Substance Use Disorders

Substance use disorder is a medical condition, not a moral failing. It changes the brain in ways that make quitting difficult, even when you want to. But recovery is possible, and millions of people are living proof.

Understanding

Substance use disorder is characterized by an inability to control use of a substance (drugs or alcohol) despite harmful consequences. It ranges from mild to severe and can develop with legal or illegal substances.

About 46.8 million people in the U.S. had a substance use disorder in 2022. It affects all ages, genders, races, and economic backgrounds. Substance use often begins in adolescence or young adulthood.

Signs & Symptoms

Recognizing symptoms is the first step toward getting help. Not everyone experiences all symptoms.

Behavioral Signs

  • Unable to control or reduce substance use despite trying
  • Spending significant time obtaining, using, or recovering from substances
  • Continuing use despite knowing it causes problems
  • Giving up important activities because of substance use
  • Using substances in dangerous situations
  • Failing to fulfill work, school, or home responsibilities
  • Relationship problems caused by substance use

Physical Signs

  • Developing tolerance (needing more to get the same effect)
  • Experiencing withdrawal symptoms when stopping
  • Changes in appetite or sleep patterns
  • Unexplained weight loss or gain
  • Declining physical appearance
  • Unusual smells, tremors, or slurred speech

Psychological Signs

  • Strong cravings or urges to use
  • Using more or for longer than intended
  • Unsuccessful efforts to cut down or control use
  • Denial about the extent of the problem
  • Mood swings or personality changes
  • Loss of motivation

Causes

Addiction is complex, resulting from multiple interacting factors:

  • Genetics account for about half of addiction risk
  • Early exposure to substances increases risk
  • Childhood trauma, abuse, or neglect
  • Mental health conditions like depression or anxiety
  • Environmental factors (peer pressure, easy access, family attitudes)
  • Age of first use—earlier use increases risk
  • How the drug is used (smoking or injecting increases addiction potential)
  • Stress and lack of healthy coping mechanisms

Treatment Options

Effective treatments are available. Many people benefit from a combination of approaches.

Detoxification

Medically supervised withdrawal helps you safely stop using substances. Medications can ease withdrawal symptoms and reduce cravings.

Medication-Assisted Treatment (MAT)

Medications like buprenorphine, methadone, or naltrexone help manage cravings and withdrawal for opioid use disorder. Other medications help with alcohol dependence.

Cognitive Behavioral Therapy (CBT)

Helps identify triggers, develop coping strategies, and change thinking patterns that contribute to substance use.

Motivational Enhancement Therapy

Strengthens personal motivation to change and creates a plan for recovery.

Support Groups

12-step programs like AA or NA, SMART Recovery, and other peer support groups provide community and accountability.

Residential Treatment

Intensive programs provide 24/7 care in a substance-free environment for severe addiction or when outpatient treatment hasn't worked.

Living With Substance Use Disorders

These strategies can help you manage symptoms and improve your quality of life.

Building a Recovery Foundation

Early recovery requires significant lifestyle changes:

  • Avoid people, places, and things associated with substance use
  • Build a support network of people in recovery
  • Develop new, healthy routines and activities
  • Address co-occurring mental health conditions
  • Find purpose and meaning beyond substance use
  • Be patient—recovery is a process, not an event

Managing Cravings and Triggers

Cravings are normal and can be managed without using:

  • Identify your personal triggers (stress, emotions, places)
  • Develop a craving management plan
  • Use distraction techniques (call someone, exercise, change environments)
  • Practice urge surfing—observe the craving without acting on it
  • Remember that cravings pass, usually within 20-30 minutes
  • Keep emergency contacts readily available

Preventing Relapse

Most people relapse at least once. Having a plan helps you get back on track quickly:

  • Attend support groups regularly
  • Work with a sponsor or mentor
  • Continue therapy even when feeling stable
  • Address stress and negative emotions quickly
  • Recognize early warning signs (romanticizing past use, isolating)
  • If you do relapse, reach out for help immediately—it's not failure

How to Support Someone

Supporting someone with substance use disorder is challenging. Your care matters, but remember you can't control their recovery.

What helps

  • Learn about addiction as a brain disease
  • Encourage treatment without forcing it
  • Set clear, healthy boundaries
  • Support their recovery efforts
  • Celebrate milestones, no matter how small
  • Take care of your own physical and mental health
  • Consider Al-Anon or Nar-Anon for families
  • Be patient—recovery takes time and often includes setbacks

What to avoid

  • Don't enable use by making excuses or bailing them out
  • Don't try to control their recovery
  • Don't take their addiction personally
  • Don't expect them to recover according to your timeline
  • Don't give up if they relapse
  • Don't ignore the impact on your own well-being

Conversation starters

"I'm concerned about your substance use. Can we talk?"

"I love you and I'm worried. How can I support you?"

"I've noticed changes that concern me. Are you okay?"

"I'm here if you want to talk about getting help."

Statistics & Facts

46.8 million

people in the U.S. had a substance use disorder in 2022

Only 10.6%

received treatment in the past year

106,000+

drug overdose deaths occurred in 2021

40-60%

is the relapse rate for substance use disorders, similar to other chronic diseases

You're not alone

Recovery is possible with the right support and treatment. If you're struggling, please reach out to a mental health professional or call 988 for immediate support.

This information is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment.