Substance Use Disorder: Breaking Down the Basics
Blog by Kristin Young (LICSW)
Substance Use Disorder (SUD) is a complex disease characterized by the excessive and prolonged use of substances despite negative consequences. Anyone who has ever loved someone with SUD knows this all too well. Many of us hear the term “hitting bottom” and wonder how it’s possible for them to go any lower? That is one of the many reasons I don’t like the hitting-bottom narrative, but that is a blog for another day. Simply speaking, I prefer to look at the biological model, based on science, to help us better understand this disease. Understanding the basics of the neurobiology of substance use disorder helps us recognize the signs and support those who may be struggling.
First of all, SUD involves a range of problematic behaviors, including increased tolerance, withdrawal symptoms, unsuccessful attempts to quit or cut back, and continued substance use despite negative effects on physical health, mental well-being, relationships, and other areas of life. In other words the substance use causes many negative consequences, yet the person doesn’t stop. This is how you can tell the difference between problem use, or using more than you should, and SUD, which is a disease process in the brain. Human behavior is typically shaped by pain. If you put your hand in the fire only to get burned, you won’t stick your hand in the fire again. That is normal human neurology. If your loved one is continually making the same choice, only to get the same negative result. There is something wrong.
Let’s take a closer look at SUD. Substance use disorder is considered a medical condition that affects the brain, causing changes in neurotransmitters and reward pathways, leading to compulsive drug-seeking behavior. All substances can lead to addiction, which includes illicit drugs like cocaine and heroin, prescription medications, marijuana, and alcohol. Many people believe that there are “safe drugs” like marijuana because they are legal (in most states) and not physically addictive. Unfortunately, all drugs, including marijuana and alcohol, create a release of the neurotransmitter dopamine in the brain. This stimulates the reward pathway, which can set off a chain of reactions that, for many, lead to SUD.
Science can’t yet explain the exact reasons why many people end up with the disorder while others do not, and we have no way of predicting exactly who will and who won’t end up struggling. There are some factors we do know to increase the risk. Some of these are: family history of addiction, mental health issues, trauma, and parental history of use. We also know that the earlier the brain is introduced to substances, the higher the risk for SUD. The human brain isn’t fully developed until we’re about twenty-five years old. The area of the brain that is last to develop, the prefrontal cortex, is one of the main areas involved in addiction. The closer the brain is to full development, the lower the risk for SUD.
So how, then, do we treat it? Currently, treatment options include a combination of medical interventions like medicating addiction, varying forms of therapy, and social support systems. These may include medications to manage withdrawal symptoms and cravings, counseling (such as cognitive-behavioral therapy), support groups like Narcotics Anonymous or Alcoholics Anonymous, and inpatient or outpatient rehabilitation programs.
It’s crucial to approach substance use disorder with compassion and understanding, as it is not solely a matter of willpower or moral failing. Science has proven that it is, in fact, a neurobiological disease, which often requires a comprehensive approach that considers the physical, psychological, and social aspects of addiction.
If you or someone you know is struggling with substance use disorder, it is recommended to seek professional help from healthcare providers or reach out to organizations, such as Herren Project, specializing in addiction support. Remember, compassion, intervention, and support can greatly improve the chances of recovery.
If you are looking for more information on the science behind SUD, please watch the following video:
