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This topic is about substance use disorder in adults. For information about drug use in teens or children, see the topic Teen Alcohol and Drug Use.
Substance use disorder is using drugs in a way that harms you or that leads you to harm others. It can range from mild to severe. Moderate to severe substance use disorder is sometimes called addiction.
This disorder can develop from the use of almost any type of substance. This includes alcohol, illegal drugs, prescription drugs, or over-the-counter drugs.
When you have substance use disorder, you are not always able to meet work, home, or school duties. You may be late to work. You may use drugs in dangerous situations, such as when driving or operating machines. Or drugs may cause problems in your relationships.
People who have it find it hard to control substance use. Any of the following can happen:
Substance use disorder is a disease. It's not a weakness or a lack of willpower. It's your choice to begin using a drug. But as you use it more, your brain begins to change. This change can lead to a craving to use the drug, and this can influence how you act.
Drugs that may lead to substance use disorder include:
Behaviors that may be signs of substance use include:
Having these signs doesn't always mean a person is using drugs. The behavior could be because of work or school stress, or it could be a sign of depression or another medical problem. But behavior changes like these are common in people who use drugs.
Physical signs of drug use include:
Substance use disorder may be diagnosed at a routine doctor visit or when you see your doctor for a health or social problem linked to drug use, such as anxiety, depression, or family conflict. If a partner or friend thinks you have substance use disorder, he or she may urge you to see your doctor.
Your doctor will ask questions about your symptoms and past health. He or she will do a physical exam and sometimes a mental health assessment.
Treatment includes medicine, therapy, and support groups.
The first step in treatment is to quit using drugs. You may need medical care to manage withdrawal symptoms when you first quit. Some people call this detoxification, or detox.
After you stop using drugs, you focus on staying drug-free. Most people receive some type of therapy, such as group counseling. You also may need medicine to help you stay drug-free.
When you have stopped using drugs, you have taken the first step toward recovery. To gain full recovery, you need to take steps to improve other areas of your life, such as learning to deal with your work, family, and living situation in healthy ways. This makes it easier to stay drug-free.
If you are worried about your substance use, get help. You can visit a doctor or go to a self-help group. The earlier you get help, the easier your recovery will be for you and your family.
Helping someone who has substance use disorder is hard. If you are "covering" for the person, you need to stop. For example, don't make excuses for the person when he or she misses work.
You may be able to help by talking to the person about what his or her drug use does to you and others. Talk to the person in private, when he or she isn't using drugs or alcohol and when you are both calm. If the person agrees to get help, call for an appointment right away. Don't wait.
Most of the time, substance use disorder starts with the occasional use of a drug. People don't use drugs because they want to develop a substance use disorder. Drugs can make you feel good for a while. They may make you feel energetic, self-confident, and powerful. You may take a drug to reduce stress or anxiety or to help you forget a problem.
Drug use changes your brain and how it works. If you continue to use drugs, you may develop strong cravings for them, and it may get harder to say "no" to further use. At the same time, you may begin to lose interest in activities you always enjoyed. This is because you may feel that they are not as enjoyable as using drugs.
Not everyone who uses drugs develops substance use disorder. Other things that influence whether this happens include your genes, family, friends, and life situations. For more information, see What Happens and What Increases Your Risk.
You may have substance use disorder if two or more of the following are true. The more signs of this disorder you have, the more severe it may be.
People with substance use disorder are more likely to have changes in their behavior than to have physical symptoms.
These signs don't always mean a person is using drugs. The behavior could be because of work or school stress, or it could be a sign of depression or another medical problem. But behavior changes like these are common in people who use drugs.
Substance use disorders in older adults may be harder to notice. Older adults often take more medicines, such as sleep medicines and painkillers, that can lead to substance use disorder.
When you are physically dependent on a drug and you use less or stop using it, you may have physical symptoms known as withdrawal. These symptoms differ for each drug. They can include feeling sick to your stomach, vomiting, having belly pain, sweats, nervousness and shaking, and seizures.
You may not feel that using drugs is a problem. Maybe you feel this way because you use drugs only now and then. Or you may feel that you can stop using drugs at any time.
But drug use quickly can become a habit, and for many people it may lead to a substance use disorder. You may begin to use drugs without thinking about how drugs can harm you and those you care about.
Drugs can cause you to have health problems, such as:
Drugs also can lead to problems with thinking and remembering. They can affect judgment, decision-making, emotions, and learning.
Different drugs harm your body in different ways. Drugs that can cause harm include:
You are more likely to have unsafe sex when on drugs, and you may get and spread sexually transmitted infections (STIs).
If you're pregnant, drugs can pass into your uterus and harm your baby.
Drug use also can lead to problems with your partner, family, or friends. You and your family may feel that you have turned against each other. You may be angry at them, and they may be angry at you. You may do poorly at work or in school, or you may even quit. You also can have legal problems, like being arrested for driving while on drugs or for using or selling drugs.
Not everyone who uses a drug develops substance use disorder. Certain things make this disorder more likely. These are called risk factors.
Call 911 or other emergency services right away if you or someone else:
Call your doctor if:
Health professionals who can diagnose, prescribe medicine for, and treat substance use disorder include:
Counseling usually is part of treatment. This can be done by:
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.
Watchful waiting is not a good choice for substance use disorder. If you have this disorder, or if you believe that your health or other areas of your life are being affected by drugs, you need to take steps to stop using drugs.
Substance use disorder may be diagnosed during a routine doctor visit or when you see your doctor for a health or other problem linked to drug use, such as anxiety, depression, or family conflict. If your partner or a friend is worried about your drug use, he or she may urge you to see your doctor.
Your doctor will ask you questions about your symptoms and past health and will do a physical exam. If your doctor thinks you have substance use disorder, he or she may ask about current and past drug use. He or she also may ask if it's okay to give you a test to check for drug use, such as a urine or blood test.
Your doctor may ask to give you tests to look for health problems related to drug use. These may include tests for hepatitis B, hepatitis C, or HIV.
If you and your doctor agree that you have substance use disorder, your doctor probably will refer you to a specialist.
People who use drugs also may have mental health problems. These include depression, anxiety disorders, or post-traumatic stress disorder (PTSD). If your doctor thinks this may be true for you, he or she may do a mental health assessment.
If you use drugs and have a mental health problem, it's called a dual diagnosis. If you treat only one problem, treatment may not work well. When you treat both problems, you have a better chance of a full recovery and less chance of using drugs again.
Treatment for substance use disorder usually includes group therapy, one or more types of counseling, and drug education. A 12-step program is often part of treatment and continues afterward as part of your recovery.
Treatment doesn't just deal with drugs. It helps you take control of your life so you don't have to depend on drugs. You'll learn good reasons to quit drugs. Staying drug-free is a lifelong process that takes commitment and effort.
You might start with your family doctor, or your doctor may recommend that you enter a treatment facility. A friend could bring you to a self-help group, such as Narcotics Anonymous, or you might walk into a clinic that deals with drug use.
You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.
You may be asked questions about your drug use, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your team may write a plan, which includes your treatment goals and ways to reach those goals. This helps you stay on track.
Your doctor may decide you need medical care to manage withdrawal symptoms when you first quit using drugs. This is sometimes called detoxification, or detox.
People who are physically dependent on drugs often have to go to a hospital or treatment facility. Detox usually is done under the care of a doctor, because withdrawal can be dangerous without medical care. A doctor may prescribe medicines to help with withdrawal symptoms.
Treatment for substance use disorder usually involves one or more types of therapy.
Treatment usually includes going to a support group, such as going to Narcotics Anonymous (NA) meetings. Your family members might also want to attend a support group such as Nar-Anon.
You may take medicines to help you quit or to help you overcome withdrawal symptoms. Medicines often are used for physical dependence on opioid drugs like heroin or certain painkillers. Medicines that can help you include methadone (such as Dolophine) or naltrexone (such as ReVia).
Treatment programs can be outpatient, inpatient, or residential. They offer similar therapies. Your treatment team can help you decide which type of program is best for you.
Some treatment programs give rewards, called vouchers, when you stay off drugs. The rewards may get bigger when you go for a long time without drugs.
Many programs give regular drug tests while you go through treatment. Knowing that you will be tested can make you more likely to resist your cravings.
People with drug problems often have other problems. They may need other treatments, or other resources may be available to help them with the drug problem.
Your doctor may prescribe medicine during detoxification to ease withdrawal symptoms or during treatment to help control cravings and prevent relapse. These medicines are mainly used for physical dependence on heroin or other opioids.
Medicines that can help include:
Recovery from substance use disorder means finding a way to stay drug-free while changing your attitudes and behaviors. In recovery, you work to restore relationships with your family and friends and with people at your job or school.
To help stay drug-free after treatment, you can find things to do, such as sports or volunteer work. Stay away from friends or family members who use drugs. Learn how to say "no" to alcohol and drugs.
An important part of recovery is being sure you have support. You can:
Stopping drug use is very hard. It's normal to have setbacks, even years later. Very few people succeed the first time they try. A lapse or relapse is likely.
A lapse or relapse doesn't mean that you or your treatment has failed. It may mean that you just slipped up. You also may need more treatment, another type of treatment, or more time in support groups such as Narcotics Anonymous.
It's smart to plan for a relapse before it happens. Your doctor, family, and friends can help you do this.
Part of recovery is finding your way back to a healthy lifestyle.
If someone you care about has substance use disorder, you know how hard it can be. You know how living with or being close to someone who has problems with drug use can change your life. But family members and friends can play an important role in helping a loved one recover from substance use disorder.
It's hard to get someone who uses drugs into treatment if he or she doesn't want it. You may be able to help the person get treatment by:
After the choice for treatment has been made:
You probably will feel relief and happiness when the person decides to get help. But treatment and recovery mean changes in your life too. Your emotions may become more complicated. You may:
These feelings are common. You've been through a bad period of your life, and what happened isn't easy to forget. Nor is it easy to forgive the person. Keep in mind that recovery is the road to a better life and that you can help your loved one get there.
Find your own support. Nar-Anon and similar programs are for people with family members or friends who have substance use disorder. They help you recover from the effects of being around someone who has this disorder. You also may try family therapy.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2010). Results From the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (NSDUH Series H-38A, HHS Publication No. SMA 10-4586FINDINGS). Available online: http://store.samhsa.gov/product/Results-from-the-2009-National-Survey-on-Drug-Use-and-Health/SMA10-4586FINDINGS.
National Institute on Drug Abuse (2010). Drugs, Brains, and Behavior: The Science of Addiction (NIH Publication No. 10-5605). Available online: http://www.nida.nih.gov/scienceofaddiction/sciofaddiction.pdf.
Current as of:
August 22, 2019
Author: Healthwise StaffMedical Review: Adam Husney MD - Family MedicineE. Gregory Thompson MD - Internal MedicineKathleen Romito MD - Family MedicineMartin J. Gabica MD - Family MedicinePeter Monti PhD - Alcohol and AddictionChristine R. Maldonado PhD - Behavioral HealthHeather Quinn MD - Family Medicine
Current as of: August 22, 2019
Author: Healthwise Staff
Medical Review:Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Martin J. Gabica MD - Family Medicine & Peter Monti PhD - Alcohol and Addiction & Christine R. Maldonado PhD - Behavioral Health & Heather Quinn MD - Family Medicine
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