Substance Use Disorder and Its Treatments

Substance Use Disorder and Its Treatments
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More than 20 million people in the United States have a substance use disorder, and the majority don’t get the treatment that they need, according to national data from the Substance Abuse and Mental Health Services Administration (SAMHSA).

What is substance use disorder (SUD)? 

Substance use disorder (SUD) is an umbrella term for the uncontrolled use of a substance, such as nicotine, alcohol or another illicit drug, despite known harmful consequences associated with such use. In general, substance use disorder is characterized by the increasing urge to drink or to use drugs and the inability to stop drinking or using those drugs. 

Substance use disorder is a disease and considered a mental health condition that affects the brain and behavior. It often impairs a person’s quality of life. When a person has substance use disorder, they are distracted by the desire to use the substance, may develop an increased tolerance to the substance and/or experience withdrawal symptoms when they stop taking it. 

Substance use disorder can run the gamut from mild to severe. The most severe substance use disorders are called addictions.

The most commonly abused substances are:

  • Alcohol

  • Marijuana

  • Phenylcyclohexyl piperidine (PCP)

  • Lysergic acid diethylamide (LSD)

  • Other hallucinogens

  • Inhalants, including paint thinners and glue

  • Opioids such as codeine and oxycodone 

  • Street opioids like heroin

  • Anxiety medicines 

  • Cocaine

  • Speed and other stimulants

  • Tobacco/nicotine

Types of substance use disorders 

There are many different types of substance use disorders. This list includes:

  • Opioid use disorder 

  • Marijuana use disorder 

  • Nicotine use disorder 

  • Stimulant use disorder 

  • Sedative use disorder 

  • Hallucinogen use disorder 

  • Alcohol use disorder, including binge drinking

With any of these substance use disorders, the person affected is unable to stop using the substance despite its negative impact on their life. Some people misuse more than one kind of substance. This is referred to as polysubstance use disorder.

Breaking down substance use disorder symptoms

Spotting a person with substance use disorder isn’t always easy. Many people become very skilled at hiding their alcohol or drug use. Substance use disorder symptoms may include physical (dramatic weight loss or gain), social (changing friend groups) or emotional (sudden outbursts of anger) features.

Physical changes that may point to a possible substance use disorder include:

  • Changes in appetite

  • Changes in sleeping schedule

  • Bloodshot eyes 

  • Enlarged pupils

  • Weight loss or gain

  • Bad breath

  • Body odor

  • Slurred speech

Psychosocial signs of a substance use disorder may include: 

  • Missing work or school

  • Brushes with the law, such as getting into fights, accidents or behaving suspiciously 

  • Shifting of friend groups

  • Deteriorating romantic relationships

  • Asking for (or stealing) money

Psychological changes associated with substance use disorder may include:

  • Personality changes 

  • Mood swings 

  • Acting anxious, paranoid or fearful 

  • Unusual hyperactivity

  • Pronounced agitation

  • Decreased motivation

Causes of substance use disorder 

There is no one cause of substance use disorder. Both genetics and the environment may play a role. Substance use disorder does tend to travel with other mental health disorders, such as:

In fact, more than 1 in 4 adults living with serious mental health problems also has a substance use problem, according to SAMHSA.

Substance use disorder may also run in families due to both nature and nurture. Children who witness their parents using drugs or alcohol are more likely to do the same, and some genes may predispose folks to substance use disorder.

Other factors that may increase the risk of substance use disorder include stress, coping mechanisms and low self-esteem. Life events may be life-altering as well. Kids who were exposed to traumatic events have a higher risk for developing substance abuse with advancing age.

Substance use disorder treatment 

Getting help for a substance use disorder starts with acknowledging that you have a problem. This is a big and important first step. It has to come from you and be for you. 

The good news is that there is treatment for substance use disorder. The bad news? Most people don’t seek treatment. 

Once you are ready to seek help, your doctor will perform a substance abuse evaluation. This includes a physical exam and a frank discussion about the substance(s) you are using. Your doctor should also screen for any psychiatric symptoms. It’s also important to disclose any current life stressors. 

Make sure to share details about the last time the substance was used and how often it was used. This information can help determine your risk of withdrawal symptoms. Honesty is an essential part of any substance abuse evaluation.

There are many avenues to change the trajectory of substance use. Substance use disorder treatment may include:

  • Medication to ease withdrawal symptoms or prevent use

  • Individual or group counseling

  • Support groups such as Alcoholics Anonymous, Narcotics Anonymous or SMART Recovery

  • Inpatient or outpatient care

Medication to treat substance use disorder

There are U.S. Food and Drug Administration (FDA)-approved medications to help treat nicotine, alcohol and opioid addiction. 

Smoking cessation medications

Several medications may help you break up with nicotine.

Bupropion decreases cravings and other nicotine withdrawal symptoms. Another quit smoking pill, varenicline, curbs the urge to smoke and eases some withdrawal symptoms. It also helps reduce the enjoyment you get from nicotine. Nicotine replacement therapy, such as gum, patches, lozenges and inhalers, may also help you kick the smoking habit by making it less uncomfortable as you ease off of tobacco use.

Medications to treat alcohol use disorder

The FDA has approved three medications to treat alcohol use disorder: acamprosate, naltrexone and disulfiram. Acamprosate helps tame withdrawal symptoms, naltrexone reduces cravings, and disulfiram causes headache, nausea and vomiting when alcohol is consumed.

Medications to treat opioid use disorder

Several approved medications may help treat opioid use disorder. The list includes methadone, naltrexone and buprenorphine. These drugs essentially block the high you get from opioids and relieve cravings. Opioid treatment programs may be called methadone clinics. These facilities offer medication-assisted outpatient treatment.

Naloxone is used to prevent opioid overdose by rapidly reversing the toxic effects of these drugs.

There are many places and ways to seek care for substance use disorder. Some people may need to be hospitalized initially due to severe withdrawal symptoms. Inpatient residential treatment or rehab centers are immersive and offer a supportive environment to help people recover without distractions. Intensive outpatient programs offer psychosocial support and other types of therapy to help people overcome substance use disorders.

Counseling may help you understand your addiction, become more aware of your triggers and learn to avoid them. It may be done in person or via telehealth.

Living with substance use disorder

Don’t lose hope: Help is available, and recovery from substance use disorder is possible. Along with outside help and guidance, it's important to take good care of yourself during your recovery journey. For starters, this includes:

Being aware of your triggers and taking steps to avoid them is also a key component of empowering yourself. Since certain social situations and groups of people may increase the urge to use substances, this may include changing where you hang out and who you hang out with. Seek out and spend time with supportive friends and loved ones only.

Resources and help for substance use disorder 

There are many resources available to help connect you with substance use treatment, including:


Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.

Office of Disease Prevention and Health Promotion: Addiction.

U.S. Department of Veterans Affairs: Substance Use.

Jahan AR, Burgess DM. Substance Use Disorder. StatPearls. 2023 January. 

American Psychiatric Association: What Is a Substance Use Disorder?

Addiction Policy Forum: Types of Substance Use Disorders.

Substance Abuse and Mental Health Services Administration (SAMHSA): Mental Health and Substance Use Co-Occurring Disorders.

National Institute of Mental Health: Substance Use and Co-Occurring Mental Disorders.

The National Library of Medicine: Substance use disorder.

Centers for Disease Control and Prevention: How Quit Smoking Medicines Work.

SAMHSA: Medications for Substance Use Disorders.

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