Also commonly referred to as a Drug Addiction, substance use disorders are typically evidenced when there is a significant impact on health (be it physically or mentally), work, school, family or relationships.
Substances can include but are not limited to:
- Opioids such as heroin, oxycodone, fentanyl and codeine
- Marijuana, including synthetic cannabinoids such as spice
- Stimulants such as amphetamine, methamphetamine and MDMA (ecstasy)
- Sedatives such as painkillers and sleeping pills, including ketamine
- Inhalants such as nitrous oxide or butane
- Hallucinogens such as Lysergic acid diethylamide (LSD)
Substance use disorder is constantly evolving, with users finding new ways to circumvent local laws, and new ways to get ‘high’. Therefore, it is important to consider all mood- and mind-altering chemicals as substances that can potentially lead to a drug addiction.
Reward-seeking behaviour and coping with one’s emotional state through the use of substances can become pathological in nature.
An individual may end up with the inability to consistently abstain, as well as the inability to recognise the problems that accrue as a result of the usage. There would also be an impairment in behavioral control, experiencing cravings and the urge to continue substance abuse. As the disorder progresses, the individual will enter a stage of denial. This means that he/she will start rationalising and trying to justify his/her use to themselves and others. There would often be cycles of relapse and remission as well.
People with substance use disorder use substances to the point of compulsivity and often continue despite harmful consequences.
- Impaired control – taking larger amounts for longer than anticipated
- Becoming increasingly obsessed with when you are next going to use your substance of choice
- Unsuccessful attempts to cut down or limit usage
- More time spent on usage
- Social impairment – not fulfilling obligations at school, work or home
- Social and interpersonal problems
- Reduced or ceased social, occupational and recreational activities
- Increasingly hazardous use
- Continuation despite negative physical or psychological consequences
- Increased tolerance
- Signs of withdrawal
The effects and withdrawals may differ for each type of substance. These can take the form of physical, psychological, emotional, social and spiritual effects.
|Bad skin||Increased anxiety, depression||Increased emotional volatility||Isolation||Lack of meaning|
|Weight loss/gain||Increased suicidal ideation||Inability to manage emotions||Secrecy||Lack of purpose|
|Poor diet / Disordered eating||Paranoia||Dishonesty||Lack of inspiration|
|Sleeplessness / Over-sleeping||Withdrawal from loved ones||Manipulation|
As with other forms of addiction, it involves complex interactions among genetics, our biological neural network, the environment and one’s life experiences. This may also include a history of developmental trauma.
Some signs you can look out for include:
- Furtiveness or an instinctual sense that you are being lied to
- Compromised personal hygiene or lack of interest in personal grooming
- Drastic changes in day-to-day routines
- Appearing increasingly irritable, restless and discontent (i.e unusual mood changes)
- Changes in their sleep patterns, with increasing sleep disruptions and insomnia
Substance Use Disorder is a treatable condition. Treatment approaches for addiction are generally as successful as those for other chronic diseases (American Society of Addiction Medicine, 2019).
The intake assessment will be conducted by a certified addiction therapist or psychologist. They will start off by conducting a full biological, psychological and social assessment, after which they will proceed to provide the best clinical recommendation for treatment.
Treatment may include an inpatient detoxification depending on the severity of the addiction, or include an outpatient medical management with a home detoxification. Seeing a therapist on an outpatient basis will – in most cases – be recommended, which may include intensive outpatient groups for a period of time, with the potential to step down into a continuing care group.
The overall treatment plan would typically include:
- Relapse prevention work
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Acceptance and Commitment Therapy (ACT)
- Motivational Interviewing (depending on the client’s presentation)
- Identification of comorbidities and appropriate referrals to medical professionals.