Addiction and substance misuse

What is substance use disorder?

Substance use disorder (SUD), once called drug addiction, is a mental health condition in which a pattern of substance use starts to harm your health, relationships, and daily life. Substances change how the brain's reward system works over time, which is part of what makes them so hard to stop, even when you want to. Common examples include alcohol, tobacco, cannabis, and opioids.

SUD exists on a spectrum from mild to severe, and the most severe end is what many people call addiction. It is different from casual or occasional use because it involves losing control over the substance despite clear harm. Alcohol use disorder is the most common type in the U.S., and it is common to have more than one at once.

The exact cause is not fully understood, but it involves changes to the brain's reward system, shaped by genetics, mental health, and environment. Developing a substance use disorder is not a moral failing or a simple lack of willpower.

What are the symptoms of substance use disorder?

Signs of substance use disorder vary by the substance and how severe the condition is. They tend to show up in a person's behavior around the substance and in how their body responds to it. The signs below are common ones to be aware of.

Behavioral signs show up in how substance use starts to take over.

• Using more of a substance, or for longer, than you intended
• Strong urges or cravings, and cutting-back attempts that do not stick
• Spending a lot of time getting, using, or recovering from the substance
• Neglecting responsibilities or giving up activities you once valued

Physical signs reflect how the body adapts to the substance.

• Needing more of the substance to feel the same effect (tolerance)
• Withdrawal symptoms, like nausea, sweating, or trouble sleeping, when it wears off
• Continuing to use despite a physical or mental health problem it worsens
• Changes in sleep, appetite, mood, or energy

A provider diagnoses SUD when a person shows at least two of these signs over a year, and having more of them points to a more severe disorder. Noticing even a few, in yourself or someone you love, is reason enough to reach out.

Who is at increased risk for substance use disorder?

The exact cause of substance use disorder is not well understood, and it develops through a mix of biology and circumstance. Changes to the brain's reward system, genetics, mental health, and access to substances all play a part. Knowing the common risk factors can help you make sense of your own experience, even though having them does not mean SUD will develop.

Biological factors

• A biological relative with a substance use disorder
• A genetic susceptibility that makes SUD more likely
• Having another mental health condition, like anxiety or depression

Life and environmental factors

• Adverse childhood experiences or trauma
• Easy access to or exposure to substances
• High stress or major life changes, like job loss or divorce

Anyone can develop a substance use disorder, at any age. Because so many factors are involved, these describe risk rather than certainty.

How is substance use disorder treated?

Substance use disorder is treatable, and recovery is possible, though it often takes time and ongoing support. Care usually begins with safely managing withdrawal, then continues with therapy, medication, and community support.

Withdrawal management is often the first step, letting the substance leave your body safely. Because withdrawal can be hard physically and mentally, a provider may use medication to ease symptoms during this stage.

Cognitive behavioral therapy (CBT) helps you spot the thoughts and situations that drive substance use and build healthier ways to cope. Other approaches, like motivational and family therapy, can help as well.

Medication can ease cravings and withdrawal for some substances. FDA-approved medications are available for opioid, alcohol, and tobacco use disorders, and they work best alongside therapy.

Support groups such as Narcotics Anonymous or Alcoholics Anonymous give many people the encouragement and accountability that strengthen long-term recovery.

Treatment is highly individual, and relapses can happen. A relapse is a normal part of the process rather than a failure, and a care team can adjust the plan over time.

When should you seek help?

If you are using a substance regularly and worry it is becoming something you cannot stop on your own, that is a good reason to talk to a provider. Reaching out early, before problems pile up, tends to make recovery smoother, and you do not need to have hit a low point to deserve help.

An overdose is a medical emergency; call 911 right away if someone has trouble breathing, cannot be woken, or loses consciousness. If you are struggling with thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline. Recovery is possible, and asking for help is a sign of strength. Whenever you feel ready, support will be there for you.