Understanding Substance Use Disorder

1. Understanding
Addiction
Substance Use Disorder

2. Lesson #1
In this Training we will address:
Where Addiction starts, and the effects of the major categories of substances.
• Substance use occurs along a continuum from not using (abstinence) to a substance
use disorder.
• A substance use disorder is a chronic, relapsing brain disease.
• Substance use disorders are treatable public health concerns, and recovery is possible.
Objectives
By the end of the lesson you will be able to:
• Identify the main reasons people start using substances.
• Recognize the effects of the most common categories of drugs.
• Describe how substance use disorders (SUDs) are treated differently from other
chronic diseases.
• Distinguish person/people-first language from problem-first language.

3. Commonly
Used
Substances
Which substances are most commonly used and what are their effects? Two
useful resources include the Drugs of Abuse page (NIH) and the Alcohol,
Tobacco, and Other Drugs page (SAMHSA). Grouping substances into general
categories makes it easier to talk about and compare them. Substances are
typically grouped depending on their Effect and Active Ingredient.
Most Commonly
Used Substances
Alcohol
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives, hypnotics, or anxiolytics
Stimulants
Tobacco
Substance Categories

4. Commonly
Used
Substances
We are usually familiar with the pleasurable effects of substances, such as
euphoria, relaxation, or increased alertness. But these are not the only
affects the substances have on our bodies. What other effects do they
have?
For a more complete listing of substances, street names, and effects,
select Commonly Abused Drugs Chart or Commonly Abused Rx
Drugs (downloadable NIDA charts).
Understanding a person's substance use requires knowing not only what
the person uses but also how he or she uses substances. A person's use
falls along a continuum ranging from no use (abstinence), through low-risk
use, risky use, harmful use, to the chronic, relapsing brain disease known
as a severe Substance Use Disorder (SUD).

5. Substance
Use
Disorders
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5) no longer uses the terms "substance abuse" and
"substance dependence." Rather, it refers to substance use disorders,
which are defined as mild, moderate, or severe. The level of severity is
determined by the number of diagnostic criteria met by an individual.
• The most common substance use disorders in the United States include:
• Alcohol Use Disorder (AUD)
• Tobacco Use Disorder
• Cannabis Use Disorder
• Stimulant Use Disorder
• Hallucinogen Use Disorder
• Opioid Use Disorder
Source: SAMHSA http://www.samhsa.gov/disorders/substance-use

6. A chronic disease
•A substance use disorder (SUD) is a chronic
brain disease, and like other chronic
diseases it involves:
•Periods of recovery/remission
•Periods of relapse
•Medication and behavior change needed
to manage and treat the disease
•Yet currently, SUDs are often viewed and
treated very differently from other chronic
diseases like diabetes and hypertension.

7. Stigma and Discrimination
Among the reasons SUDs are treated differently from
other chronic diseases are that stigma and
discrimination have been attached to SUDs.
Stigma: a mark of disgrace associated with a
particular circumstance, quality, or person
(Synonyms: shame, disgrace, dishonor, humiliation,
bad reputation)
Discrimination: the unjust or prejudicial treatment of
different categories of people or things, especially on
the grounds of race, age, or sex (Synonyms:
prejudice, bias, bigotry, intolerance, unfairness,
inequity)

8. Stigma and Discrimination
No one brings dinner….
A father explained that his friends, family, and
community offered help and brought dinner when his
wife had cancer and when his daughter was in an
accident. Then he discovered that "no one brings
dinner when your daughter is an addict." Why?
Healthcare education
This differentiation between substance use disorders
and other chronic diseases can also influence how
healthcare providers are educated. In your
professional education, how often have you had a
course, a unit, or even a lesson on substance use
disorders? Why do we view and react to SUDs
differently than, say, diabetes?

9. Explaining Addiction
Diseases such as diabetes, cancer, heart disease, and addiction
similarly follow a pattern of remission and relapse. These can
be managed and treated, but not necessarily cured.
Changes in the brain make addiction more difficult to cope with
as a physical dependency is formed. The ability to make rational
decisions is destroyed by the loss of behavior control.
Willpower just isn’t strong enough for a person to stop using a
substance for good on their own. When explaining addiction to
a non-addict, it’s essential to understand that addicts’ brains
are different, as changes in neurons and circuits do compromise
health and decision-making.

10. Explaining Addiction
Psychological issues can make a person susceptible to addiction,
but can also occur after the addiction begins. Severe mental
illnesses can make a person one-half times more likely to go
through substance abuse. Mood disorders, panic/anxiety
disorders, and personality disorders all have a considerable
amount of susceptibility to addiction.
Diseases of this criteria include bipolar disorder, general anxiety
disorder, schizophrenia, and depression. People suffering from
anxiety and mood disorders are two times more likely to develop
an addiction. Some people find it difficult to learn how to explain
an addiction because they may hide information on their mental
health status.

11. Explaining Addiction
According to the National Alliance on Mental Illness, those with
schizophrenia are actually four times more likely to develop an
addiction issue, and bipolar disorders are more than five times.
Working in reverse, people who have suffered from addiction are
likely to have a mental illness.
Among alcoholics, mental illnesses play a key role. Anxiety and
PTSD are classified as the most diagnosed illnesses among
alcoholics. Connecting both addiction and mental illnesses is
called dual diagnosis. The treatments for dual diagnosis often
address the problems associated with both problem areas.
Treatment centers that treat coinciding issues tend to have the
best results in life management and sobriety.
Mental illnesses and addiction both can be classified as diseases.
Addiction cannot be cured, but adequately managed with the
appropriate treatment. Mental illnesses are not all diseases,
although some have the same criteria when it comes to
management and coping vs. curing.

12. Does Environment Play a Role?
A person’s regular environment revolves around friends,
family, lifestyle activities, and economic status. With these
factors, an environment could also include peer pressure,
potential abuse, stress, and exposure to drug.
For every addiction, different factors take a part of why it
was initially started. Other than the environment, a
person’s genetic makeup can also present a mental
disorder. This is especially difficult to understand because
unless you’re pre-diagnosed, the addiction is not
necessarily foreseen. There are also stages in an individual’s
life that also affect a person’s risk for addiction.
Teens are in a dangerous and vulnerable time of their lives
where drug use is deemed trendy, and their brain’s are still
in development.

13. Historical
Responses
Think of how the problems of chronic illnesses such as diabetes or heart
disease are typically discussed and addressed. Is the emphasis on science
or on stigma? Compare this with how we have dealt with substance use
disorders. Historically we have addressed them as:
A social problem
During the late 1800s and early 1900s, the Anti-Saloon League lobbied to
prohibit consumption of alcohol, which was blamed for many social ills.
These efforts led to passage of the 18th Amendment (Prohibition) in
1920.
A moral problem
Ever see the 1930s anti-drug film Reefer Madness? This
exaggerated exploitation film on the use of marijuana "reefer"
cigarettes shows innocent teenagers being lured by evil drug dealers into a
world of wild jazz parties, crime, and tragedy.
A personal responsibility problem
In the 1980s, federal prevention and education programs such as the "Just
Say No" to drugs campaign focused on personal responsibility as the
means of resisting pressure to use substances.
A criminal justice problem
In the 1980s and 1990s, public service ads urged citizens to help reduce
crime. "Users are losers" according to the highly popular icon McGruff the
Crime Dog.

14. Science NOT Stigma
Stigma can be a powerful obstacle to our ability to recognize, understand, and effectively
address problematic substance use and substance use disorders in ourselves and in
others.
Science is the best way to dispel misinformation and stigma. You can read more
about How Science Has Revolutionized the Understanding of Drug Addiction. Our goal is
to provide you with accurate, science-based information and resources about substance
use and substance use disorders.

15. People-Centered Language
Because the very language we use can contribute to perpetuating stigma and discrimination, healthcare professions are
working to replace stigmatizing, problem-first language with people-first language.
Example of People-First v. Problem-First:
An Individual who uses Substances v. Drug Abuser
A person with an Addiction or Substance Use Disorder v. Addict
A person who tested positive for Opiates v. A person with Dirty Urine
To learn more and explore additional resources, click Person-First Language.

16. People-First Language
Because the very language we use can contribute to perpetuating stigma and discrimination,
healthcare professions are working to replace stigmatizing, problem-first language with people-first
language.
To learn more and explore additional resources, select Person-First Language.