substance use disorder

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Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability to or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders.{{cite journal | vauthors = Wu LT, Blazer DG | title = Substance use disorders and psychiatric comorbidity in mid and later life: a review | journal = International Journal of Epidemiology | volume = 43 | issue = 2 | pages = 304–317 | date = April 2014 | pmid = 24163278 | pmc = 3997371 | doi = 10.1093/ije/dyt173 | doi-access = free }}

This section divides substance use disorder causes into categories consistent with the biopsychosocial model. However, it is important to bear in mind that these categories are used by scientists partly for convenience; the categories often overlap (for example, adolescents and adults whose parents had (or have) an alcohol use disorder display higher rates of alcohol problems, a phenomenon that can be due to genetic, observational learning, socioeconomic, and other causal factors); and these categories are not the only ways to classify substance use disorder etiology.

Similarly, most researchers in this and related areas (such as the etiology of psychopathology generally), emphasize that various causal factors interact and influence each other in complex and multifaceted ways.{{cite journal | vauthors = Kendler KS | title = Toward a philosophical structure for psychiatry | journal = The American Journal of Psychiatry | volume = 162 | issue = 3 | pages = 433–440 | date = March 2005 | pmid = 15741457 | doi = 10.1176/appi.ajp.162.3.433 | quote = psychiatric disorders are etiologically complex ... }}{{cite journal | vauthors = Borsboom D, Cramer AO, Kalis A | title = Brain disorders? Not really: Why network structures block reductionism in psychopathology research | journal = The Behavioral and Brain Sciences | volume = 42 | issue = e2 | pages = e2 | date = January 2018 | pmid = 29361992 | doi = 10.1017/S0140525X17002266 | url = https://core.ac.uk/download/pdf/208478186.pdf | access-date = 13 November 2020 | url-status = dead | quote-page = 1 | quote = mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders. | s2cid = 13665601 | archive-date = 14 November 2020 | archive-url = https://web.archive.org/web/20201114055035/https://core.ac.uk/download/pdf/208478186.pdf | hdl = 10468/7846 }}{{cite journal | vauthors = Kendler KS, Ohlsson H, Edwards AC, Sundquist J, Sundquist K | title = A developmental etiological model for drug abuse in men | journal = Drug and Alcohol Dependence | volume = 179 | pages = 220–228 | date = October 2017 | pmid = 28806639 | pmc = 5623952 | doi = 10.1016/j.drugalcdep.2017.06.036 | quote = DA [drug abuse] in men is a highly multifactorial syndrome with risk arising from familial-genetic, psychosocial, behavioral and psychological factors acting and interacting over development. }}{{Cite book| vauthors = MacKillop J, Ray LA |chapter=The Etiology of Addiction: a Contemporary Biopsychosocial Approach | veditors = MacKillop J, Kenna GA, Leggio L, Ray LA |title=Integrating Psychological and Pharmacological Treatments for Addictive Disorders: An Evidence-Based Guide|publisher=Routledge|year=2017|isbn=978-1-138-91909-9|location=New York|pages=32–53|quote=The goal of the current chapter is to review contemporary perspectives on the etiology, or the causes, of addictive disorders. ... this is no small task because of the complexity of these conditions and because the study of addiction is the focus of multiple disciplines using highly divergent perspectives. Furthermore, these different perspectives have not generated a single accepted account for why a person develops an addiction, but a number of empirically-grounded theoretical approaches that broadly fall into three domains—biological determinants, psychological determinants, and social determinants. These are collectively referred to as the biopsychosocial model of addiction|quote-page=32 |chapter-url=https://www.routledge.com/rsc/downloads/9781138919105_chapter_2.pdf }}{{cite journal | vauthors = Glackin SN, Roberts T, Krueger J | title = Out of our heads: Addiction and psychiatric externalism | journal = Behavioural Brain Research | volume = 398 | pages = 112936 | date = February 2021 | pmid = 33065141 | doi = 10.1016/j.bbr.2020.112936 | s2cid = 222317541 | url = https://philarchive.org/rec/GLAOOO | hdl = 10871/124796 | hdl-access = free }}

Among older adults, being divorced, separated, or single; having more financial resources; lack of religious affiliation; bereavement; involuntary retirement; and homelessness are all associated with alcohol problems, including alcohol use disorder.{{cite journal | vauthors = Kuerbis A, Sacco P, Blazer DG, Moore AA | title = Substance abuse among older adults | journal = Clinics in Geriatric Medicine | volume = 30 | issue = 3 | pages = 629–654 | date = August 2014 | pmid = 25037298 | pmc = 4146436 | doi = 10.1016/j.cger.2014.04.008 }} Many times, issues may be interconnected, people without jobs are most likely to abuse substances which then makes them unable to work. Not having a job leads to stress and sometimes depression which in turn can cause an individual to increase substance use. This leads to a cycle of substance abuse and unemployment.{{Cite tech report | vauthors = Spooner C, Hetherington K |date=2004 |title=Social determinants of drug use |institution=NDARC |number=35-184 }} The likelihood of substance abuse can increase during childhood. Through a study conducted in 2021 about the effect childhood experiences have on future substance use, researchers found that there is a direct connection between the two factors. Individuals that had experiences in their childhood which left them traumatized in some way had a much higher chance of substance abuse.{{cite journal | vauthors = Davis JP, Tucker JS, Stein BD, D'Amico EJ | title = Longitudinal effects of adverse childhood experiences on substance use transition patterns during young adulthood | journal = Child Abuse & Neglect | volume = 120 | pages = 105201 | date = October 2021 | pmid = 34245974 | pmc = 8384697 | doi = 10.1016/j.chiabu.2021.105201 }}

While SUD is often viewed as a person-centered issue, it is also a family disease. Individuals struggling with substance abuse frequently damage relationships with loved ones, and in severe cases, SUD can lead to family separation through divorce or intervention by government agencies like Child Protective Services (CPS). Unfortunately, it may even result in suicide, leaving families to grieve. SUD is commonly associated with a range of emotional and psychological problems, including anger, guilt, depression, anxiety, and violence. These issues not only affect the individual but also their family and community. To effectively combat SUD, it's crucial to address its causes particularly in mental health challenges. By improving access to mental health care, people can help prevent and treat substance use more effectively. There are many programs available to support individuals and families affected by SUD. These include therapy centers, support groups, and dedicated treatment facilities such as Bear River Health, Sacred Heart, Harbor Hall, and ATS. Peer support plays a vital role in recovery. Organizations like Al-Anon/Nar-Anon, AA/NA, Celebrate Recovery, and DHARMA provide the support to individuals and families navigating the challenges of substance use.

Psychological causal factors include cognitive, affective, and developmental determinants, among others. For example, individuals who begin using alcohol or other drugs in their teens are more likely to have a substance use disorder as adults. Other common risk factors are being male, being under 25, having other mental health problems (with the latter two being related to symptomatic relapse, impaired clinical and psychosocial adjustment, reduced medication adherence, and lower response to treatment{{cite journal | vauthors = Bartoli F, Cavaleri D, Moretti F, Bachi B, Calabrese A, Callovini T, Cioni RM, Riboldi I, Nacinovich R, Crocamo C, Carrà G | title = Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study | journal = Medicina | volume = 56 | issue = 11 | pages = 613 | date = November 2020 | pmid = 33203127 | pmc = 7696058 | doi = 10.3390/medicina56110613 | doi-access = free }}), and lack of familial support and supervision. (As mentioned above, some of these causal factors can also be categorized as social or biological). Other psychological risk factors include high impulsivity, sensation seeking, neuroticism and openness to experience in combination with low conscientiousness.{{cite journal | vauthors = Belcher AM, Volkow ND, Moeller FG, Ferré S | title = Personality traits and vulnerability or resilience to substance use disorders | journal = Trends in Cognitive Sciences | volume = 18 | issue = 4 | pages = 211–217 | date = April 2014 | pmid = 24612993 | pmc = 3972619 | doi = 10.1016/j.tics.2014.01.010 }}{{cite book | vauthors = Fehrman E, Egan V, Gorban AN, Levesley J, Mirkes EM, Muhammad AK |date= 2019|title= Personality Traits and Drug Consumption. A Story Told by Data|doi= 10.1007/978-3-030-10442-9|publisher= Springer, Cham|isbn=978-3-030-10441-2 |arxiv= 2001.06520 |s2cid= 151160405}}

Children born to parents with who have a substance use disorder have roughly a two-fold increased risk in developing a substance use disorder compared to children born to parents without this disorder.{{cite book |year=2020 |veditors=AAVV |title=Ferri's Clinical Advisor |author-last=Thair |author-first=Tellioglu |chapter=Substance Use Disorder |chapter-url=https://books.google.com/books?id=YxWbDwAAQBAJ&pg=PA1321 |location=Philadelphia |publisher=Elsevier |pages=1321–2 |isbn=978-0-323-67254-2}} Other factors such as substance use during pregnancy, or the persistent inhalation of secondhand smoke can also influence a person's substance use behaviors in the future.

{{addiction glossary|reverse citation order=yes}}

It is important when diagnosing substance use disorder to define the difference between substance use and substance abuse. "Substance use pertains to using select substances such as alcohol, tobacco, illicit drugs, etc. that can cause dependence or harmful side effects."On the other hand, substance abuse is the use of drugs such as prescriptions, over-the-counter medications, or alcohol for purposes other than what they are intended for or using them in excessive amounts.{{Cite web |title=National Cancer Institute |url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/substance-abuse}} Individuals whose drug or alcohol use cause significant impairment or distress may have a substance use disorder (SUD). Diagnosis usually involves an in-depth examination, typically by psychiatrist, psychologist, or drug and alcohol counselor.{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112|title=Drug addiction (substance use disorder) – Symptoms and causes|website=Mayo Clinic|access-date=7 December 2018}} The most commonly used guidelines are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are 11 diagnostic criteria which can be broadly categorized into issues arising from substance use related to loss of control, strain to one's interpersonal life, hazardous use, and pharmacologic effects.

There are additional qualifiers and exceptions outlined in the DSM. For instance, if an individual is taking opiates as prescribed, they may experience physiologic effects of tolerance and withdrawal, but this would not cause an individual to meet criteria for a substance use disorder without additional symptoms also being present. A physician trained to evaluate and treat substance use disorders will take these nuances into account during a diagnostic evaluation.

Symptoms for a substance use disorder include behavioral, physical and social changes. Changes in behavior include being absent from school or work; changes in appetite or sleep patterns; personality and attitude changes; mood swings, and anxiety. Signs include physical changes such as weight gain or loss; tremors, and bloodshot eyes.{{cite web |title=Mental Health and Substance Use Co-Occurring Disorders |url=https://www.samhsa.gov/mental-health/mental-health-substance-use-co-occurring-disorders |website=www.samhsa.gov |access-date=20 December 2023 |language=en |date=7 February 2023}} Different substances used can give different signs and symptoms.{{Cite web |title=Drug addiction (substance use disorder) – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112 |access-date=2023-04-06 |website=Mayo Clinic |language=en}}

There are a number of psychological changes associated with substance use disorders, including anxiety and depression. Anxiety and depression symptoms are closely linked to greater substance use over time, especially in adolescents. Some adolescents who are lifetime and / or current users will experience / are experiencing clinical levels of anxiety and depression, screenable through the PHQ-4.{{Cite journal |last1=Jonathan |first1=Geneva |last2=Evins |first2=Anne Eden |last3=Gray |first3=Caroline |last4=Bodolay |first4=Alec |last5=Potter |first5=Kevin |last6=Schuster |first6=Randi |date=2025-02-01 |title=S19 - Co-Occurring Substance Use is a Marker for Greater Internalizing Symptoms Among Adolescents Meeting Screening Criteria for Depression or Anxiety |url=https://www.sciencedirect.com/science/article/abs/pii/S0376871624003648 |journal=Drug and Alcohol Dependence |series=Abstracts from the 2024 Annual Meeting of the College on Problems of Drug Dependence |volume=267 |pages=111439 |doi=10.1016/j.drugalcdep.2024.111439 |issn=0376-8716|url-access=subscription }} Hallucinations can also occur due to the use of psychoactives such as cannabis, which may lead to onset of disorders like schizophrenia. {{Cite journal |last1=Fuster |first1=Daniel |last2=Zuluaga |first2=Paola |last3=Muga |first3=Robert |date=2024-05-17 |title=Substance use disorder: Epidemiology, medical consequences and treatment |url=https://www.elsevier.es/es-revista-medicina-clinica-english-edition--462-articulo-substance-use-disorder-epidemiology-medical-S2387020624001463 |journal=Medicina Clínica (English Edition) |language=en |volume=162 |issue=9 |pages=431–438 |doi=10.1016/j.medcle.2023.11.021 |issn=2387-0206|url-access=subscription }}

The list of physical health conditions associated with various substance use disorders is comprehensive; different substances tax the body in different ways, and each organ system experiences some form of distress or disruption as a result of substance use disorders. Some of the many health conditions are as follows:

• Language and Coordination impairment
• Memory loss
• Liver failure
• Hypertension
• Kidney failure
• Deep comatose states
• Transmission of HIV and other diseases carried on needles
• Osteoporosis
• Immunodeficiencies

Substance use disorders can range widely in severity, and there are numerous methods to monitor and qualify the severity of an individual's SUD. The DSM-5 includes specifiers for severity of a SUD. Individuals who meet only two or three criteria are often deemed to have mild SUD. Substance users who meet four or five criteria may have their SUD described as moderate, and persons meeting six or more criteria as severe. In the DSM-5, the term drug addiction is synonymous with severe substance use disorder.{{cite web | title=Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health | url=https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf | website = Office of the Surgeon General | publisher=US Department of Health and Human Services | date=November 2016 | access-date=28 January 2017 | pages = 35–37, 45, 63, 155, 317, 338 }} The quantity of criteria met offer a rough gauge on the severity of illness, but licensed professionals will also take into account a more holistic view when assessing severity which includes specific consequences and behavioral patterns related to an individual's substance use. They will also typically follow frequency of use over time, and assess for substance-specific consequences, such as the occurrence of blackouts, or arrests for driving under the influence of alcohol, when evaluating someone for an alcohol use disorder. There are additional qualifiers for stages of remission that are based on the amount of time an individual with a diagnosis of a SUD has not met any of the 11 criteria except craving. Some medical systems refer to an Addiction Severity Index to assess the severity of problems related to substance use.Butler SF, Budman SH, Goldman RJ, Newman FL, Beckley KE, Trottier D. Initial Validation of a Computer-Administered Addiction Severity Index: The ASI-MV Psychology of Addictive Behaviors 2001 March The index assesses potential problems in seven categories: medical, employment/support, alcohol, other drug use, legal, family/social, and psychiatric.{{cite web|url=http://www.alcoholrehab.com/|title=DARA Thailand|access-date=4 June 2017|archive-date=3 June 2017|archive-url=https://web.archive.org/web/20170603005345/http://alcoholrehab.com/|url-status=dead}}

There are several different screening tools that have been validated for use with adolescents, such as the CRAFFT, and with adults, such as CAGE, AUDIT and DALI.{{Cite book| vauthors = Antony MM, Barlow DH |url=https://books.google.com/books?id=7bzyDwAAQBAJ|title=Handbook of Assessment and Treatment Planning for Psychological Disorders | edition = Third =|date=2020-08-18|publisher=Guilford Publications|isbn=978-1-4625-4488-2|pages=32, 490, 521|language=en}} Laboratory tests to detect alcohol and other drugs in urine and blood may be useful during the assessment process to confirm a diagnosis, to establish a baseline, and later, to monitor progress.{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK64820/|title=Chapter 2—Screening for Substance Use Disorders| author = Center for Substance Abuse Treatment |date=1997|publisher=Substance Abuse and Mental Health Services Administration (US)}} However, since these tests measure recent substance use rather than chronic use or dependence, they are not recommended as screening tools. Other recent ones include statistical software based on the Data Driven Diagnostic Method(DDDM).{{Cite journal |last1=Soltanifar |first1=Mohsen |last2=Lee |first2=Chel Hee |date=2025 |title=CMHSU: An R Statistical Software Package to Detect Mental Health Status, Substance Use Status, and Their Concurrent Status in the North American Healthcare Administrative Databases |journal=Psychiatry International |volume=6 |issue=2 |pages=50 |doi=10.3390/psychiatryint6020050 |doi-access=free |issn=2673-5318|arxiv=2501.06435 }}

Along with CRAFFT, CAGE, AUDIT, and DALI, there are a number of specific screening tools which can be utilized for adolescents. Focusing specifically on tobacco and alcohol use, the S2BI, BSTAD, and TAPS are reliable tools which can screen for DSM diagnoses across the three types of addiction.{{Cite journal |last1=Levy |first1=Sharon |last2=Brogna |first2=Melissa |last3=Minegishi |first3=Machiko |last4=Subramaniam |first4=Geetha |last5=McCormack |first5=Jennifer |last6=Kline |first6=Margaret |last7=Menzin |first7=Eleanor |last8=Allende-Richter |first8=Sophie |last9=Fuller |first9=Alyssa |last10=Lewis |first10=Mitra |last11=Collins |first11=Julia |last12=Hubbard |first12=Zach |last13=Mitchell |first13=Shannon G. |last14=Weiss |first14=Roger |last15=Weitzman |first15=Elissa |date=2023-05-01 |title=Assessment of Screening Tools to Identify Substance Use Disorders Among Adolescents |journal=JAMA Network Open |volume=6 |issue=5 |pages=e2314422 |doi=10.1001/jamanetworkopen.2023.14422 |issn=2574-3805 |pmc=10203888 |pmid=37213103}} The S2BI is useful for identifying a broader range of addictions, and TAPS is useful in clinical settings for a more comprehensive screening of substance use disorders. One of the greatest challenges related to screening adolescents is parental consent. IRB regulations require that research on individuals under the age of 18 includes informed consent from the parents or legal guardians, yet these studies ask participants to report behaviors which are violations of law at that age.{{Cite web |first=HHS |date=March 8, 1983 |title=Subpart D - Additional Protections for Children Involved as Research Subjects |url=https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/common-rule-subpart-d/index.html |access-date=April 22, 2025 |website=Health and Human Services Office for Human Research Protections}} Notably, this produces a selection bias in which participants whose parents provided consent were less likely to experience substance use issues.

{{Main|Addiction#Mechanisms|Substance dependence#Biomolecular mechanisms}}Several factors contribute to the rehabilitation of SUD, including coping, craving, motivation to change, self-efficacy, social support, motives and expectancies, behavioral economic indicators, and neurobiological, neurocognitive, and physiological factors. These can be treated in a variety of ways, such as by cognitive behavioral therapy (CBT), which is an intervention treatment that helps individuals identify and change harmful thought patterns that may influence their emotions and behaviors negatively.{{Cite journal |title=Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies |journal= Biopsychosocial Medicine|date=2021 |pmc=8489050 |last1=Nakao |first1=M. |last2=Shirotsuki |first2=K. |last3=Sugaya |first3=N. |volume=15 |issue=1 |page=16 |doi=10.1186/s13030-021-00219-w |doi-access=free |pmid=34602086 }} As well as motivational interviewing (MI) that is a technique used to help motivate doubtful patients to change their behavior.{{Cite journal |title=Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice |journal= Deutsches Ärzteblatt International|date=2021 |pmc=8200683 |last1=Bischof |first1=G. |last2=Bischof |first2=A. |last3=Rumpf |first3=H. J. |volume=118 |issue=7 |pages=109–115 |doi=10.3238/arztebl.m2021.0014 |pmid=33835006 }} Lastly combined behavioral intervention (CBI), can be used which involves combining elements of alcohol interventions, motivational interviewing, and functional analysis to help the clinician identify skill deficits and high risk situations that are associated with drinking or drug use.{{cite journal | vauthors = Witkiewitz K, Pfund RA, Tucker JA | title = Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment | journal = Annual Review of Clinical Psychology | volume = 18 | issue = 1 | pages = 497–525 | date = May 2022 | pmid = 35138868 | doi = 10.1146/annurev-clinpsy-072720-014802 }}{{Cite journal |title=Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project. |journal=Journal of Consulting and Clinical Psychology| date=2016 | doi=10.1037/ccp0000074 | last1=Moyers | first1=Theresa B. | last2=Houck | first2=Jon | last3=Rice | first3=Samara L. | last4=Longabaugh | first4=Richard | last5=Miller | first5=William R. | volume=84 | issue=3 | pages=221–229 | pmid=26795938 | pmc=4760890 }}

Withdrawal management is the medical and psychological care of patients who are experiencing withdrawal symptoms due to the ceasing of drug use.{{Cite book |title=Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings |date=2009 |publisher=World Health Organization |isbn=978-92-9061-430-2}} Depending on the severity of use, and the given substance, early treatment of acute withdrawal may include medical detoxification. Of note, acute withdrawal from heavy alcohol use should be done under medical supervision to prevent a potentially deadly withdrawal syndrome known as delirium tremens. See also Alcohol detoxification.

{{main|Drug rehabilitation}}

Therapists often classify people with chemical dependencies as either interested or not interested in changing. About 11% of Americans with substance use disorder seek treatment, and 40–60% of those people relapse within a year.{{cite journal | vauthors = McLellan AT, Lewis DC, O'Brien CP, Kleber HD | title = Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation | journal = JAMA | volume = 284 | issue = 13 | pages = 1689–1695 | date = October 2000 | pmid = 11015800 | doi = 10.1001/jama.284.13.1689 | s2cid = 2086869 }} Treatments usually involve planning for specific ways to avoid the addictive stimulus, and therapeutic interventions intended to help a client learn healthier ways to find satisfaction. Clinical leaders in recent years have attempted to tailor intervention approaches to specific influences that affect addictive behavior, using therapeutic interviews in an effort to discover factors that led a person to embrace unhealthy, addictive sources of pleasure or relief from pain.

From the applied behavior analysis literature and the behavioral psychology literature, several evidence-based intervention programs have emerged, such as behavioral marital therapy, community reinforcement approach, cue exposure therapy, and contingency management strategies.{{cite journal | vauthors = O'Donohue W, Ferguson KE | title = Evidence-Based Practice in Psychology and Behavior Analysis| journal = The Behavior Analyst Today| volume = 7| issue = 3| pages = 335–350| year = 2006| url = http://www.baojournal.com|access-date=24 March 2008| doi = 10.1037/h0100155| url-access = subscription}}{{cite journal | vauthors = Chambless DL | title = An update on empirically validated therapies| journal = Clinical Psychology| volume = 49| pages = 5–14| publisher = American Psychological Association| year = 1998| url = http://www.apa.org/divisions/div12/est/newrpt.pdf| access-date = 24 March 2008|display-authors=etal}} In addition, the same author suggests that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious.

Medication-assisted treatment (MAT) refers to the combination of behavioral interventions and medications to treat substance use disorders.{{cite journal | vauthors = Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G | title = Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options | journal = Journal of the National Medical Association | volume = 104 | issue = 7–8 | pages = 342–350 | date = July 2012 | pmid = 23092049 | pmc = 4039205 | doi = 10.1016/s0027-9684(15)30175-9 }} Certain medications can be useful in treating severe substance use disorders. In the United States five medications are approved to treat alcohol and opioid use disorders.{{Cite book|title=American Psychiatric Association practice guidelines for the treatment of psychiatric disorders.|url=https://archive.org/details/americanpsychiat0000amer_f1j6|url-access=registration|publisher=American Psychiatric Association|date=2002 |isbn=0-89042-320-2|oclc=48656105}} There are no approved medications for cocaine, methamphetamine.{{cite journal | vauthors = Cheron J, Kerchove d'Exaerde A | title = Drug addiction: from bench to bedside | journal = Translational Psychiatry | volume = 11 | issue = 1 | pages = 424 | date = August 2021 | pmid = 34385417 | pmc = 8361217 | doi = 10.1038/s41398-021-01542-0 }}{{cite journal |vauthors=Rizk JG, Saini J, Kim K, Pathan U, Qato DM |title=County-level factors associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities |journal=PLOS ONE |volume=19 |issue=4 |pages=e0301863 |date=2024 |pmid=38578818 |pmc=10997118 |doi=10.1371/journal.pone.0301863 |doi-access=free|bibcode=2024PLoSO..1901863R }}

Medications, such as methadone and disulfiram, can be used as part of broader treatment plans to help a patient function comfortably without illicit opioids or alcohol.{{Cite book|title=Access to substance use disorder treatment in Massachusetts| location = Massachusetts | publisher = Center for Health Information and Analysis, issuing body.|oclc=911187572}} Medications can be used in treatment to lessen withdrawal symptoms. Evidence has demonstrated the efficacy of medication-assisted treatment at reducing illicit drug use and overdose deaths, improving retention in treatment, and reducing HIV transmission.{{Cite journal|title=Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment|journal=Advance| vauthors = Holt H |date=2019-07-15|doi = 10.31124/advance.8866331|s2cid=241858682}}{{cite journal | vauthors = Schwartz RP, Gryczynski J, O'Grady KE, Sharfstein JM, Warren G, Olsen Y, Mitchell SG, Jaffe JH | title = Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009 | journal = American Journal of Public Health | volume = 103 | issue = 5 | pages = 917–922 | date = May 2013 | pmid = 23488511 | pmc = 3670653 | doi = 10.2105/ajph.2012.301049 }}{{Cite book| chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK424859/ |id=NBK424859| chapter = Early intervention, treatment, and management of substance use disorders | title = Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet] |author1=((Substance Abuse and Mental Health Services Administration (US)))|author2=((Office of the Surgeon General (US)))|date=November 2016|publisher=US Department of Health and Human Services}}

Vaccines for addiction have been investigated as a possibility since the early 2000s.{{Cite book|url=https://www.ncbi.nlm.nih.gov/sites/books/NBK24623/|title=Vaccines and Immunotherapies to Control Addiction in Minors: The Legal Framework| vauthors = Harwood HJ, Myers TG, Addiction NR | collaboration =National Research Council (US) and Institute of Medicine (US) Committee on Immunotherapies and Sustained-Release Formulations for Treating Drug Addiction |date=July 23, 2004|publisher=National Academies Press (US)|via=www.ncbi.nlm.nih.gov}} The general theory of a vaccine intended to "immunize" against drug addiction or other substance abuse is that it would condition the immune system to attack and consume or otherwise disable the molecules of such substances that cause a reaction in the brain, thus preventing the addict from being able to realize the effect of the drug. Addictions that have been floated as targets for such treatment include nicotine, opioids, and fentanyl.{{cite web|url=https://www.scripps.edu/news-and-events/press-room/2020/20200730-janda-heroinvaccine.html |title='Heavy' heroin vaccine provides hope for addiction treatment|publisher=Scripps Research|date=July 30, 2020}}{{Cite web|url=https://www.cuimc.columbia.edu/news/experimental-opioid-vaccine-being-tested-columbia|title=Experimental Opioid Vaccine Being Tested at Columbia|date=July 1, 2021|website=Columbia University Irving Medical Center}}{{Cite web|url=https://www.seattletimes.com/seattle-news/mental-health/to-fight-opioid-crisis-uw-researchers-take-new-shot-at-developing-vaccine-against-addictive-drugs/|title=To fight opioid crisis, UW researchers take new shot at developing vaccine against addictive drugs| vauthors = Furfaro H |date=January 5, 2022|website=The Seattle Times}}{{Cite web|url=https://www.addictioncenter.com/news/2022/01/vaccine-against-addiction/|title=A Vaccine Against Addiction|website=Addiction Center|date=12 January 2022 }} Vaccines have been identified as potentially being more effective than other anti-addiction treatments, due to "the long duration of action, the certainty of administration and a potential reduction of toxicity to important organs".{{Cite web|url=https://drugabuse.com/blog/why-dont-we-have-addiction-vaccines/|title=Why Don't We Have Addiction Vaccines?|author=American Addiction Centers Editorial Staff|orig-date=December 29, 2016|date=January 4, 2022|website=DrugAbuse.com}}

Specific addiction vaccines in development include:

• NicVAX, a conjugate vaccine intended to reduce or eliminate physical dependence on nicotine.{{cite web|url=http://www.drugabuse.gov/NIDA_Notes/NNVol15N5/Vaccine.html |title=Nicotine Vaccine Moves Toward Clinical Trials |author=Barbara Shine |publisher=National Institute on Drug Abuse |date=October 2000 |access-date=2006-09-19 |archive-url=https://web.archive.org/web/20060810101935/http://www.drugabuse.gov/NIDA_Notes/NNVol15N5/Vaccine.html |archive-date=2006-08-10 |url-status=dead }} This proprietary vaccine is being developed by Nabi Biopharmaceuticals{{cite web | url=http://www.nabi.com | title = Nabi Biopharmaceuticals Website}} of Rockville, MD. with the support from the U.S. National Institute on Drug Abuse. NicVAX consists of the hapten 3'-aminomethylnicotine which has been conjugated (attached) to Pseudomonas aeruginosa exotoxin A.{{cite journal | vauthors = Hatsukami DK, Rennard S, Jorenby D, Fiore M, Koopmeiners J, de Vos A, Horwith G, Pentel PR | title = Safety and immunogenicity of a nicotine conjugate vaccine in current smokers | journal = Clinical Pharmacology and Therapeutics | volume = 78 | issue = 5 | pages = 456–467 | date = November 2005 | pmid = 16321612 | doi = 10.1016/j.clpt.2005.08.007 | s2cid = 1218556 | author-link = Dorothy Hatsukami }}
• TA-CD, an active vaccine{{cite journal | vauthors = Martell BA, Mitchell E, Poling J, Gonsai K, Kosten TR | title = Vaccine pharmacotherapy for the treatment of cocaine dependence | journal = Biological Psychiatry | volume = 58 | issue = 2 | pages = 158–164 | date = July 2005 | pmid = 16038686 | doi = 10.1016/j.biopsych.2005.04.032 | s2cid = 22415520 }} developed by the Xenova Group which is used to negate the effects of cocaine. It is created by combining norcocaine with inactivated cholera toxin. It works in much the same way as a regular vaccine. A large protein molecule attaches to cocaine, which stimulates response from antibodies, which destroy the molecule. This also prevents the cocaine from crossing the blood–brain barrier, negating the euphoric high and rewarding effect of cocaine caused from stimulation of dopamine release in the mesolimbic reward pathway. The vaccine does not affect the user's "desire" for cocaine—only the physical effects of the drug.{{cite web |url=http://news.bbc.co.uk/2/hi/health/3804741.stm |title=Cocaine vaccine 'stops addiction' |access-date=2009-10-07|work=BBC News |date=14 June 2004 }}
• TA-NIC, used to create human antibodies to destroy nicotine in the human body so that it is no longer effective.{{Cite web |url=http://www.celticpharma.com/theportfolio/ta-nic.html |title=CelticPharma: TA-NIC Nicotine Dependence. |access-date=2009-10-27 |archive-url=https://web.archive.org/web/20091206100218/http://www.celticpharma.com/theportfolio/ta-nic.html |archive-date=2009-12-06 |url-status=dead }}

As of September 2023, it was further reported that a vaccine "has been tested against heroin and fentanyl and is on its way to being tested against oxycontin".{{cite news|url=https://www.kiro7.com/news/local/uw-researcher-explains-new-vaccine-being-made-prevent-opioid-overdoses/HXFQ3AZ2YBAGDIELRDIGKCWN6M/ |title=UW researcher explains new vaccine in the works to prevent opioid overdoses|author=((KIRO 7 News Staff))|work=KIRO 7|date=September 19, 2023}}

File:Drug use disorders world map - DALY - WHO2004.svg, a measure of overall disease burden (number of years lost due to ill-health, disability or early death), from drug use disorders per 100,000 inhabitants in 2004

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Rates of substance use disorders vary by nation and by substance, but the overall prevalence is high.{{Cite book| vauthors = Galanter M, Kleber HD, Brady KT |date=17 December 2014|title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment|doi=10.1176/appi.books.9781615370030|doi-broken-date=22 April 2025 |isbn=978-1-58562-472-0}} On a global level, men are affected at a much higher rate than women. Younger individuals are also more likely to be affected than older adults.Rizk JG, Saini J, Kim K, Pathan U, Qato DM. County-level factors associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities. *PLoS One*. 2024 Apr 5;19(4):e0301863. doi: [10.1371/journal.pone.0301863](https://doi.org/10.1371/journal.pone.0301863). PMID: 38578818; PMCID: PMC10997118.

In 2020, 14.5% of Americans aged 12 or older had a SUD in the past year.{{Cite web|url=https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020/NSDUHDetailedTabs2020/NSDUHDetTabsSect5pe2020.htm|title=Reports and Detailed Tables From the 2020 National Survey on Drug Use and Health (NSDUH) {{!}} CBHSQ|website=www.samhsa.gov|access-date=11 February 2022|date=11 September 2020}} Rates of alcohol use disorder in the past year were just over 5%. Approximately 3% of people aged 12 or older had an illicit drug use disorder. The highest rates of illicit drug use disorder were among those aged 18 to 25 years old, at roughly 7%.

There were over 72,000 deaths from drug overdose in the United States in 2017,{{Cite web|url=https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates|title=Overdose Death Rates | work = National Institute on Drug Abuse | publisher = U.S. National Institutes of Health |date=9 August 2018 |access-date=6 December 2018}} which is a threefold increase from 2002. However the CDC calculates alcohol overdose deaths separately; thus, this 72,000 number does not include the 2,366 alcohol overdose deaths in 2017.Centers for Disease Control and Prevention, National Center for Health Statistics. [https://wonder.cdc.gov/controller/saved/D76/D78F796 Substance-induced cause, 2017, percent total, with standard error] from the Underlying Cause of Death 1999–2018 CDC WONDER Online Database. Accessed at http://wonder.cdc.gov/ucd-icd10.html on 18 March 2020 at 18:06 UTC. Overdose fatalities from synthetic opioids, which typically involve fentanyl, have risen sharply in the past several years to contribute to nearly 30,000 deaths per year. Death rates from synthetic opioids like fentanyl have increased 22-fold in the period from 2002 to 2017. Heroin and other natural and semi-synthetic opioids combined to contribute to roughly 31,000 overdose fatalities. Cocaine contributed to roughly 15,000 overdose deaths, while methamphetamine and benzodiazepines each contributed to roughly 11,000 deaths. Of note, the mortality from each individual drug listed above cannot be summed because many of these deaths involved combinations of drugs, such as overdosing on a combination of cocaine and an opioid.

Deaths from alcohol consumption account for the loss of over 88,000 lives per year.{{Cite web|vauthors=((Centers for Disease Control and Prevention)) | url=https://nccd.cdc.gov/DPH_ARDI/Default/Report.aspx?T=AAM&P=f6d7eda7-036e-4553-9968-9b17ffad620e&R=d7a9b303-48e9-4440-bf47-070a4827e1fd&M=8E1C5233-5640-4EE8-9247-1ECA7DA325B9&F=&D=|title=Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI) |website=Centers for Disease Control and Prevention (CDC) | year=2013 |access-date=6 December 2018 }} Tobacco remains the leading cause of preventable death, responsible for greater than 480,000 deaths in the United States each year.{{Cite web|url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/|title=Smoking and Tobacco Use; Fact Sheet; Fast Facts|date=9 May 2018|website=Centers for Disease Control and Prevention (CDC)|access-date=6 December 2018}} These harms are significant financially with total costs of more than $420 billion annually and more than $120 billion in healthcare.{{cite journal | vauthors = Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD | title = 2010 National and State Costs of Excessive Alcohol Consumption | journal = American Journal of Preventive Medicine | volume = 49 | issue = 5 | pages = e73–e79 | date = November 2015 | pmid = 26477807 | doi = 10.1016/j.amepre.2015.05.031 }}

According to Statistics Canada (2018), approximately one in five Canadians aged 15 years and older experience a substance use disorder in their lifetime.{{Cite web|url=https://www.canada.ca/en/health-canada/services/substance-use/canadian-drugs-substances-strategy/strengthening-canada-approach-substance-use-issue.html|title=Strengthening Canada's Approach to Substance Use Issues | work =Health Canada |date=2018-09-05 |access-date=2019-11-01}} In Ontario specifically, the disease burden of mental illness and addiction is 1.5 times higher than all cancers together and over 7 times that of all infectious diseases.{{Cite web|url=https://www.publichealthontario.ca/en/Health%20Topics/Health%20Promotion/Mental%20Health/Opening%20Eyes%20Opening%20Minds|title=Opening Eyes, Opening Minds: The Ontario Burden of Mental Illness and Addictions Report|website=Public Health Ontario|access-date=2019-11-01}} Across the country, the ethnic group that is statistically the most impacted by substance use disorders compared to the general population are the Indigenous peoples of Canada. In a 2019 Canadian study, it was found that Indigenous participants experienced greater substance-related problems than non-Indigenous participants.{{cite journal | vauthors = Bingham B, Moniruzzaman A, Patterson M, Distasio J, Sareen J, O'Neil J, Somers JM | title = Indigenous and non-Indigenous people experiencing homelessness and mental illness in two Canadian cities: A retrospective analysis and implications for culturally informed action | journal = BMJ Open | volume = 9 | issue = 4 | pages = e024748 | date = April 2019 | pmid = 30962229 | pmc = 6500294 | doi = 10.1136/bmjopen-2018-024748 }}

Statistics Canada's Canadian Community Health Survey (2012) shows that alcohol was the most common substance for which Canadians met the criteria for abuse or dependence. Surveys on Indigenous people in British Columbia show that around 75% of residents on reserve feel alcohol use is a problem in their community and 25% report they have a problem with alcohol use themselves. However, only 66% of First Nations adults living on reserve drink alcohol compared to 76% of the general population.{{Cite web|url=https://www.heretohelp.bc.ca/aboriginal-mental-health-statistical-reality|title=Aboriginal Mental Health: The statistical reality {{!}} Here to Help|website=www.heretohelp.bc.ca|access-date=2019-11-01|archive-date=27 August 2021|archive-url=https://web.archive.org/web/20210827134003/https://www.heretohelp.bc.ca/aboriginal-mental-health-statistical-reality|url-status=dead}} Further, in an Ontario study on mental health and substance use among Indigenous people, 19% reported the use of cocaine and opiates, higher than the 13% of Canadians in the general population that reported using opioids.{{Cite web|url=https://www.ccsa.ca/prescription-opioids-canadian-drug-summary|title=Prescription Opioids (Canadian Drug Summary) {{!}} Canadian Centre on Substance Use and Addiction|website=www.ccsa.ca|access-date=2019-11-01}}{{cite journal | vauthors = Firestone M, Smylie J, Maracle S, McKnight C, Spiller M, O'Campo P | title = Mental health and substance use in an urban First Nations population in Hamilton, Ontario | journal = Canadian Journal of Public Health | volume = 106 | issue = 6 | pages = e375–e381 | date = June 2015 | pmid = 26680428 | pmc = 6972211 | doi = 10.17269/CJPH.106.4923 | jstor = 90005913 }}

Historical and ongoing colonial practices continue to impact the health of Indigenous Australians, with Indigenous populations being more susceptible to substance use and related harms.{{Cite journal| vauthors = Berry SL, Crowe TP |date=January 2009|title=A review of engagement of Indigenous Australians within mental health and substance abuse services|journal=Australian e-Journal for the Advancement of Mental Health|volume=8|issue=1|pages=16–27|doi=10.5172/jamh.8.1.16|s2cid=26033698|issn=1446-7984|url=https://ro.uow.edu.au/hbspapers/1043}} For example, alcohol and tobacco are the predominant substances used in Australia.{{cite journal | vauthors = Haber PS, Day CA | title = Overview of substance use and treatment from Australia | journal = Substance Abuse | volume = 35 | issue = 3 | pages = 304–308 | date = 2014 | pmid = 24853496 | doi = 10.1080/08897077.2014.924466 | s2cid = 36761260 | doi-access = free | bibcode = 2014JPkR...35..304H }} Although tobacco smoking is declining in Australia, it remains disproportionately high in Indigenous Australians with 45% aged 18 and over being smokers, compared to 16% among non-Indigenous Australians in 2014–2015.{{Cite web|url=https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/aboriginal-and-torres-strait-islander-people|title=Alcohol, tobacco & other drugs in Australia, Aboriginal and Torres Strait Islander people|website=Australian Institute of Health and Welfare|access-date=2019-11-24}} As for alcohol, while proportionately more Indigenous people refrain from drinking than non-Indigenous people, Indigenous people who do consume alcohol are more likely to do so at high-risk levels.{{cite journal | vauthors = Sanson-Fisher RW, Campbell EM, Perkins JJ, Blunden SV, Davis BB | title = Indigenous health research: a critical review of outputs over time | journal = The Medical Journal of Australia | volume = 184 | issue = 10 | pages = 502–505 | date = May 2006 | pmid = 16719748 | doi = 10.5694/j.1326-5377.2006.tb00343.x | s2cid = 43868317 }} About 19% of Indigenous Australians qualified for risky alcohol consumption (defined as 11 or more standard drinks at least once a month), which is 2.8 times the rate that their non-Indigenous counterparts consumed the same level of alcohol.

However, while alcohol and tobacco usage are declining, use of other substances, such as cannabis and opiates, is increasing in Australia. Cannabis is the most widely used illicit drug in Australia, with cannabis usage being 1.9 times higher than non-Indigenous Australians. Prescription opioids have seen the greatest increase in usage in Australia, although use is still lower than in the US.{{cite journal | vauthors = Leong M, Murnion B, Haber PS | title = Examination of opioid prescribing in Australia from 1992 to 2007 | journal = Internal Medicine Journal | volume = 39 | issue = 10 | pages = 676–681 | date = October 2009 | pmid = 19460051 | doi = 10.1111/j.1445-5994.2009.01982.x | s2cid = 205503169 }} In 2016, Indigenous persons were 2.3 times more likely to misuse pharmaceutical drugs than non-Indigenous people.

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{{reflist}}

{{refbegin}}

• {{cite book | title = Concurrent substance use and mental health disorders : an information guide | isbn = 978-1-77052-604-4 | year = 2010 | vauthors = Skinner WW, O'Grady CP, Bartha C, Parker C | publisher = Centre for Addiction and Mental Health (CAMH) | url = http://www.camh.ca/-/media/files/guides-and-publications/concurrent-disorders-guide-en.pdf }}
• {{cite book | title = Best Practices: Concurrent Mental Health and Substance Use Disorders | year = 2001 | publisher = Health Canada | isbn = 0-662-31388-7 | url = http://www.hc-sc.gc.ca/hc-ps/alt_formats/hecs-sesc/pdf/pubs/adp-apd/bp_disorder-mp_concomitants/bp_concurrent_mental_health-eng.pdf }}

{{refend}}

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|F|10||f|10}}-{{ICD10|F|19||f|10}}

| ICD9 = {{ICD9|303}}-{{ICD9|305}}

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| MeshID = D019966

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{{Psychoactive substance use|state=expanded}}

{{Reinforcement disorders|state=expanded}}

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Category:Addiction

Category:Substance dependence

Category:Substance-related disorders