Case Studies Detail

There are brief self‐report instruments with high sensitivity and good specificity146 available for use in general health settings. These are based on single questions, such as “How many times in the past year have you had five (four for women) or more drinks in a day? ” for alcohol, and “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons? The dopamine shift from reward to stimuli that predict the reward is referred to as conditioning, and drug‐predictive stimuli (objects, environments, routines or emotions) are referred to as drug cues. Conditioning, driven by stimulation of D1 receptors in the nucleus accumbens, explains the addictive potential of drugs47, 48. Once the experience from drug reward has been turned into a conditioned memory, the cues by themselves drive the desire for the drug and energize the dopamine motivational circuit that propels the behaviors to pursue it33.

Addiction & Substance Use Disorders

In some cases, stigmatization (either self, public, or structural) and discrimination represent a violation of the human rights of people with SUDs and often interfere with these individuals’ choice of seeking treatment or with their adherence to the treatment 5. Gender inequalities are also visible, as women seem to face more barriers than men to treatment services worldwide. For example, in 2021, only 27% of individuals receiving treatment for amphetamine-type stimulant use were women, despite 45% of all the individuals using these substances being women 4. Nevertheless, biological sex differences (e.g., endocrine, metabolic, neuronal processes) often determine the individual’s response to a specific treatment. In particular, women with SUDs have been reported to be more vulnerable to family and social relationships’ impairment than men with the same conditions 6.

Substance use, however, can cause or worsen anxiety, sadness, anger and depression, according to the CDC. The annual ‘economic burden’ of alcohol and illicit drug misuse in the US is estimated to be $442 billion. Each factor raises vulnerability by influencing behavior and how people cope with emotions. The longer the pattern continues, the more mood, judgment, and behavior are altered, leading to the development of SUD. There are genes that influence dopamine and serotonin regulation, potentially increasing addiction risk.

Prenatal and antenatal interventions

Failing to treat a co-existing mental health disorder alongside addiction can make it more difficult for you to abstain from drugs, often leading to relapse. You may also find that your mood and mental health symptoms worsen as treatment for addiction progresses and you’re no longer self-medicating. In previous generations, addiction to drugs and alcohol was regarded as a moral failing or weakness, and people experiencing it were subjected to imprisonment and scorn. While the media sometimes still deploys these outdated stereotypes and the justice system still criminalizes and jails people addicted to illicit substances, addiction is now widely regarded by doctors and scientists as a medical condition—chronic, sometimes relapsing, but treatable. There are many interrelated factors between chronic pain and substance use disorders.

Macro: Syringe Service Programs

Service providers and policy makers should consider how they can create a health-promoting environment regardless of whether an individual has ever used drugs, is diagnosed with SUD, or engages in high-risk substance use. Indeed, the health care industry depends on the biomedical model, with a focus on diagnosis, precise and prescriptive treatment, and decision-chart resolutions (Fricton et al., 2015). However, expanding the broader health care system’s understanding of prevention beyond the body’s mechanistic functions is critical to stemming the nation’s ongoing rise in overdoses and future substance use epidemics. Prescriptive biomedical views of SUD prevention have led to simplistic problem statements and unidimensional solutions. For example, the United States experienced an excessive focus on increased opioid prescribing as a response to the opioid overdose crisis, often at the expense of supportive strategies (Dasgupta, Beletsky, and Ciccarone, 2018).

• Selective serotonin reuptake inhibitor (SSRI) antidepressants in combination with CBT have been found to be highly effective for treating clients with an AUD and depression (Cornelius et al., 1997; Moak et al., 2003).
• Some people use drugs to try to improve their focus in school or at work or their abilities in sports.
• For many people, the passage from use to dependence occurs without clear warning signs.
• This has led to the adoption of community-based prevention models in many parts of the world, which focus not only on reducing problem behaviors but also enhance a sense of well-being and ownership among communities.
• One complication of the SUD/GAD comorbidity is that GAD cannot be accurately evaluated during active withdrawal from substances.
• Improved understanding of the neurobiological mechanisms underlying substancedependence can lead to better strategies to prevent substance involvementand dependence.

Cannabis use disorder

Moreover, it may be difficult to establish whether functional impairment or use of opioids in amounts larger than prescribed are the result of undertreated pain or represent symptoms of opioid use disorder171, 294. Another consideration when selecting a medication for opioid use disorder is whether there are any co‐occurring disorders. For example, naltrexone is also effective in treating alcohol use disorder129, whereas buprenorphine’s kappa opioid receptor antagonist properties may offer benefits for individuals with comorbid depression.

• This model “meets clients where they are” and is a critical element of maintaining a therapeutic alliance so clients remain active in therapy and stay in treatment rather than drop out.
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• Substance use disorders are chronic, treatable medical conditions from which people can recover.
• There is also a paucity of evidence on pharmacotherapies for SUDs among adolescents.
• They release dopamine, a chemical in your brain that makes you feel good — until the substance wears off.

What skill-building approaches are utilized?

The sections that follow provide an overview of integrated treatment of SUDS combined with (a) psychotic disorders, (b) mood disorders (depression and bipolar disorder), and (c) anxiety disorders. One other particular manifestation of the interaction of substance and psychological symptoms is the similarity between cannabis withdrawal and depression. Until recently cannabis withdrawal symptoms were considered to be of questionable significance (American Psychiatric Association APA, 2000). However, a withdrawal syndrome for cannabis is proposed for the newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the APA.

Additionally, the National Prevention Week fosters community engagement, encouraging collaborative efforts to address substance use challenges. The focus on early intervention and resource accessibility is a priority as research shows that early behavioral issues may lead to higher risks of substance use later in life. Community-based interventions leverage local resources to address substance use issues collectively.

Why are some people more likely to develop substance use disorders?

This is because the enzymes mediating epigenetic modifications play a fundamental role in embryonic and postnatal brain development, so that their modification with in utero or early postnatal exposure to drugs might contribute to a higher vulnerability to addiction later in life113. Biological risk for SUDs emerges early in life, changes at various life stages, and is differentially influenced by social factors and experiences during those different life stages and transitions78. This developmental conceptualization of SUDs79 helps explain the diversity of possible pathways from the various risk factors to a SUD. In 2019, the number of premature deaths attributed to smoking was estimated at 7.7 million3, to alcohol use at 2.4 million4, and to use of other drugs at 550,7005, 6.

Though significant, the declines in the prevalence of past 30-day marijuana use were less pronounced, declining by 1.3 percentage points among middle school students and by 0.7 percentage points among high school students. Learn more from the Drug Free Communities Support Program 2012 National Evaluation Report. Understanding this interplay, social epidemiology recognizes that people make places and places make people (Macintyre and Ellaway, prevention of substance use and mental disorders 2003).

However, the mechanistic view of drugs “hijacking” the brain was not in conflict with the interdiction paradigm that similarly targeted drugs as the source of growing social ills. The mechanistic causal narrative continued to focus on regulating drugs and the drug supply instead of interrogating the social factors that drove the demand for drugs (El-Sabawi, 2019; Office of the Surgeon General, 2016; Institute of Medicine et al., 1994; Hawkins, Catalano, and Miller, 1992). In the ensuing years, US drug policy has consistently prioritized addressing the perceived moral outrage against drug use through tough-on-crime policies and a seemingly unrestricted cascade of federal dollars invested in drug interdiction (Shepard and Blackley, 2004). However, rather than serving as an effective public health strategy, this punitive approach has only served to perpetuate stigmatizing attitudes by erroneously associating drug use with social deviance and criminality (Dineen and Pendo, 2021).