse has unfortunately become normalized in today's society, and the […]

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The Effect of Substance Abuse on the Family System

When someone decides to start a family, they have a certain picture in their head for how the future will plan out. Mom and dad will love their child and have their best interest at heart throughout their whole life. Most parents go into it, thinking nothing will break up their bond or make them less close to their son/daughter. They believe their child is to love, cherish, and respect their grandparents and elders. They will spend quality time with […]

Sexual Re-victimization and Increase in the Chance of Alcohol and Substance Abuse

Sexual re-victimization refers to a form of sexual abuse which is insensitive and causes fear for the victims of violence. Currently, there are many kinds of research concerning the female re-victimization of few sexual assaults, child sexual abuse, and adult sexual abuse survivors. Despite this, there is little research concerning male victimization and any form of service is available to them, this is because most attention has been shifted to females leaving men behind. Also, there is variance on the […]

The Effect of Substance Abuse on Depression

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• What Is a Substance Use Disorder?

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Substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus--sometimes called an addiction--on using a certain substance(s) such as alcohol, tobacco, or other psychoactive substances, to the point where their ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems.

Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate intoxication wears off. Intoxication is the intense pleasure, euphoria, and calm that is caused by the substance; these symptoms are different for each substance. With continued use of a substance, tolerance can develop, where someone may require larger amounts in order to fell these effects. Additionally, discontinuing use can lead to symptoms of withdrawal and intense cravings to return to use, often experienced as anxiety.

People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain's structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision-making, learning, memory, and behavioral control.

According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:

• To feel good — feeling of pleasure, “high” or "intoxication."
• To feel better — relieve stress, forget problems, or feel numb.
• To do better — improve performance or thinking.
• Curiosity and peer pressure or experimenting.

People with substance use and behavioral addictions may be aware of their problem but not be able to stop even if they want and try to. The addiction may cause physical and psychological problems as well as interpersonal problems such as with family members and friends or at work.

Symptoms of substance use disorder are grouped into four categories:

• Impaired control: the experience of a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use.
• Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities may be cut back or given up entirely.
• Dangerous use: substance is used in unsafe settings; continued use despite known problems.
• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance).

Many people experience substance use disorder along with another psychiatric disorder. Another psychiatric disorder can, but does not necessarily, precede another psychiatric disorder. It is also possible that the use of a substance may trigger or worsen another psychiatric disorder.

Top 10 Things Everyone Should Know About Addiction (.pdf)

How Is Substance Use Disorder Treated?

Effective treatments for substance use disorders are available.

The first step is recognition of the problem. The recovery process can be delayed when a person lacks awareness of problematic substance use. Although interventions by concerned friends and family often prompt treatment, self-referrals are always welcome and encouraged.

A medical professional should conduct a formal assessment of symptoms to identify if a substance use disorder is present. All patients can benefit from treatment, regardless of whether the disorder is mild, moderate, or severe. Unfortunately, many people who meet criteria for a substance use disorder and could benefit from treatment don’t receive help.

Because SUDs affect many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s specific situation and any co-occurring medical, psychiatric, and social problems are optimal for sustained recovery.

Medications are used to control cravings, relieve symptoms of withdrawal, and to prevent relapses. Psychotherapy can help individuals with SUD better understand their behavior and motivations, develop higher self-esteem, cope with stress, and address other psychiatric problems.

A person's recovery plan is unique to the person's specific needs and may include strategies outside of formal treatment. These may include:

• Hospitalization or outpatient guidance for medical withdrawal management (detoxification).
• Therapeutic communities (highly controlled, drug-free environments) or sober houses.
• Outpatient medication management and psychotherapy.
• Intensive outpatient programs.
• Residential treatment ("rehab").
• Mutual-aid groups (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery).
• Self-help groups that include family members (Al-Anon or Nar-Anon Family Groups).

13 principles of effective drug addiction treatment

These 13 principles of effective drug addiction treatment were developed based on three decades of scientific research. Research shows that treatment can help drug-addicted individuals stop drug use, avoid relapse and successfully recover their lives.

• Addiction is a complex, but treatable, disease that affects brain function and behavior.
• No single treatment is appropriate for everyone.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
• Remaining in treatment for an adequate period of time is critical.
• Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment.
• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
• An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.
• Many drug-addicted individuals also have other mental disorders.
• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
• Treatment does not need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
• Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

Source: National Institute on Drug Abuse. These principles are detailed in NIDA's Principles of Drug Addiction Treatment: A Research-Based Guide .

How to Help a Friend or Family Member

Some suggestions to get started:.

• Learn all that you can about alcohol and drug dependence and addiction.
• Speak up and offer your support. Talk to the person about your concerns, and offer your help and support, including your willingness to go with them and get help. Like other chronic diseases, the earlier addiction is treated, the better.
• Express love and concern. Focus the conversation on specific behaviros and avoid name-calling, which may cause the person to shut down.
• Do not expect the person to change without help. Treatment, support, and new coping skills are needed to overcome addiction.
• Support recovery as an ongoing process: once your friend or family member is receiving treatment, or going to meetings, remain involved. The goal is to let them know you care and are availalble when they need someone in their corner.

Some things to avoid:

• Avoid lectures, threats, bribes, or emotional appeals, which can worsen shame and lead to isolation or the compulsion to use.
• Do not cover up, lie or make excuses for their behavior; open and honest communication is vital for people with SUD to get the help they deserve.
• Avoid confrontations with someone who is intoxicated; they will likely not be able to have a meaningful or rational conversation and could escalate to violence.
• Do your best to not feel guilty for their behavior; people with substance use disorder are suffering from an illness and, like other forms of disease, it is not caused by any one person or action.
• Do not join them; drinking or using alongside someone with SUD will harm not only them but also you. 

Adapted from: National Council on Alcoholism and Drug Dependence and One Love Foundation's "How to Talk to a Friend."

Related Conditions

• Opioid Use Disorder

Opioids produce high levels of positive reinforcement in the brain, increasing the odds that people will continue using them despite experiencing negative consequences. Opioid use disorder is a chronic lifelong disorder, with serious potential consequences including disability, relapse, and death. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)  describes opioid use disorder as a problematic pattern of opioid use, including experiencing tolerance or withdrawal symptoms and leading to impairment or distress. More about opioid use disorder.

• Gambling Disorder

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ), gambling disorder is included in a category of behavioral addictions. This reflects research findings that gambling disorder is similar to substance-related disorders and these similarities will help people with gambling disorder get the necessary treatment and services, and may help others better understand the challenges. More about gambling disorder

• Internet Gaming

Internet gaming disorder is included in DSM-5 in the section of disorders requiring further research. This reflects the scientific literature showing that persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. The condition criteria do not include general use of the Internet or social media. More about internet gaming

Technology Addiction

Smartphones and other technology are an integral and growing part of our lives. However, excessive and compulsive use of the internet or online activities can lead to negative consequences in various aspects of an individual's life. Technology addiction can potentially involve various forms of online activity including social media, gaming, gambling, problematic use of online pornography, and others.

• E-Cigarettes and Vaping

The use of e-cigarettes, informally called "vaping," involves using electronic cigarettes to inhale vapor created from a liquid heated inside of the device. E-cigarettes have become the most commonly used tobacco product among youth since 2014. The aerosol from vaping generally can contain harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents, according to the CDC. More about vaping.

Caffeine Intoxication and Withdrawal

Caffeine intoxication and caffeine withdrawal are included in DSM-5-TR . Caffeine use disorder, however, is in the section of DSM-5-TR for conditions requiring further research. While there is evidence to support this as a disorder, experts conclude it is not yet clear to what extent it is a clinically significant disorder.

Physician Review

Brigette Torrise, M.D.

More on substance use disorder

• Substance Abuse and Mental Health Services Administration (SAMHSA)
• National Institute on Drug Abuse: Drugs, Brains, and Behavior - The Science of Addiction
• National Council on Alcoholism and Drug Dependence
• National Center on Addiction and Substance Abuse at Columbia University
• Alcoholics Anonymous
• Narcotics Anonymous

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• Drug addiction (substance use disorder)

Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're addicted, you may continue using the drug despite the harm it causes.

Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins when they take prescribed medicines or receive them from others who have prescriptions.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill. These are called withdrawal symptoms.

Help from your health care provider, family, friends, support groups or an organized treatment program can help you overcome your drug addiction and stay drug-free.

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Drug addiction symptoms or behaviors include, among others:

• Feeling that you have to use the drug regularly — daily or even several times a day
• Having intense urges for the drug that block out any other thoughts
• Over time, needing more of the drug to get the same effect
• Taking larger amounts of the drug over a longer period of time than you intended
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can't afford it
• Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use
• Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm
• Doing things to get the drug that you normally wouldn't do, such as stealing
• Driving or doing other risky activities when you're under the influence of the drug
• Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug
• Failing in your attempts to stop using the drug
• Experiencing withdrawal symptoms when you attempt to stop taking the drug

Recognizing unhealthy drug use in family members

Sometimes it's difficult to distinguish normal teenage moodiness or anxiety from signs of drug use. Possible signs that your teenager or other family member is using drugs include:

• Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
• Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
• Neglected appearance — lack of interest in clothing, grooming or looks
• Changes in behavior — major efforts to bar family members from entering the teenager's room or being secretive about going out with friends; or drastic changes in behavior and in relationships with family and friends
• Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

Recognizing signs of drug use or intoxication

Signs and symptoms of drug use or intoxication may vary, depending on the type of drug. Below you'll find several examples.

Marijuana, hashish and other cannabis-containing substances

People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling "high"
• A heightened sense of visual, auditory and taste perception
• Increased blood pressure and heart rate
• Decreased coordination
• Difficulty concentrating or remembering
• Slowed reaction time
• Anxiety or paranoid thinking
• Cannabis odor on clothes or yellow fingertips
• Major cravings for certain foods at unusual times

Long-term use is often associated with:

• Decreased mental sharpness
• Poor performance at school or at work
• Ongoing cough and frequent lung infections

K2, Spice and bath salts

Two groups of synthetic drugs — synthetic cannabinoids and substituted or synthetic cathinones — are illegal in most states. The effects of these drugs can be dangerous and unpredictable, as there is no quality control and some ingredients may not be known.

Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea. A liquid form can be vaporized in electronic cigarettes. Despite manufacturer claims, these are chemical compounds rather than "natural" or harmless products. These drugs can produce a "high" similar to marijuana and have become a popular but dangerous alternative.

• Elevated mood
• An altered sense of visual, auditory and taste perception
• Extreme anxiety or agitation
• Hallucinations
• Increased heart rate and blood pressure or heart attack
• Violent behavior

Substituted cathinones, also called "bath salts," are mind-altering (psychoactive) substances similar to amphetamines such as ecstasy (MDMA) and cocaine. Packages are often labeled as other products to avoid detection.

Despite the name, these are not bath products such as Epsom salts. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.

• Feeling "high"
• Increased sociability
• Increased energy and agitation
• Increased sex drive
• Increased heart rate and blood pressure
• Problems thinking clearly
• Loss of muscle control
• Panic attacks
• Psychotic and violent behavior

Barbiturates, benzodiazepines and hypnotics

Barbiturates, benzodiazepines and hypnotics are prescription central nervous system depressants. They're often used and misused in search for a sense of relaxation or a desire to "switch off" or forget stress-related thoughts or feelings.

• Barbiturates. An example is phenobarbital.
• Benzodiazepines. Examples include sedatives, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
• Hypnotics. Examples include prescription sleeping medicines such as zolpidem (Ambien) and zaleplon (Sonata).
• Slurred speech
• Lack of coordination
• Irritability or changes in mood
• Problems concentrating or thinking clearly
• Memory problems
• Involuntary eye movements
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Falls or accidents

Meth, cocaine and other stimulants

Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall XR, Mydayis). They're often used and misused in search of a "high," or to boost energy, to improve performance at work or school, or to lose weight or control appetite.

• Feeling of happy excitement and too much confidence
• Increased alertness
• Increased energy and restlessness
• Behavior changes or aggression
• Rapid or rambling speech
• Larger than usual pupils, the black circles in the middle of the eyes
• Confusion, delusions and hallucinations
• Irritability, anxiety or paranoia
• Changes in heart rate, blood pressure and body temperature
• Nausea or vomiting with weight loss
• Poor judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Mouth sores, gum disease and tooth decay from smoking drugs ("meth mouth")
• Depression as the drug wears off

Club drugs are commonly used at clubs, concerts and parties. Examples include methylenedioxymethamphetamine, also called MDMA, ecstasy or molly, and gamma-hydroxybutyric acid, known as GHB. Other examples include ketamine and flunitrazepam or Rohypnol — a brand used outside the U.S. — also called roofie. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects.

Because GHB and flunitrazepam can cause sedation, muscle relaxation, confusion and memory loss, the potential for sexual misconduct or sexual assault is associated with the use of these drugs.

Signs and symptoms of use of club drugs can include:

• Larger than usual pupils
• Chills and sweating
• Involuntary shaking (tremors)
• Behavior changes
• Muscle cramping and teeth clenching
• Muscle relaxation, poor coordination or problems moving
• Reduced inhibitions
• Heightened or altered sense of sight, sound and taste
• Memory problems or loss of memory
• Reduced consciousness
• Increased or decreased heart rate and blood pressure

Hallucinogens

Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP).

LSD use may cause:

• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Impulsive behavior
• Rapid shifts in emotions
• Permanent mental changes in perception
• Rapid heart rate and high blood pressure
• Flashbacks, a reexperience of the hallucinations — even years later

PCP use may cause:

• A feeling of being separated from your body and surroundings
• Problems with coordination and movement
• Aggressive, possibly violent behavior
• Lack of pain sensation
• Increase in blood pressure and heart rate
• Problems with thinking and memory
• Problems speaking
• Intolerance to loud noise
• Sometimes seizures or coma

Signs and symptoms of inhalant use vary, depending on the substance. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products. Due to the toxic nature of these substances, users may develop brain damage or sudden death.

Signs and symptoms of use can include:

• Possessing an inhalant substance without a reasonable explanation
• Brief happy excitement
• Behaving as if drunk
• Reduced ability to keep impulses under control
• Aggressive behavior or eagerness to fight
• Nausea or vomiting
• Appearing under the influence of drugs, with slurred speech, slow movements and poor coordination
• Irregular heartbeats
• Lingering odor of inhalant material
• Rash around the nose and mouth

Opioid painkillers

Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes, among others, heroin, morphine, codeine, methadone, fentanyl and oxycodone.

Sometimes called the "opioid epidemic," addiction to opioid prescription pain medicines has reached an alarming rate across the United States. Some people who've been using opioids over a long period of time may need physician-prescribed temporary or long-term drug substitution during treatment.

Signs and symptoms of narcotic use and dependence can include:

• A sense of feeling "high"
• Reduced sense of pain
• Agitation, drowsiness or sedation
• Problems with attention and memory
• Pupils that are smaller than usual
• Lack of awareness or inattention to surrounding people and things
• Problems with coordination
• Constipation
• Runny nose or nose sores (if snorting drugs)
• Needle marks (if injecting drugs)

When to see a doctor

If your drug use is out of control or causing problems, get help. The sooner you seek help, the greater your chances for a long-term recovery. Talk with your health care provider or see a mental health provider, such as a doctor who specializes in addiction medicine or addiction psychiatry, or a licensed alcohol and drug counselor.

Make an appointment to see a provider if:

• You can't stop using a drug
• You continue using the drug despite the harm it causes
• Your drug use has led to unsafe behavior, such as sharing needles or unprotected sex
• You think you may be having withdrawal symptoms after stopping drug use

If you're not ready to approach a health care provider or mental health professional, help lines or hotlines may be a good place to learn about treatment. You can find these lines listed on the internet or in the phone book.

When to seek emergency help

Seek emergency help if you or someone you know has taken a drug and:

• May have overdosed
• Shows changes in consciousness
• Has trouble breathing
• Has seizures or convulsions
• Has signs of a possible heart attack, such as chest pain or pressure
• Has any other troublesome physical or psychological reaction to use of the drug

Staging an intervention

People struggling with addiction usually deny they have a problem and hesitate to seek treatment. An intervention presents a loved one with a structured opportunity to make changes before things get even worse and can motivate someone to seek or accept help.

It's important to plan an intervention carefully. It may be done by family and friends in consultation with a health care provider or mental health professional such as a licensed alcohol and drug counselor, or directed by an intervention professional. It involves family and friends and sometimes co-workers, clergy or others who care about the person struggling with addiction.

During the intervention, these people gather together to have a direct, heart-to-heart conversation with the person about the consequences of addiction. Then they ask the person to accept treatment.

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Like many mental health disorders, several factors may contribute to development of drug addiction. The main factors are:

• Environment. Environmental factors, including your family's beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
• Genetics. Once you've started using a drug, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.

Changes in the brain

Physical addiction appears to occur when repeated use of a drug changes the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate. These changes can remain long after you stop using the drug.

Risk factors

People of any age, sex or economic status can become addicted to a drug. Certain factors can affect the likelihood and speed of developing an addiction:

• Family history of addiction. Drug addiction is more common in some families and likely involves an increased risk based on genes. If you have a blood relative, such as a parent or sibling, with alcohol or drug addiction, you're at greater risk of developing a drug addiction.
• Mental health disorder. If you have a mental health disorder such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, you're more likely to become addicted to drugs. Using drugs can become a way of coping with painful feelings, such as anxiety, depression and loneliness, and can make these problems even worse.
• Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people.
• Lack of family involvement. Difficult family situations or lack of a bond with your parents or siblings may increase the risk of addiction, as can a lack of parental supervision.
• Early use. Using drugs at an early age can cause changes in the developing brain and increase the likelihood of progressing to drug addiction.
• Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or opioid painkillers, may result in faster development of addiction than other drugs. Smoking or injecting drugs can increase the potential for addiction. Taking drugs considered less addicting — so-called "light drugs" — can start you on a pathway of drug use and addiction.

Complications

Drug use can have significant and damaging short-term and long-term effects. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. Here are some examples.

• Methamphetamine, opiates and cocaine are highly addictive and cause multiple short-term and long-term health consequences, including psychotic behavior, seizures or death due to overdose. Opioid drugs affect the part of the brain that controls breathing, and overdose can result in death. Taking opioids with alcohol increases this risk.
• GHB and flunitrazepam may cause sedation, confusion and memory loss. These so-called "date rape drugs" are known to impair the ability to resist unwanted contact and recollection of the event. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol.
• MDMA — also known as molly or ecstasy — can interfere with the body's ability to regulate temperature. A severe spike in body temperature can result in liver, kidney or heart failure and death. Other complications can include severe dehydration, leading to seizures. Long-term, MDMA can damage the brain.
• One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.
• Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity. Sudden death can occur even after a single exposure.

Other life-changing complications

Dependence on drugs can create a number of dangerous and damaging complications, including:

• Getting an infectious disease. People who are addicted to a drug are more likely to get an infectious disease, such as HIV , either through unsafe sex or by sharing needles with others.
• Other health problems. Drug addiction can lead to a range of both short-term and long-term mental and physical health problems. These depend on what drug is taken.
• Accidents. People who are addicted to drugs are more likely to drive or do other dangerous activities while under the influence.
• Suicide. People who are addicted to drugs die by suicide more often than people who aren't addicted.
• Family problems. Behavioral changes may cause relationship or family conflict and custody issues.
• Work issues. Drug use can cause declining performance at work, absenteeism and eventual loss of employment.
• Problems at school. Drug use can negatively affect academic performance and motivation to excel in school.
• Legal issues. Legal problems are common for drug users and can stem from buying or possessing illegal drugs, stealing to support the drug addiction, driving while under the influence of drugs or alcohol, or disputes over child custody.
• Financial problems. Spending money to support drug use takes away money from other needs, could lead to debt, and can lead to illegal or unethical behaviors.

The best way to prevent an addiction to a drug is not to take the drug at all. If your health care provider prescribes a drug with the potential for addiction, use care when taking the drug and follow instructions.

Health care providers should prescribe these medicines at safe doses and amounts and monitor their use so that you're not given too great a dose or for too long a time. If you feel you need to take more than the prescribed dose of a medicine, talk to your health care provider.

Preventing drug misuse in children and teenagers

Take these steps to help prevent drug misuse in your children and teenagers:

• Communicate. Talk to your children about the risks of drug use and misuse.
• Listen. Be a good listener when your children talk about peer pressure and be supportive of their efforts to resist it.
• Set a good example. Don't misuse alcohol or addictive drugs. Children of parents who misuse drugs are at greater risk of drug addiction.
• Strengthen the bond. Work on your relationship with your children. A strong, stable bond between you and your child will reduce your child's risk of using or misusing drugs.

Preventing a relapse

Once you've been addicted to a drug, you're at high risk of falling back into a pattern of addiction. If you do start using the drug, it's likely you'll lose control over its use again — even if you've had treatment and you haven't used the drug for some time.

• Follow your treatment plan. Monitor your cravings. It may seem like you've recovered and you don't need to keep taking steps to stay drug-free. But your chances of staying drug-free will be much higher if you continue seeing your therapist or counselor, going to support group meetings and taking prescribed medicine.
• Avoid high-risk situations. Don't go back to the neighborhood where you used to get your drugs. And stay away from your old drug crowd.
• Get help immediately if you use the drug again. If you start using the drug again, talk to your health care provider, your mental health provider or someone else who can help you right away.

Drug addiction (substance use disorder) care at Mayo Clinic

• Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Aug. 15, 2022.
• Brown AY. Allscripts EPSi. Mayo Clinic. April 13, 2021.
• DrugFacts: Understanding drug use and addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction. Accessed Aug. 15, 2022.
• American Psychiatric Association. What is a substance use disorder? https://psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder. Accessed Sept. 2, 2022.
• Eddie D, et al. Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology. 2019; doi:10.3389/fpsyg.2019.01052.
• Commonly used drugs charts. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/commonly-used-drugs-charts. Accessed Aug. 16, 2022.
• Drugs, brains, and behavior: The science of addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction. Accessed Aug. 16, 2022.
• Drugs of abuse: A DEA resource guide/2020 edition. United States Drug Enforcement Administration. https://admin.dea.gov/documents/2020/2020-04/2020-04-13/drugs-abuse. Accessed Aug. 31, 2022.
• Misuse of prescription drugs research report. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/overview. Accessed Aug. 17, 2022.
• Principles of drug addiction treatment: A research-based guide. 3rd ed. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/preface. Accessed Aug. 17, 2022.
• The science of drug use: A resource for the justice sector. National Institute on Drug Abuse. https://nida.nih.gov/drug-topics/criminal-justice/science-drug-use-resource-justice-sector. Accessed Sept. 2, 2022.
• Naloxone DrugFacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/naloxone. Accessed Aug. 31, 2022.
• Drug and substance use in adolescents. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/problems-in-adolescents/drug-and-substance-use-in-adolescents. Accessed Sept. 2, 2022.
• DrugFacts: Synthetic cannabinoids (K2/Spice). National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice. Accessed Aug. 18, 2022.
• Hall-Flavin DK (expert opinion). Mayo Clinic. March 5, 2021.
• Poppy seed tea: Beneficial or dangerous?

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Understanding Drug Use and Addiction DrugFacts

Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

• decision-making

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

• Biology . The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.
• Environment . A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.
• Development . Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient’s drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

• Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
• Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
• Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
• Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.
• Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.
• No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.
• Drug addiction is treatable and can be successfully managed.
• More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

For information about understanding drug use and addiction, visit:

• www.nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction

For more information about the costs of drug abuse to the United States, visit:

• www.nida.nih.gov/related-topics/trends-statistics#costs

For more information about prevention, visit:

• www.nida.nih.gov/related-topics/prevention

For more information about treatment, visit:

• www.nida.nih.gov/related-topics/treatment

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

• https://findtreatment.samhsa.gov/

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

Essay on Substance Abuse Disorder

Substance use problems are widespread over the world and are still a difficult medical challenge to solve. For the years of 2010 to 2016, the United Nations Office on Drugs and Crime (UNDOC) projected that there were around 275 million people in the world with the condition, ranging in age from 15 to 64. (Office of the Surgeon General & U.S Department of Health and Human Services, 2017). Addiction has a negative impact on the addict as well as their family and the community as a whole. Clinically substantial deficits in physical and mental health, as well as social function, are all characteristics of substance use disorders. Milder to more severe forms of these illnesses can be found. Substance abuse and alcoholism were blamed for 160, 235, and 145,565 deaths worldwide in 2016, respectively, according to WHO estimates.

Healthcare systems continue to face enormous obstacles as a result of these persistent problems. Substance abuse disorder can begin with occasional social use of a recreational drug and become more severe for certain people. The use of prescribed drugs can lead to addiction in certain people. Individuals’ susceptibility to addiction and how quickly they become addicted to a substance differ depending on its nature. Opioids, for example, have a higher potential for abuse and addiction than other medications. People may require more drugs to get high in the long run, and eventually they’ll merely want the substance to feel good (Tran et al., 2019).Other risk factors include a family history of addiction, mental health disorder where individuals can begin using drugs to cope with mental health, peer pressure, and difficult family situations. Substance disorder symptoms and behaviors include individuals feeling the urge to use a drug regularly, taking larger amounts of drugs than one intended to, continuing substance use even when it causes the inability to fulfill one’s responsibilities, and interpersonal problems.

Given the detrimental effects of this disorder, prevention and management of substance, disorder is a key priority. In order to better understand the mechanisms that underlie addiction and relapse, more study is being conducted on topics such as reinforcement and reward, tolerance and withdrawal, negative consequences, cravings, and stress sensitivity, among others. Treatments for substance use disorders have included both pharmacological and non-pharmacological techniques in recent decades (Tran et al., 2019). Smoking cessation has been maintained for over a 6-month follow-up with nicotine replacement therapies and pharmaceutical techniques such counseling, self-help, and behavioral therapies. Alcohol dependence is commonly treated with non-pharmacological methods such as skills training, cognitive behavior therapy, and family and marital therapy.

There have also been strategies to reduce the harm developed to help individuals not ready for drug abuse. The programs provide people evidence-based, safe, and cost-effective alternatives to prevent and lessen the hazards associated with substance dependence. The needle exchange program, overdose prevention initiatives, and naloxone are just a few of the tools available. Outreach and education assist in identifying those who do not seek treatment and in making them aware that it is both possible and vital for them to receive therapy (Tran et al., 2019). To reduce the danger of infection spread, those who inject narcotics are given sterile needles as part of a needle exchange program. The FDA has approved the use of Naloxone to treat opioid overdoses. As the number of opioid overdose deaths has risen, so has public anxiety, resulting in initiatives to make naloxone more widely available to those most at risk.These interventions significantly decrease the effects of substance abuse; however, much more must be done to end this challenge of drug abuse.

Office of the Surgeon General, & U.S. Department of Health and Human Services. (2017).  facing addiction in America: The surgeon general’s report on alcohol, drugs, and health . Create space Independent Publishing Platform.

Tran, B. X., Moir, M., Latkin, C. A., Hall, B. J., Nguyen, C. T., Ha, G. H., Nguyen, N. B., Ho, C. S., & Ho, R. C. (2019). Global research mapping of substance use disorder and treatment 1971–2017: Implications for priority setting.  Substance Abuse Treatment, Prevention, and Policy ,  14 (1).  https://doi.org/10.1186/s13011-019-0204-7

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217 Substance Abuse Essay Topics + Examples

Writing a paper about addiction to drugs and alcohol is your chance to explore the substance abuse risk factors, experiences, treatment options, and prevention. Need catchy substance abuse research topics? You’re at the right place! StudyCorgi has plenty of essay and research topics on drug abuse, alcohol, and other psychoactive substances.

💊 7 Substance Abuse Essay Topics

🏆 best research topics on substance abuse, ❓ research questions on substance abuse, 👍 good substance abuse research topics & essay examples, 🔎 research questions on drug abuse among students, 🌶️ hot drug addiction research topics, 🎓 most interesting research topics on drug abuse, 💡 simple substance abuse essay ideas, 📝 more substance abuse research questions.

• Drug Abuse among Teenagers Causes and Effects
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• Substance Abuse Prevention in Adolescence Parents and school administrations should implement measures of stopping substance abuse as the first step in safeguarding the future of the next generation.
• Alcohol and Drug Abuse in the Workplace Alcohol and drug abuse is one of the major causes of accidents in the workplace. Random alcohol and drug tests would discourage employees of organization from abusing alcohol or drugs.
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• Drug Abuse Relation to the Violent Behavior Various groups of drugs greatly vary and relate to violence in different ways. Any person with heavy drug habits may act negatively and involve in violent acts punishable by law.
• Substance Abuse Among Adolescents Substance abuse and addiction are rampant within the adolescent age. Children abuse substances due to peer pressure, poor parenting, and lack of sufficient sensitization.
• Overcoming the Drug Abuse Addiction The use of narcotic drugs brings irreparable harm to health and diminishes the quality of life. Opioid abuse is a predominant problem that continues to be a concern.
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• Substance Abuse: The Cause of Social Problems Substance abuse is a contributing factor to social problems but cannot be said to be the one that is most responsible.
• Parental Substance Abuse: Negative Impact on Child Development The researchers focus on the negative impact of parental substance abuse on child development, leading to addiction problems when these children become teenagers or young adults.
• Alcohol Abuse: Causes and Solutions Alcohol abuse remains one of the key healthcare concerns around the globe, not least because addicts do not purely injure their own health.
• Drugs and Substance Abuse in College: Effects and Treatments The paper will give a review of a treatment approach to drug abuse and describe the effects of substance abuse on a person who is in college.
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• Personal Relationship With Alcohol Abuse Given that alcohol abuse affects myriad families, ruining people’s health and harming social life, it is still a sensitive and critical issue to consider.
• Leadership in Drug Abuse Program Development Within the context of a potential intervention for drug abuse, the roles and competencies of leaders are the primary emphasis of this paper.
• Victimless Crimes: Drug Abuse and Sex Work This work’s primary objective is to research and analyze victimless crimes, namely drug abuse and sex work, from the viewpoint of criminology.
• The Factors Which Determine Substance Abuse Substance addiction is a disease that affects the patient’s behavior and physical well-being. It is associated with mood modification and chemical intoxication.
• Health Issue Analysis: Prescription Drug Abuse Prescription drug abuse is a rapidly growing epidemic that spreads worldwide. Various national and international health organizations research this field.
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• Drug Abuse and Its Effects on Families Because of the lack of control that a substance abuse patient has over their actions, families of the people that develop chemical dependency are under constant threat.
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• A Comprehensive Annotated Bibliography on Substance Use and Abuse The annotated bibliography provides a comprehensive overview of academic sources on the multifaceted issue of substance use and abuse.
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• How Does Substance Abuse Affect the Community?
• What Are the Causes and Effects of Substance Abuse?
• How Do Psychologists Define and Explain Substance Abuse?
• What Are the Social Problems That Are Caused by Substance Abuse?
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• How Can We Prevent Substance Abuse Among Youth?
• Why Is It Important to Talk About Substance Abuse?
• How Can Substance Abuse Be Addressed and Reduced?
• Developments in Global Tobacco and Alcohol Policy WHO reports that about 8 million people die from smoking every year. Tobacco is a major cause of the emergence and development of multiple complications such as cancer, heart disease.
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• Drug Abuse in Homeless Community The number of homeless people is continuously increasing, creating a severe threat to a country’s general well-being.
• Drug Abuse in the United States’ Social Context Drug abuse is one of the problems affecting people in the United States. Society has contributed to the continued misuse of drugs today, through bad parenting or the environment.
• Substance Abuse Relapse among Women For substance abuse relapse among women, it is the issue of resumption of females to substance abuse after they have recovered from using such drugs.
• Substance Abuse and Preventive Measures The paper analyzes socio-economic and health issues for families, communities, and nations caused by psychoactive substances abuse.
• Personality and Substance Abuse This article looks at personalities of frequent substance users, experimenters, and non-users from the point of view of social psychology.
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• Drug Abuse During Pregnancy: Policy Options Heated discussions on whether or not drug abuse during pregnancy should be illegal due to the potential risks to the developing fetus or child persist.
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• The CAGE Substance Abuse Screening Tool Issues The paper states that the CAGE Assessment has a high rate of false positives, which can lead to individuals being wrongly accused of drug abuse.
• The Experience of Substance Abuse in Homeless Veterans The problem of homelessness often affects the most vulnerable segments of society, one of them being veterans. This particular group also experiences significant issues.
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• Substance Abuse in Population and How to Address It Substance abuse is one of the issues in the population that affect not only the people who conduct the abuse but those around them as well.
• Parental Alcohol Abuse as a Family Issue Parental alcohol abuse is a serious problem in the community that impacts not only one individual but spreads to different social units.
• Substance Abuse and Its Financial Dimension The purpose of this paper is to explore substance use as a healthcare finance issue and review its significance with regard to healthcare policy.
• Assessment of Clients with Substance Abuse Up-to-date medicine struggles with treating humans’ bodies and spirit as sometimes spending more attention to the first aspect lead to an increase in human addictions.
• The Drug Abuse Problem in Indiana Drug usage is one of Indiana’s most serious societal problems, affecting the state’s health, economy, behavioral, and criminal elements.
• What are the commonly abused drugs among students?
• How does peer pressure affect students’ drug abuse?
• What are the gender and socioeconomic differences in students’ substance abuse?
• How does drug abuse influence the overall campus environment?
• What are the psychological and behavioral effects of drug abuse on students?
• What is the link between the accessibility of drugs on campus and student drug abuse?
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• Female Drug Abuser’s Recovery Care Plan A woman is an IV drug abuser. The laboratory tests reveal elevated alanine aminotransferase and antibody-positive for Hepatitis C and Hepatitis B.
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• Contingency Management for Patients With Substance Abuse Contingency management is a behavioral treatment for patients with substance abuse problems. This work discusses methods of treatment and contingency management.
• Substance Abuse Disorder Causes, Syptoms, Types Substance abuse – illicit, prescriptive, or licit drugs – has been linked to multiple chronic behavioral and psychotic disorders.
• Mental Health and Substance Abuse in Obamacare The Affordable Care Act (ACA) offered an opportunity to improve healthcare for people with mental illnesses. The implementation of new regulations required certain payment reform.
• Substance Abuse Treatment and Domestic Violence The histories of child abuse and neglect form the present behavior of a person a define his administering treatment needs regarding the fact of whether a person was sexually or emotionally abused.
• Substance Abusers Alcoholics – Psychology Alcoholics suffer from a distinct physical yearning to take alcohol past their capability to manage it, irrespective of every law of common sense.
• Minimizing Prescription Drug Abuse in Oklahoma Over the past few years, the rates of prescription drug abuse in Oklahoma have grown impressively. The issue must be addressed by raising awareness via modern media.
• Crisis of Chemical Dependence: Drug Abuse Drug abuse mainly begins during teenage. The first part of this essay discusses social and cultural determinants of substance abuse. The second part focuses on the dynamics of addiction.
• Substance Abuse: How Much Is Enough? Drug and substance abuse is caused by many factors that include environmental, age, race and ethnicity, gender, sexual orientation, income level and socioeconomic class
• Social Cultural Determinants of Substance Abuse This paper presents a discussion on the social cultural determinants of substance abuse. It also addresses the dynamics of addiction and the mechanisms that are cope with challenges that arise.
• How do genetic factors contribute to one’s susceptibility to substance abuse?
• What is the impact of substance abuse on brain development in adolescents?
• How do co-occurring mental health disorders affect substance abuse treatment outcomes?
• What are the long-term physical health consequences of prolonged substance abuse?
• How does substance abuse affect family relationships?
• What are the economic costs of substance abuse?
• How do healthcare professionals’ attitudes affect substance abuse treatment quality?
• How does substance abuse affect occupational performance?
• What are the unique challenges of LGBT people in accessing substance abuse treatment?
• How do drug laws affect substance abuse rates?

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Substance Abuse Disorder

Introduction.

It is challenging to define drug and drug abuse as several definitions exist. However, there exists a consensus that a drug is a substance that, when used repeatedly, might lead to addiction or dependency because it has stimulating, depressive, narcotic, or psychedelic effects. Substance Abuse Disorder remains among the most contentious issues contemporary society has to grapple with. Considering the detrimental impacts of substance abuse, a dire need arises to understand narcotic usage in the societal context comprehensively. I thus chose to analyze this social phenomenon to elucidate better the grounds that catalyze drug and substance abuse within society and lead to Substance Abuse Disorder. Considering the prevalence of narcotics abuse within society, it becomes quite essential to study this social phenomenon to get findings and give recommendations that perform a balancing function in creating a normative culture of safety, moderation, and informed judgment. Additionally, it is by having a profound elucidation on the catalysts of drug abuse that essential and effective interventions can be applied successfully to fight this social problem in the future.

As social and economic inequalities continue to draw a rift between existing social classes, drug and substance abuse disparities between social and economic classes become more apparent. Additionally, research-based affirmations indicate that societal and economic disparities are well associated with Drug Use Disorders (DUDs) (Sáenz et al.). Several research findings also find a direct link between socio-economic status and the prevalence of narcotic drug usage. Furthermore, members of higher social classes tend to have a much more self-controlled indulgence in drug abuse than low social class members. In this essay, I seek to define this social phenomenon on the grounds of socio-economic inequalities through the interactionist theory lens.

Interactionalism Theory

Interactionalism theory is quite an essential micro-sociological perspective of understanding narcotics substance abuse from a socio-economic perspective. Since this theory perceives that essence is only achievable through interpersonal relationships, it becomes an effective tool to identify how social constructions within the lower socio-economic class catalyze drug and substance abuse. Below are the essential components of this theory.

• One essential component of interactionist theory is that, based on the reading of situational elements, people consciously choose their behaviors in encounters with other people. As a result, human behavior is indeed the result of human social interactions.
• The social and cultural framework in which interactions occur necessitates the definition and characterization of things, persons, and circumstances following the subjective meanings of the participants (Nickerson).
• Every time a person interacts with another person, a process of interpretation takes place that creates and reconstructs the meanings that person possesses (Nickerson). Thus, interactions between people can transform individuals’ behavioral traits to embrace drug and substance abuse.
• People behave based on the personal significance they ascribe to items (Nickerson). For instance, minors who grow up in challenging backgrounds characterized by marital conflicts may develop a negative attitude and indulge in drug abuse.

The interactionism theory is relatively better than the other theories in understanding the societal issue of drug and substance abuse which is well associated with the profound prevalence of socio-economic inequality. Additionally, at the core of this theory is the fundamental emphasis that behavioral characteristics are shaped by the individual’s self-concept of identity, which is indeed the product of social interactions. It is a relatively comprehensive approach that views society from the individual’s perception rather than defining individualistic characteristics per society’s characteristics.

Description of the Phenomena

Drug addiction is a shared experience that has a cascading impact on the lives of people close to the addict. Drug addiction may initially seem to impact the user, but it has far-reaching consequences. This social issue that continues to take a toll on a fair share of the youthful population has many catalysts that are the product of society’s social and economic disparities. Among the catalysts factors of drug abuse in a society that is economically less endowed include; peer pressure, micro socio factors such as ego, the need for identity definition, and individual marginalization, as well as macro socio factors such as drug usage prevalence in the society, social economic marginalization’s as well as lack of economic and educational opportunities. Below are examples of drug addiction phenomena.

• Among the most common drug addiction disorder is Phencyclidine Use Disorder, which is considered a type of hallucinogen. This drug is easily addictive due to the mental stimulation associated with it. Its prevalence of usage is among the teenage population, which can be attributed to peer pressure and socio-economic disparity within society.
• Another prevalent substance abuse disorder is Stimulant Use Disorder, associated with the use of narcotic stimulants such as cocaine and methamphetamine. This disorder is prevalent among the youthful population worldwide. It is also much prevalent in low socio-economic viability neighborhoods.
• Sedatives are also common among drug users in economically disadvantaged backgrounds as they seek to relieve anxiety and tension that is common in everyday lives. They are also primarily used for recreational purposes to relieve mental distress in users.

Analysis of Interactionism and Drug and Substance Abuse

Since biology and other sciences lack comprehensive and entirely satisfactory hypotheses to link the prevalence of Drug Abuse Disorder rationally, existing scientific genetic predisposition still fails to develop a direct link between drug usage prevalence and genetic factors. Interactionist sociologists perceive that drug and substance abuse runs on the fault lines of social inequality and is not relatively evenly distributed.

• Peer pressure is among the key drivers of the observable differences in drug usage. This existing narcotic subculture creates an alternative break from the normal economically disadvantaged livelihoods and the significant psychological effects associated with narcotic drugs (GitHub). Considering the focus of Interactionism theory on the interaction of individuals, in this kind of social contact based on economic challenges, people might learn how to take drugs and acquire a variety of attitudes that support drug use and characterize a drug’s effects as pleasurable (GitHub).
• Unemployment is well attributed to individual economic hardships, which overpowers other members of society in the long run. Existing research already sufficiently likens such economic downturns to heavy drug abuse. Recent research by Azagba et al. (8) indicates that tough economic times resulting from unemployment are catalysts of drug and substance abuse.
• Poverty is still a significant issue that society has to grapple with. It is among the contributory factors to the prevalence of drug and substance abuse in society. Poverty is well attributed to causing certain attitudes, life circumstances, and behavioral transformations that drive young people into drug abuse (Shivalik and Chileshe 72).
• Peer pressure from fellow peers with the same economic delinquency in society, as Shivalik and Chileshe (71) suggest, is indeed the real culprit of drug and substance abuse among minors living in economically marginalized backgrounds. Thus, since interactionism is grounded on the relationships between people, peer pressure can be viewed from the conceptual lens of being an agent of drug and substance abuse in economically disadvantaged backgrounds.
• The unconducive home background is also an essential example of the social and economic inequality that leads to drug and substance abuse. As some families living in economically downgraded settings break up or are characterized by the prevalence of marital fights, minors may tend to embrace drug abuse (Shivalik and Chileshe 72). This drug indulgence could be pervasive in minors’ strategy to escape life’s constant disappointments present at home.

The interactionist theory efficiently analyzes the prevalence of drug and substance abuse and associated Drug Usage Disorders. Its effectiveness in analyzing this phenomenon is grounded on its firm approach that people develop specific characteristics based on their interactions with other members of society. Though other sociological theories, such as the functionalist theory, could be applied to analyze such a contentious social issue, they may fail to comprehensively analyze all the catalytic factors of drug abuse. Thus, the interactionist theory has been an effective tool for a better personal understanding of the societal phenomenon of drug and substance abuse through the socio-economic inequality lens. Indeed, I have developed a polished-up understanding of the issue of Substance Abuse Disorder within society.

Works Cited

Azagba, Sunday, et al. “Unemployment rate, opioids misuse, and other substance abuse: quasi-experimental evidence from treatment admissions data.” BMC Psychiatry 21.1 (2021): 1–9.

GitHub. “Explaining Drug Use.”  GitHub , saylordotorg.github.io/text_social-problems-continuity-and-change/s10-04-explaining-drug-use.html.

Nickerson, C. “Symbolic Interactionism Theory & Examples.”  Study Guides for Psychology Students – Simply Psychology , 12 Oct. 2021, www.simplypsychology.org/symbolic-interaction-theory.html.

Sáenz, E., et al. “Socio-economic inequalities and drug use disorders: Current knowledge and future directions for research and action.”  National Institute on Drug Abuse , 4 Aug. 2020, nida.nih.gov/international/abstracts/socioeconomic-inequalities-drug-use-disorders-current-knowledge-future-directions-research-action.

Shivalik, Misheck, and Bernard Chileshe. “Perceptions of Stakeholders on the Causes of Drug Abuse among Primary School Learners in Shibuyunji District, Zambia.” Multidisciplinary Journal of Language and Social Sciences Education (2664-083X, Online ISSN: Print ISSN: 2616–4736) 5.1 2022: 69–78.

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Giving Voice to Women with Substance Use Disorder: Findings from Expressive Writing About Trauma

Nancy jallo.

1 Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.

Patricia A. Kinser

Michelle eglovitch.

2 Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.

Nicola Worcman

3 Interdisciplinary Cooperation for Ayahuasca Research and Outreach, State University of Campinas, Campinas, Brazil.

Parker Webster

4 Chinle Comprehensive Healthcare Facility, Indian Health Service, Chinle, Arizona, USA

Anika Alvanzo

5 Substance Use Disorders Consultation Services, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

Dace Svikis

Sarah meshberg-cohen.

6 Department of Psychiatry, Yale University School of Medicine, West Haven, Connecticut, USA.

Background:

Trauma exposure is a risk factor for substance use disorders (SUD) among women. This study explores written content from an expressive writing (EW) intervention conducted within a residential SUD program to examine themes across trauma experiences and characterize their deep insight into such experiences.

Materials and Methods:

This qualitative study is a secondary data analysis of written content of the first writing session from women ( n  = 44) randomized to an EW condition while in residential SUD treatment.

Nearly all participants (72.7% African American; mean age 37.3 years) reported a significant trauma event (93.2%) with an average of 3.7 types of trauma events (54.4% had a current posttraumatic stress disorder diagnosis). Four primary themes emerged: (1) trauma across the lifespan; (2) loss of safety; (3) altered self-concept; and (4) desire to move on. Most participants identified interpersonal trauma, especially at an early age, as well as parental neglect and physical and/or sexual violence. These themes indicate a pattern of interpersonal betrayal and paint a picture of trauma and the subsequent “rippling effect” such that the physical, mental, and emotional consequences were often as impactful as the event itself. However, there was also a desire to move on and gain a sense of normalcy.

Conclusions:

Findings highlight the importance of the written word and addressing underlying trauma in addiction treatment to facilitate healing and the woman's desire to move on.

Introduction

In the United States, substance use disorder (SUD) is a major public health crisis taking a toll on the individual, family, and community. 1 Affecting over 20 million Americans, SUD is associated with a number of major medical conditions leading to increased risk for reduced quality of life, physical and emotional health comorbidities, and early mortality. 2–5 In addition, SUDs are among the costliest public health problems, with an estimated loss of over $420 billion a year in the form of health care, lost economic productivity, and criminal justice system costs. 6 , 7

Women are the fastest-growing group of substance users in the United States. 8 This increase in prevalence of women with SUDs has unique serious adverse health consequences given that such consequences are particularly ominous for women. Compared to men, the prevalence of fatal overdoses in women has increased at a higher rate. 9–11 Notably, women face distinctive issues using substances to deal with emotional and physical pain as well as attempt to self-treat mental health problems, often as a result of experiencing trauma. 11

There is a heightened vulnerability among women who, compared to men, experience higher rates of lifetime trauma, including physical and sexual abuse. 12–14 While childhood abuse is more likely among men with SUD, women may be more likely to be exposed to trauma at any age, and trauma is particularly a risk factor for development and severity of SUD among women. 15 , 16 For example, traumas such as child abuse have been reported to be associated with earlier initiation and escalation in substance use in women. 17 , 18

Traumatic events can lead to prolonged psychological distress and posttraumatic stress disorder (PTSD). 19 , 20 Such distress may produce a cycle of avoidance behaviors. 21 Expressive writing (EW) is an exposure-based approach that targets such avoidance by directly exploring an event and the resultant emotions and thoughts. Typically, individuals are asked to write about their traumatic experiences and their feelings for 15–20 minutes at a time over the course of several days. 19

According to Pennebaker, who first investigated therapeutic journaling for traumatic events, what makes writing therapeutic is that the writer openly acknowledges their emotions and becomes able to give voice to blocked feelings and to construct a meaningful story in a safe environment. Evidence indicates that disclosure of traumatic and emotional experiences through EW has physical and psychological benefits, and the narratives offer insight for the participant as well as the health care provider (9–11). Written self-disclosure enables people to transfer thoughts to paper, which facilitates meaning making and soothe negative emotions. 22

Because EW is a type of storytelling in which sensations, thoughts, and emotions are prioritized, it emphasizes emotional truth over objective truth. 23 Mechanistically, researchers have noted that it is the reflective component in written meaning-making that contributes to changes in narratives and development of adaptive emotions. 24 In EW, these completely self-driven narratives can achieve a power to garner understandings and shape self-identity ( e.g. , Syed and McLean, 2015). 25 Thus, it is not the accuracy of memory so much as the selection and connection of lived experiences that shape the sense of self.

Thus, the content of EW output can provide valuable insight, particularly into women with SUD. Treatment-seeking women with SUD who report trauma histories also report high rates of depression, 26 , 27 guilt and blame, 28 , 29 disruption of intergenerational family dynamics, 26 and transgenerational patterns of trauma. 30 This study provided a unique opportunity to explore these factors through the women's voices and analyze EW content that was not written with the intention of providing researchers with qualitative data; rather, was intended to help facilitate processing.

The purpose of this qualitative study was to explore the written self-reported experiences and perceptions of trauma among women in residential SUD treatment facing the challenges of addiction. Our aim was to give voice to these women and characterize their deep insight into lived experiences.

Materials and Methods

Research design.

This study is a secondary data analysis focused on content from the first writing session of women randomized to EW while in a residential SUD treatment facility. The primary outcome data have been previously reported. 31 Virginia Commonwealth University (VCU)'s Institutional Review Board approved the research.

Participants ( N  = 149) were recruited during the first several days of residential treatment. Participants were randomly assigned to the expressive or control writing condition. EW instructions, adapted from Pennebaker's paradigm, 32 instructed participants to write for 20 minutes about your deepest emotions and thoughts about the most traumatic experience in your life. In your writing, I'd like you to really let go and explore your very deepest emotion and thoughts. You might tie this trauma to your childhood, your relationship with others including your parents, lovers, friends, or relatives. You may also link this event to your past, present, or your future, or to who you have been, who you would like to be, or who you are now. 31 , 33 Writing instructions were read aloud to each participant before every session and a copy of the writing instructions was provided. Following 20 minutes of writing, participants placed their journals, identified by participant ID, into a cardboard box. 31 The data were collected from June 17, 2007, through November 8, 2008.

Data analysis

This study uses qualitative descriptive approach using conventional content analysis to examine transcribed written data for n  = 44 women assigned to the EW condition. Qualitative description is data-derived, to conceptualize participants' experiences using their own words 34–36 ; we used an inductive conventional content analysis approach. 34 This approach is intended to let the written voices speak for themselves, rather than depending upon a priori coding or deep interpretation of the researcher.

Four research team members engaged in analysis. Driven by the stepwise approach described in Coloarafi and Evans (2016), 34 the team engaged in the following process: First, analysts read transcripts independently in their entirety to garner a sense of the data. Second, analysts read transcripts line by line and assigned codes to key concepts. Third, the team met to review the coding, which was combined and grouped into key themes. Fourth, team members conducted another analysis of the data independently, by re-reading the entire transcripts and ensuring that the coding and key themes accurately represented the data. Finally, the team connected relationships between themes and identified quotes. To ensure scientific rigor, the team comprehensively read and analyzed the data, employed team-based decision-making about coding and themes, and created an audit trail during all meetings. 37 , 38

Sample description

Table 1 summarizes the participants' sociodemographic characteristics. The mean age of participants was 37.3 years (standard deviation [SD] = 8.8), and the majority identified their race as African American (72.7%). The average years of education was 11.2 years (SD = 1.4), and the majority were single/never married (65.9%). Many met Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) SUD criteria for more than one substance (68.2%), with 81.1% reporting a cocaine use disorder. The next most commonly diagnosed SUD was opioid (43.2%), followed by alcohol (38.6%). Overall, 54.4% met criteria for current PTSD via the Posttraumatic Diagnostic Scale 39 ; with an average of 3.7 (SD = 2.3) different types of trauma events, with nearly all participants (93.2%) reporting at least one trauma event significant enough to meet PTSD. Four participants explicitly linked addiction to their traumatic experiences.

Participant Characteristics

DSM-IV, Diagnostic and Statistical Manual of Mental Disorders 4th edition; SD, standard deviation.

Emergent themes

Four primary themes emerged, including (1) trauma across the lifespan, (2) loss of safety, (3) altered self-concept, and (4) desire to move on.

Theme 1: Trauma across the lifespan

Common traumas included physical/sexual violence, either experienced or witnessed, and psychological abuse. Overall, 42 (95.5%) women described at least one of these traumatic experiences. Two women who did not describe violence or abuse depicted experiences such as difficulties with parental and social relationships.

While trauma may have occurred throughout their lives, most women described key events occurring during childhood. Physical abuse was often by mothers or fathers and included being beaten and burned, as illustrated by comments, such as, “ my mom would beat me with a belt, ” “ my mom burnt me when I was 2 years old and use to beat us ,” “ my father was an alcoholic and would beat us and have sex with his own girls. ” In addition, participants were often threatened with harm to them or a family member if they told anyone what they witnessed, resulting in multiple forms of abuse.

Women also described sexual abuse involving a high level of familiarity between them and the perpetrator. Often, the perpetrator was a family member or close friend. One participant wrote, The most traumatic experience in my life was when I was four years old. At that age my brother, who was twelve, sexually assaulted me . Another wrote, I was about 6 [years old], and my stepdad came into my room to put me to bed and touched my private areas … he continued to molest me until I was about 10–12. Another participant was raped at 18 years of age by her boyfriend's friend, and another was raped at 13 years of age by her mother's boyfriend's friend.

As adults, participants experienced physical abuse, with one woman describing she married at 15 to get away from abusive home and soon realized he turned out to be an alcoholic and wife beater . Witnessing violence and the aftermath was also experienced as an adult. As one participant described her most traumatic experience my friend got shot when I was standing there. I feared for my life and my children's life. Likewise, another participant witnessed her parents murdered in their home and seeing my dad laying [in] the bed in a pool of blood and my mother was trying to fight …. I remember seeing my mother get stabbed to death.

Theme 2: Loss of safety

Loss of emotional and/or physical safety was expressed as a form of betrayal in many of the written entries. Many women wrote about traumatic scenarios within a backdrop of an unsafe physical environment and a lack of protection, especially as children. Those who experienced child abuse remember a lack of support or protection by family members during or after these experiences. One woman wrote about being sexually assaulted as a child by her stepfather and wondered why her mother did not protect her: I wondered where my mom was, and did she know what was really going on. This lack of protection became apparent when she was older and realized her mother knew what was happening—her mother told her to allow him to play—touch me.

Similarly, one woman described a sense of betrayal when her parents allowed her grandfather to move in even though they knew he had a history of assaulting children. As a child between the age of 8–11, I was sexually molested by my grandfather who was living in our house—My mother years later informed me that my grandfather had been accused of molesting other children and he had to move in so he wouldn't be arrested …. my parents never warned me or my brother. I never felt so betrayed.

Participants verbalized that lack of safety also occurred often in the form of parental neglect. When, as children, they were left unattended at home, participants reported being sexually assaulted by friends: My mother was at work, I was at home by myself scared to death . As consequences of abuse and neglect, participants wrote about being taken away and entered into foster care or adopted to another family. Pervasive drug use in their family, friends, or community added to loss of safety. Writings included, my brother was selling drugs out of the house, and it wasn't really a safe environment for no one .

Theme 3: Altered self-concept

Consequences of the trauma experiences included a range of emotions, best described as altered self-concept. Self-concept is the image people have of themselves and is influenced by many forces, including trauma. 40 Trauma can profoundly affect the sense of self, where both cognitive and somatic disturbances to the sense of self are reported clinically by individuals. 40 Overall, many participants described the emotional impact of exposure to both psychological and/or physical violence. They often voiced how their identity was shaped by these experiences, as one participant explained: I feel that self-image is greatly affected by the relationships we have.

Emotional changes were expressed in different ways. Many participants expressed a generalized feeling of being inferior due to repetitive loss of safety over time. The sense of loss of self-esteem was evident as women expressed a general sense of deserving their current situation and/or the traumatic events, often playing out in dysfunctional relationships with others. Participants reported crossing their limits in unhealthy relationships, as exemplified by I cannot have normal relationships because of my own self- which is very poor, no matter what I do in my life.

Relatedly, many women shared a feeling of not being loved or wanted by others. For example, one participant revealed that being a victim of physical and psychological abuse from her father resulted in not feeling self-love: I felt loss and unloved because of this, I never had a childhood and still feel I missed a lot. Parental abandonment may impact the construction of the self because it produces a ripple effect on the children. First, the feeling of a lack of protection leading to doubt: Wasn't I loved? Next, the feeling of self-blame contributing to this abandonment, as one explained: One of the most traumatic experiences I have had in my life is the fact that my birth mother gave me up for adoption. I never understood the reason why. I have asked my birth mother time after time, but she would never give me an answer. I wonder, was it something that I did?

Participants often described anger as a result of such experiences, ranging from hatred of a specific person that played a central role, as described by a woman who witnessed her father's violent behaviors toward her sister and mother: I felt helpless afraid and that turned into hate, hate for my dad. I hated my dad for many reasons. How could someone inflict so much pain to an entire family? ; to anger targeting themselves, as illustrated by another participant after being raped by her boyfriend: I felt in anger, and I directed it towards myself as if it was my fault. Guilt was also commonly expressed, and some commented that they blamed themselves, including one participant, who reported that after witnessing her parent's murder: I blamed myself for a long time. I felt like I should've been the one dead, not my parents.

Theme 4: Desire to move on

Despite the trauma these women faced, a common theme was the desire to move on, regain a sense of normalcy, and look toward the future. For example, one participant commented, [the trauma] keeps me sick because I hold on to it instead of working through it. I don't want to carry this weight anymore. I need help and am willing to do whatever it takes to get better … I am sick and tired of being sick and tired.

Women also wrote about efforts to establish positive relationships with close family members by whom they felt betrayed. One woman who identified being sexually assaulted as a child by her older brother stated, Now I am learning to trust him more so we can be a family again. In the future, I want us to be like one with family and watching our nieces and nephews grow up, and rock rocking chairs on the front porch of my house. Another participant, after detailing a rape by her two older brothers and the loss of her family wrote, I don't know my real family—I want to get to know them again—I want my family back.

Lastly, participants identified a desire to forgive themselves to move on. One participant who did not report a sexual assault to the police wrote, I want to forgive myself for all the women he raped after me because I was scared of people knowing and not being popular or believed. Another stated, I wish it hadn't happened to me, but it did, so now I have to deal with it and go on with my life and learn that it wasn't my fault and tell myself that I didn't deserve what happened.

This study examined written content from the first writing session in a sample of women who engaged in a study examining EW as a therapeutic process among women in residential SUD treatment. While not seeking treatment for PTSD or trauma, results demonstrated that most women clearly experienced significant trauma events with far-reaching effects. One of the main findings of this qualitative study was the “ripple effect” of trauma. In these women, trauma experience appeared to ripple over the life-course, negatively impacting participants' physical, mental, and emotional well-being. This image provides a lens through which to see the challenges of trauma and substance use in these women and provides a possible direction for treatment and intervention development.

Consistent with previous research, these participants identified multiple forms of emotional and physical interpersonal trauma (IPT) experiences throughout their life. 3 , 28 , 29 , 41–44 This is noteworthy, as IPT is considered among the most detrimental forms of trauma and is associated with increased somatic symptom severity, SUD, suicide risk, and overdose. 45–49 IPT victims are at higher risk for experiencing cumulative trauma and re-victimization, increasing the probability of additional substance issues. 45 , 50 , 51

Adverse childhood experiences (ACE), a form of IPT, can have long-lasting negative effects on psychosocial development including SUD. 52 Our results are consistent with previous research revealing significant rates of ACEs among women with SUDs. 3 , 30 , 53–55 ACEs, such as physical abuse, emotional and physical neglect, parental substance abuse, parental separation, and death, were voiced by participants in this study. Findings emphasize the extensive nature of childhood abuse and neglect and may underscore a self-medication hypothesis to suggest why some women turn to drugs and alcohol to cope with consequences from childhood abuse and stress feelings related to exposure of ACEs. 3 , 56

Another common theme in this study was the desire to move on, which underlined complicated relationships with forgiveness of perpetrators of such events. These findings are consistent with literature suggesting that the concept of forgiveness in the face of abuse is highly complex. Difficult to define, forgiveness may involve compassion, reconciliation, and/or a reframing of the offense from negative to either positive or neutral. 57 Researchers found that forgiveness was associated with psychological health in women with history of abuse, but not in women currently experiencing abuse; in fact, forgiveness was associated with increased stress when physical abuse was ongoing. 58 Future research is warranted to explore the concept of forgiveness with women with SUD who have experienced IPTs.

Notably, despite being in SUD treatment, only four participants explicitly discussed an association between their traumatic experiences and their addiction in this first writing session. Use of substances as a maladaptive self-medication strategy is well supported in the literature. 59 , 60 Thus, these lack of findings may reflect a limitation in the study design as the data are derived from written journal entries and, thus, the team was unable to ask clarifying questions or elaboration on whether the experience of traumatic events was directly connected to their use of substances. More research is needed in this area to further explicate this finding.

Overall, the emotional resonance of the content of the sessions demonstrates the power of EW and writing for yourself. The advantages of EW can be understood in relation to cognitive, physical, and psychological health. 61 Guo posits three mechanisms for which this manifests: Cognitively, translating thoughts into writing enables people to symbolize the experience, which enhances processing and understanding. 23 Physiologically, written disclosure decreases the work of repressing emotions which is associated with stress. Psychologically, confronting the crisis through written word allows individuals to reframe and integrate it into their schema, such that negative emotionality eventually diminishes. This trifold of impact has particular salience with women with SUD, who oftentimes experience multiple traumas.

Thus, this study provides support for future interventions that utilize EW in this population. Written exposure therapy (WET) is a newer form of exposure therapy that builds upon Pennebaker's initial EW paradigm that has been studied primarily in veterans with PTSD. 62 Recently, Nillni et al. have piloted WET among women with comorbid PTSD and SUD and found that it was effective in reducing PTSD symptoms. 63 However, there is limited research around how WET might improve substance use outcomes in this population. Future research should continue to explore its effectiveness for this population given the high comorbidity of PTSD and SUD and explore the impact on substance use in addition to PTSD symptomatology.

Limitations

There are several limitations to this study. Only women with SUD in residential treatment were included and thus are not representative of all women seeking SUD services, limiting generalizability. This study examined the first writing session and further research should investigate the EW entries over time to examine whether there were changes in the way that the women reflected upon written events. Despite this, the present study provides the context and meaning of these traumatic experiences within this subgroup, which is the goal of qualitative research.

Our findings revealed a complex nature of trauma among women in residential SUD treatment settings. Such findings might highlight the importance of addressing underlying trauma during early stages of SUD treatment. Incorporating a model of informed care that acknowledges the role trauma may play in an individual's life could help contextualize the individual's experience and strengths to tailor behavioral and treatment strategies to better cope with addiction and facilitate healing. 26 , 64

Abbreviations Used

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research was supported by grants from NIH (Grant No. R36 DA024021-01 and T32DA007027) and the VCU Institute for Women's Health.

Cite this article as: Jallo N, Kinser PA, Eglovitch M, Worcman N, Webster P, Alvanzo A, Svikis D, and Meshberg-Cohen S (2024) Giving voice to women with substance use disorder: Findings from expressive writing about trauma, Women's Health Reports 5:1, 223–230, DOI: 10.1089/whr.2023.0173.

Substance Abuse in Teenagers Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Substance abuse issue, causes of substance abuse.

I picked this topic because teenage drug addiction has prevailed in society, making it a growing problem. Teenagers frequently experiment with various activities and substances that often result in abuse and addiction. Brain development in adolescents is more vulnerable to drug deficits, which concerns society. Substance abuse causes injury, sexually transmitted diseases, teenage pregnancies, poor mental health, and suicide. The essay presents the issues and the causes of substance abuse among adolescents.

The prevalence of drug use is higher in boys than in girls. For example, a survey conducted by Molinaro et al. (2011) presents cannabis as five times more prevalent than other drugs. Figure 1 below shows the rate of use of cannabis by male adolescents.

A comparison of the two figures shows more males using cannabis. The prevalence of cannabis in 2009 in females is 24.7, while in males, it is 33.8, which affirms that males are more subject to drug addiction than females (Molinaro et al., 2011). The results show men being the bigger addicts to heroin, cocaine, stimulants, and hallucinogens.

Drug consumption also exhibits a dynamic evolution over time influenced by cultural, political, and economic factors like changing laws and market price volatility (Molinaro et al., 2011). Despite significant legislative and social communication efforts in the field, the prevalence of drug use remained relatively unchanged for the commonly used drugs like cocaine and cannabis, with a decrease in heroin overbalanced by a significant increase in hallucinogen and stimulant use (Molinaro et al., 2011). Between 2005 and 2008, the trend for cannabis use and availability decreased while its price increased, whereas the prevalence of cocaine and stimulant use increased significantly (Molinaro et al., 2011). In spite of the various social communication and legislative initiatives to prevent substance misuse, the situation has not improved considerably.

There are various reasons why teenagers and young adults become involved with drugs. Regrettably, the root of substance abuse often goes deeper than experimentation. The availability of illegal drugs for adolescents predicts increased substance use as an adult. According to a survey conducted between 1999 and 2009, cannabis has been the most widely available illicit substance, with cocaine’s availability rising since 2006, where one out of every five students reported easy access to the drug (Molinaro et al., 2011). Substance availability influences the use of substances by adolescents as they can obtain them easily. Cannabis is a consistently available illicit drug that adolescents abuse.

An increase in the prices of illicit substances affects the rates of abuse. The cheaper the illegal drugs are, the easier it is for adolescents to access them. An example is from the survey conducted by Molinaro et al. (2011) on cannabis.

Cannabis use and availability decreased in 2006, and its price increased, although cocaine and stimulant use prevalence increased significantly from 2005 to 2006, and their price decreased (Molinaro et al., 2011). The prices set for drugs influence their abuse. The higher the set costs, the less their abuse and inversely.

Drug usage is common among high school students, with cannabis being the most common and heroin being the least. Girls are less susceptible to illicit substance use than boys. The root of substance abuse often goes deeper than experimentation. Substance availability influences the use of substances by adolescents as they can obtain them easily. In spite of the various social communication and legislative initiatives to prevent substance misuse, the situation has not improved considerably.

Molinaro, S., Siciliano, V., Curzio, O., Denoth, F., Salvadori, S., & Mariani, F. (2011). Illegal substance use among Italian high school students: Trends over 11 years (1999–2009) . PloS one , 6 (6), e20482. Web.

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Bibliography

IvyPanda . "Substance Abuse in Teenagers." January 5, 2023. https://ivypanda.com/essays/substance-abuse-in-teenagers/.