Substance Use Disorder: Addiction Explained
Substance use disorder, more commonly known as addiction, affects millions of people worldwide. Over 90% of people in the United States regularly use at least one psychoactive substance. While many can do so without negative consequences, a significant portion develops problems related to their substance use. Let's take a closer look at addiction, its diagnosis, treatment, and impact across the lifespan.
The Three Reapers of Addiction
Addiction can be recognized by a specific pattern of behavior involving three key components, which we'll call the "Three Reapers":
- Repeated use of positive reinforcers
- Negative repercussions of substance use
- Inability to stop despite negative consequences
It's important to distinguish addiction from compulsion. Compulsions involve repeatedly engaging in a behavior to avoid negative feelings, while addictions involve seeking positive reinforcement despite negative consequences.
Diagnosing Substance Use Disorder
- Treatment history
- Route of administration
- Amount used
- Pattern of use
- Prior abstinence
- Effects of use (positive and negative)
- Duration of use
- Cannabis
- Alcohol
- Nicotine
- Hallucinogens
- Inhalants
- Stimulants
- Depressants
- Opioids
- Gambling and other behavioral addictions
The DSM-5 lists 11 criteria for diagnosing substance use disorders, which can be remembered with the mnemonic "TIME TO CUT DOWN PAL." To gather a complete substance use history, use the "TRAPPED" mnemonic:
The major classes of addictive substances can be remembered with "CAN HIS DOG BEHAVE":
Addiction Across the Lifespan
Addiction is one of the most common psychiatric conditions, with a lifetime prevalence of around 10% in the U.S. Most addictions begin in adolescence or early adulthood, but can continue into later life. Men and women appear equally vulnerable, but men are treated more often, likely due to using illegal substances more frequently.
Dual diagnosis, the presence of both an addiction and mental disorder, is common and worsens prognosis. Screening for addictive behaviors is crucial for all patients with mental health concerns.
Treating Substance Use Disorder
Treatment for addiction involves detoxification (stopping use) followed by rehabilitation (maintaining sobriety). Individual and group therapy can teach skills to reduce cravings and impulsivity. For some substances, medications can help by preventing withdrawal, reducing cravings, or blocking the drug's effects.
Motivational interviewing is an effective counseling technique that matches interventions to the patient's stage of change, increasing motivation for treatment. Social support is one of the most important predictors of successful recovery, highlighting that the opposite of addiction is connection and community.
FAQ (Frequently Asked Questions)
What percentage of people with mental disorders will have a substance use disorder?
Up to 50% of people with a mental disorder will meet lifetime criteria for a substance use disorder, and vice versa. This high rate of comorbidity emphasizes the importance of screening for addictive behaviors in mental health patients.
Are some substances more addictive than others?
Yes, substances differ significantly in their addictive potential. For example, less than 10% of cannabis users become dependent, compared to 15% for cocaine, 25% for heroin, and over 65% for nicotine. The inherent addictiveness of a substance also impacts how difficult it is to quit.
What role does social support play in addiction recovery?
Social support is one of the most important predictors of successful addiction treatment. Engaging in meaningful work, hobbies, and social activities can help prevent the boredom and emptiness that often lead to relapse. Connection and community are powerful antidotes to addiction.