Substance Related Disorders

Drug abuse, in one form or another, has been an aspect of human life since prehistoric times, and countless millions have fallen victim to it over the ages. Today, millions more people struggle under the burden of addiction across the world, causing untold misery to themselves and their families and placing a huge strain on police, health and social services in every society on Earth.

What is Substance-Related Disorder?

Substance-related disorders include both substance use disorder – sometimes further sub-categorised into substance abuse and substance dependence – and substance-induced disorders.

This terminology is used within the medical, psychiatric, social welfare, law enforcement and other professions to describe conditions which are often better known within the wider community by other, less official-sounding names. Substance abuse is more commonly known as drug abuse (though it includes the abuse of alcohol – often not thought of as a drug by the layperson – and prescription medication); meanwhile, substance dependence is also known as drug dependence – which many people use interchangeably with drug addiction, though in fact, the two are distinct concepts.

A substance use disorder – or drug use disorder – is a medical condition featuring the use of one or more chemical substances in a manner which leads to “clinically significant impairment or distress” (as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, the leading diagnostic publication used worldwide focusing solely on mental health). Substance use disorders can be caused by the abuse of any of the huge variety of drugs, from classes including alcohol, hallucinogens, inhalants, opioids, phencyclidine, sedatives, stimulants and tobacco, and can cause various physical and mental symptoms and behaviours that can have negative, and potentially catastrophic, effects on the affected individual and those around them.

Substance abuse, or drug abuse, is the consumption of a drug or drugs in ways and/or quantities which cause harm to the person consuming them and/or to others. Substance dependence, meanwhile, is a condition which occurs as a result of the repeated consumption of a specific substance of abuse, in which the system of an individual adapts to the presence of the drug and builds a tolerance to it, requiring further consumption of substance in order for the individual to feel “normal”; if the affected person stops taking the drug, various negative symptoms may manifest in a condition known as withdrawal syndrome, which will last until the person system has readjusted to the absence of the drug (although some symptoms may persist for a long time after cessation of use).

Substance-induced disorders are medical conditions directly caused by substance use and/or abuse. The most obvious substance-induced disorder (though one which most laypersons may not recognise as a disorder at all) is intoxication; other substance-induced disorders include withdrawal, substance-induced mood disorders, substance-induced delirium and substance-induced psychosis.

Causes of Substance-Related Disorder

Substance-related disorders are caused by the consumption of psychoactive drugs. Such drugs may be illegal, but can also be legal recreational drugs (such as alcohol) or prescription medications; the legal status of a drug has no impact on its ability to cause substance-related disorders (though may be significant in terms of some of the complications that may arise as a result of an individual’s use or abuse of such substances).

Some substance-related disorders can be caused simply by taking a drug or drugs only once: for example, intoxication can occur after only one dose of a substance (and indeed in many cases is the objective of taking it), and serious injury and death may result from accidents or acts of violence taking place whilst an individual is intoxicated. Various negative effects, including substance-induced delirium and even death, can occur as a result of taking too much of a given substance (overdose), which can happen even on the first occasion on which someone engages in substance use.

The repeated consumption of a drug or drugs can have serious consequences even if it does not lead to dependence or addiction: substance-induced delirium and substance-induced psychosis can both manifest as a result of regular drug abuse, while cognitive impairment, fatigue and other factors can have detrimental effects upon work and academic endeavours.

Dependence and addiction are caused by repeatedly taking a specific substance frequently enough that the individual develops a tolerance to it; their system becomes used to the presence of the substance and adjusts accordingly, becoming dependent upon it to function normally.

Numerous risk factors are associated with susceptibility to substance-related disorders, especially substance use disorder. Children born to one or both parents with substance use disorders are twice as likely than the average to develop their own substance use disorders. Having pre-existing mental health problems is similarly likely to result in a person engaging in substance abuse and developing a substance use disorder. Other risk factors include exposure to alcohol and/or drugs within a peer group; chronic pain or other conditions requiring the prescription of painkilling medication; stress in the workplace; loneliness and isolation, and – especially – depression prompting the desire to self-medicate.

The behavioural changes resulting from intoxication will only be temporary, and the affected individual’s behaviour is likely to revert to normal once the substance wears off (though there may be after-effects in the form of hangover or comedown which may also affect behaviour). However, long-term substance abuse may result in more permanent behavioural changes.

• An individual’s clothing style, mannerisms and vocabulary may change as a result of their exposure to drug-taking subcultures and their spending time with new peer groups.
• They may be more prone to risk-taking behaviours, and may even begin to engage in criminal activity.
• They may become secretive and furtive as they seek to conceal their drug abuse from family members and friends.
• They may display regular mood swings.
• Previously enjoyed activities and hobbies may be engaged in less and less, and eventually dropped altogether.
• Changes in eating and sleeping habits may be noticeable.
• Poor concentration and absenteeism may affect work or academic performance.
• Relationships with partners, family and friends may be neglected or may suffer due to arguments.
• Financial circumstances may suffer; the individual may frequently ask to borrow money, may end up in large amounts of debt, and may even resort to criminal activity to try and obtain money.

A great many health issues – physical and mental – can also result from long-term drug abuse (see below), and some of these may have visible symptoms which can be identified by observers.

All the above symptoms may manifest without an individual actually becoming addicted to their drug/s of choice, though drug consumption over a prolonged period which is sufficient to cause many of these symptoms is extremely likely to lead to addiction and dependence. If this is the case, as well as the symptoms listed above the individual may well experience bouts of withdrawal if and when they are unable to obtain the drug/s on which they have become dependent.

Withdrawal symptoms may vary significantly from one drug to the next, but are likely to manifest within one or two days of cessation of use and to last between one and two weeks (though some symptoms may persist long afterwards); if an individual is observed to display withdrawal symptoms on various occasions, they may well have a long-term substance dependence disorder. Some symptoms typically associated with withdrawal include cravings; nausea; headaches; heart palpitations; diarrhoea; muscle cramps; tremors; twitches; sweating; difficulty breathing; insomnia; anxiety; poor concentration; irritability; restlessness; panic attacks; lack of appetite; anorgasmia; low libido; and depression. Withdrawal from some substances, including alcohol and benzodiazepines, can be fatal.

Possible complications of substance-related disorder

Substance abuse and dependence can result in a huge number of possible complications, in terms of their impact upon an individual’s physical and mental health and of damage to their life circumstances and prospects.

Physical health conditions, which may result from the long-term consumption of substances of abuse, range from comparatively minor to catastrophic and even fatal. Obviously, different drugs and different methods of consumption have different ramifications, though addiction and dependence can also have health consequences regardless of the specific drug/s involved (for example, conditions relating to malnutrition and sleep deprivation).

addicts, and can lead to self-harm and even suicide. Anxiety disorders, bipolar disorder and other disorders featuring mania, paranoia and eating disorders are all commonly associated with substance abuse and pose their own risks to the health of the affected individual.

When an individual suffers from both a substance abuse disorder and another mental health issue, the condition is known as dual diagnosis (aka co-occurring disorders, dual pathology or comorbidity). Whether the mental health issue existed before (and possibly contributed to) the addiction, or whether it resulted from the latter, both conditions need to be treated simultaneously in order for treatment for either to be successful, greatly complicating the way in which treatment is approached and provided (see below).

As well as any health complications arising from substance abuse and addiction, an individual’s life circumstances can be hugely negatively affected. Professional or academic life can prove incompatible with a substance abuse disorder, with poor concentration, tardiness, absenteeism and general unreliability all leading to job loss in many cases, with obvious consequences for the addict’s finances. This can have long-term effects for an individual’s professional reputation and can place some careers effectively out of bounds for that person.

Relationships with loved ones can be placed under huge strain and may eventually be destroyed, in many cases leading to the breakup of families (and obvious further implications for the addict’s mental well-being). Criminal activity – whether to fund the acquisition of substances of abuse, committed as a result of intoxication or otherwise – can lead to arrest and possible imprisonment, with life-long implications.

The impact on an individual’s outlook on life and self-perception can be similarly profound. Feelings of guilt, self-loathing, anger, frustration and despair can plague anyone who has been overwhelmed by addiction, and they may be unable to see any hope for a happier future – especially if their substance abuse has resulted in chronic health conditions or those such as HIV/AIDS which are incurable.

Substance use disorders can be diagnosed according to various guidelines; the most commonly used are 11 diagnostic criteria listed in the DSM-5:

• Using more of a substance than planned, or using a substance for a longer interval than desired
• Inability to cut down despite desire to do so
• Spending a substantial amount of the day obtaining, using, or recovering from substance use
• Cravings or intense urges to use
• Repeated usage causes or contributes to an inability to meet important social, or professional obligations
• Persistent usage despite user’s knowledge that it is causing frequent problems at work, school, or home
• Giving up or cutting back on important social, professional, or leisure activities because of use
• Using in physically hazardous situations, or usage causing physical or mental harm
• Persistent use despite the user’s awareness that the substance is causing or at least worsening a physical or mental problem
• Tolerance: needing to use increasing amounts of a substance to obtain its desired effects
• Withdrawal: characteristic group of physical effects or symptoms that emerge as amount of substance in the body decreases

As noted above, withdrawal symptoms can vary significantly by substance, and withdrawal would be diagnosed depending on which symptoms manifested and their severity.

The diagnosis of substance-induced disorders (as described above, medical conditions directly caused by substance use and/or abuse) would depend upon the specific disorder in question; the diagnosing physician would need to be aware of the patient’s consumption of (and, where applicable, dependence upon) the relevant substance/s of abuse in order to make the correct diagnosis.

Treatment of Substance-Related Disorder

The treatment of substance use disorder and addiction is now a field of great sophistication and expertise, and facilities can be found throughout the UK, treating individuals addicted to a wide range of substances of abuse. Various approaches to treatment and different therapy models and methodologies are employed, with varying success; it is generally recognised that the most effective form of treatment consists of a combination of detoxification (detox) and therapy, which may be provided as part of a holistic addiction treatment programme at a residential rehabilitation (rehab) facility.

Detox addresses the immediate problem of physical dependence, cleansing the addict’s system via abstinence from all substances of abuse; during the detox phase of treatment, individuals may go through withdrawal which must be monitored by medical professionals for the patient’s safety, especially in cases of alcohol or benzodiazepine dependence, the withdrawal from which can prove fatal. Withdrawal may be medically assisted, with medication provided to alleviate some of the worst withdrawal symptoms, but so far no pharmaceutical cure for withdrawal itself has been developed.

Several different psychotherapeutic models are employed in the treatment of addiction, with cognitive behavioural therapy (CBT) the most common; other models include dialectical behavioural therapy (DBT), motivational therapy (MT), and motivational interviewing (MI). Art therapy, yoga therapy and other therapies are also provided in some facilities. A holistic treatment programme will also include the provision of dietary and fitness plans, aimed at improving the addict’s general health and increasing self-confidence and self-esteem.

Addict in recovery can benefit from various support groups operating across the country, including famous organisations such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Support groups are typically free to attend, with the only criterion being a commitment to abstinence. Individual councillors and therapists specialising in the treatment of addiction can also be found across the UK.

Get Help Today

Addiction is a catastrophic and potentially fatal condition, with thousands of people falling victim to it every year in the UK, and millions worldwide. If you are struggling with an addiction, you may feel a profound despair; however, if you are prepared to acknowledge your condition and reach out for help, that help is out there. Countless people in this country who once suffered as you do now lead happy, healthy and successful lives, free of the burden of addiction, thanks to the high-quality professional help they have received – and you too could benefit. Contact your GP and/or an addiction specialist today to discuss options that may be available to you, and take the first step back to the happiness you deserve.