About Substance Misuse

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How to tell if substances are being misused

People use drugs and alcohol for many reasons. They may experiment or use just for fun, to relax, or to cope with emotions such as stress, depression, or anxiety. 

When drug or alcohol use changes from an occasional recreational activity and begins to cause problems in a person’s day-to-day life, this can constitute substance misuse.

What kinds of problems? At home, in school, at work, or in relationships with the people we love, misuse may lead to:

• Conflicts or stress in personal relationships
• Declining mental health, physical health, or wellness
• Difficulty meeting work and family responsibilities
• Legal troubles
• Uncontrolled debt

A medical professional can diagnose someone who misuses alcohol or other drugs with a substance use disorder. A substance use disorder (SUD) is a treatable mental health condition. 

Whether you’re worried about a friend or family member or concerned about yourself, recognizing the signs of a drug or alcohol problem is an important first step toward recovery.

Substance misuse and the brain: Why our bodies can make it hard to quit

Some people think substance misuse is about a lack of willpower — that someone with a drinking or drug problem simply doesn’t want to get better and could easily quit if they really tried. That couldn’t be further from the truth. Substance use disorders are far more complex and less forgiving than many people realize. They create a stronghold on our brains in several ways:

• Creating intense craving — for reward. When drugs and alcohol are consumed, they flood the brain’s reward system with chemicals that bring the body an immediate sense of satisfaction. The brain makes a memory of the experience and can cause the body to crave it.
• Creating intense craving — for relief. Over time, the pleasure and reward from substances tend to weaken, but the sense that substances are needed for relief becomes stronger. This can be relief from stress, anxiety, or substance withdrawal, often leading to the experience of using not so much to get high but rather to get “normal.”
• Confusing pleasure with need. Continued use of drugs or alcohol can cause parts of the brain that control planning and completing tasks to mix up liking or wanting it with needing it. So the brain starts to group substance use with the things we do to survive, such as eating.
• Automating unwanted behavior. After prolonged substance use, the body eventually stops associating the drug or alcohol with pleasure. Yet the desired effect of the substance is still ingrained in the brain’s memory bank as something the body wants. The pursuit of the substance has now become automated and therefore harder to break.
• Impairing thinking. Over time, substances degrade cognitive processes, especially the higher-order “executive function” in an area of the brain called the prefrontal cortex. This part of the brain controls planning for the future, weighing risks, restraining impulses, and regulating emotions. Diminished executive function makes it harder to resist temptation. A person with a brain that is more impulsive and disinhibited can become like a speeding car without brakes.

Recognizing the root of misuse

We know that trying drugs or drinking alcohol won’t necessarily lead to misuse, but when it does, there are usually reasons that range from seeking pleasure or coping with pain, to genetics and social surroundings.

While pleasure is a fairly easy concept to understand, pain is more complex. It comes in many forms and affects everyone differently. Whether someone is suffering from a physical injury, dealing with a mental health issue, recovering from a traumatic experience, or just trying to cope with the stresses of daily life, sometimes drugs and alcohol can seem like the easiest way to drown out the pain. But relying on substances to get through tough times offers only temporary relief and often causes additional pain for both users and their loved ones.

Some individuals have a higher risk due to their family background or their surroundings. Recognizing these vulnerabilities is not an easy task, and removing yourself from certain situations isn't always possible, but there are resources available to help. 

It’s important to understand that, whether misuse of drugs or alcohol is caused by seeking pleasure, masking pain, or your surroundings and living situation, there are many ways to help overcome it, including therapy, medication, mindfulness, exercise, and other forms of treatment.

Things you should know about substance misuse

FACT 1: Your brain makes it harder to quit. Anyone who says ending a substance use disorder is easy is very mistaken. Long-term use of drugs or alcohol changes how the brain communicates with the body. Eventually, the brain begins to convince the body that it needs the substance to continue or produce pleasure or happiness — making it extremely difficult to quit through willpower alone.

FACT 2: Substance use disorders are an illness, not a life sentence. Recovery is always possible. Substance use disorders can be treated through various forms of therapy including counseling, medication, mindfulness, and exercise.

FACT 3: You don’t have to wait until you hit rock bottom to get help. There is no magic formula for treating a substance use disorder, but the earlier someone can begin the recovery process the better. Substance use disorders only grow stronger with time.

FACT 4: The risk of developing a substance use disorder to alcohol or drugs varies from person to person. Risk factors such as genetics, mental and physical health, and your environment as a child and in adulthood can increase your vulnerability to misuse and your ability to overcome it. 

FACT 5: Recovery is a journey, not a destination. Recovery is a lifelong process that has its challenges. Relapsing is part of the recovery process and doesn’t mean you failed. It means you may need to adjust your approach to treatment, the people you surround yourself with, or even your physical environment. If a relapse occurs, the best thing you can do is stay positive and move forward, taking steps to get back to a healthy place.

FACT 6: The terms “addict,” “addiction,” “alcoholic,” and “alcoholism” are falling out of favor. It has taken centuries of study to understand the complexities of substance misuse. As a result, the conversations and classifications around substance misuse continue to evolve. People who have issues with addiction are now widely referred to as having a substance use disorder, as opposed to being considered an “addict” or “alcoholic” or having issues with “alcoholism” — terms that have been discredited by many researchers and clinicians alike.

Why me? Why them? Risk factors that increase the chances of substance misuse

Some people are at greater risk of addiction than others because of the following factors:

• Genetics and family history of alcohol and/or drug misuse
• Mental health issues such as depression or PTSD
• Physical disabilities or chronic pain
• Traumatic experiences in childhood or adulthood
• Early use of drugs or alcohol 

Sources: 

Centers for Disease Control and Prevention (CDC)

National Institute on Drug Abuse (NIDA)

Substance Abuse and Mental Health Services Administration (SAMHSA) 

U.S. Department of Health & Human Services (HHS)