Substance use disorder (SUD) is a complex condition involving the uncontrolled use of a substance, despite harmful consequences. Learn more about substance use disorders including the symptoms, and how they can be managed and treated.
A substance use disorder (SUD) occurs when someone loses the ability to control their use of a substance such as drugs, medication, alcohol or tobacco, causing harm to themselves or others. These substances activate the brain’s reward system, producing pleasurable feelings, which can lead to intense cravings. A substance use disorder can result in a person being unable to function normally day-to-day.
Substance use disorders are diagnosed based on the primary substance being misused. There are two main types of substance use disorder:
Alcohol consumption is responsible for three million deaths each year globally, according to the World Health Organization. Overall, alcohol use disorders are responsible for 5.1% of the global burden of disease. Alcohol is the main risk factor for premature mortality and disability among people aged 15-49, accounting for 10% of all deaths in this age group.
The World Health Organization reports that about 270 million people (or about 5.5% of the global population aged 15-64) used psychoactive drugs in the previous year and about 35 million people are estimated to have drug use disorders. It is estimated that about half a million deaths every year are due to drug use, equating to 350,000 male deaths and 150,000 female deaths.
The symptoms of substance use disorders vary from person to person and can also depend on the type of addiction.
There are several signs and symptoms of substance use disorder that are common to most types of addiction. These include:
Behavioural and social changes:
It is important to spot the early warning signs of a substance use disorder in order to get help as soon as possible.
Alcohol abuse early signs may include:
Drug abuse early signs may include:
Like many mental health conditions, there are several factors that may lead to substance use disorders.
The exact cause of substance use disorders is not known. Instead, there may be many factors involved, including:
People of any age, sex, background or economic status can become addicted to alcohol or drugs, although it is more common in people exposed to environmental, mental health or genetic risk factors.
Although people can live with a substance use disorder, it is known to be a risk factor for premature death. These deaths can be caused by diseases and injury, including suicide, liver disease, hepatitis, cancer and HIV brought on as a result of excessive substance use.
Globally, illicit drug use is responsible for over 585,000 premature indirect and direct deaths each year and 42% of all deaths are in people younger than 50 years.
It is estimated that 2.84 million people die prematurely around the world every year as a result of alcohol consumption. Europe has the highest proportion in the world of total ill health and premature death due to alcohol and in Eastern Europe nearly one-third of deaths are attributed to alcohol consumption.4
Globally, almost three quarters of those dying from premature deaths due to alcohol are younger than 70 years and 28% are younger than 50 years.
Substance use disorders are usually diagnosed through a doctor’s evaluation, but some people will also self-report their problem if they are looking for help.
Substance use disorder is diagnosed with a thorough evaluation, which usually includes an assessment by a mental health professional. Substance use can be checked using blood or urine testing, but the outcomes of these tests are not an indication of addiction.
There are a variety of questionnaires that mental health professionals can use to undertake their clinical evaluation to assess problematic alcohol and substance use.
These include the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) developed for the World Health Organization to assist with early identification of substance use disorders, the Alcohol Use Disorders Identification Test (AUDIT) to identify the early signs of harmful drinking and mild dependence, the Drug Use Disorders Identification Test for self-administered screening for drug-related problems, and the CRAFFT Screening Test designed to assess substance-related risks in adolescents.
Treatment and medication for substance use disorders can be used to help people withdraw from the substance they are addicted to and help to prevent relapse.
Treatment for substance use disorder depends on personal circumstances and what substances someone is addicted to. A treatment plan may include a number of different treatments and strategies.
For substance use disorders, the main goal of prevention is to delay the first use of drugs or alcohol during adolescence.
It is important to address multiple risk factors which can be common in many areas of adolescent life, such as peer pressure, as well as focus on increasing protective factors, such as school support, to help young people resist the temptation to try drugs or alcohol.
Prevention interventions are also necessary to prevent people who already use some drugs from moving onto other drugs, and to prevent people who use drugs on an occasional basis from using them excessively.
The international classification of prevention interventions used in the United Nations Office on Drugs and Crime standards includes the following prevention strategies:
Targeting each population group with relevant resources and messages can help prevent substance use and associated problems from starting or escalating.
Research into substance use continues to progress in a number of key areas including evidence-based treatment practices, addiction treatment outcomes, addiction, psychiatry and the brain, addictive substances such as prescription opioids and heroin, and substance abuse in adolescents and other groups, as well as recovery management looking at how earlier detection and re-intervention can improve long-term outcomes.
Researchers are also looking at personalising treatment of substance use disorders, while noting that for meaningful recovery to occur, a substance user will need to integrate into a socially meaningful environment. With the understanding that addiction is influenced by genes, development, and social factors, treatment could in the future be personalised to accommodate each individual’s situation.