Understanding susbstance 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.