Signs of substance use disorder, and hope for recovery

My last column explained how substance use can evolve into substance disorder (SUD) — the compulsive, recurring use of alcohol, medications and other drugs despite harmful consequences.

SUD, you may recall, is not a moral failing. Rather, it causes significant, measurable changes in brain chemistry and structure, especially in areas that regulate reward, stress and self-control.

For the second part of this topic, let’s delve deeper: What are some signs of SUD and methods of treatment, and how do affected individuals achieve sustainable recovery?

SUD, like a lot of mental health disorders, exists on a spectrum. It’s characterized by the Four Cs: compulsion, craving, control and consequences. There are several recognized characteristics in four principal domains:

1. Impaired control

This is when someone takes ever larger amounts over longer periods. You may tell yourself you’re going to have one glass of wine with dinner, which becomes a cocktail before dinner, which becomes a drink after dinner, which becomes a beer at 4 o’clock, and then “it’s 5 o’clock somewhere.”

The person is unsuccessful in their efforts to cut down and spends more time obtaining, ingesting and recovering from the substance. They experience intense urges or cravings.

2. Social impairment

A person experiencing SUD may begin to neglect obligations at work or school and cancel plans with friends. Relationships suffer. Activities that used to be enjoyed — book club, tennis, dinner out — are given up. There’s anger, resentment and denial.

3. Risky use

This is continuing to use the substance even though it’s dangerous and affecting one’s health, such as liver disease from alcohol or lung disease from inhalants. The person may start getting DUIs and buying drugs from people they don’t know.

4. Pharmacological factors

The substance affects the individual less and less, so more and more must be taken to achieve the high they’re seeking. We call this tolerance. Attempts at withdrawal cause symptoms like sweats, headaches, shakes and vomiting.

This is very important: SUD is not curable, but it is treatable.

Treatment usually begins with a stay of not less than 45 to 60 days at a licensed recovery facility that uses a 12-step program. Detox should only be done in a detox-licensed facility or hospital with a detox unit. Not all hospitals or substance abuse facilities can assist with this. If it’s determined that someone can’t detox on their own because the level of addiction is too high, medication can help them tolerate withdrawal (MAD, or medically assisted detox).

Today, there are many forms of 12-step programs besides Alcoholics Anonymous and Narcotics Anonymous. Options include Marijuana Anonymous, SMART Recovery and Dharma Recovery, which is based on Buddhist principles. The individual needs to find one that resonates with them, so that they can fully participate.

The important thing is to recognize that you can’t do this on your own, that you need a sponsor and the support of a sober community. Most professionals recommend 90 meetings in 90 days and to get involved in a sober community.

Lots of people with SUD are struggling with underlying mental health conditions and are using drugs or alcohol to treat their symptoms. Find a good therapist and take prescribed medication as directed.

It’s not unusual for an addict to enter treatment multiple times before they achieve sustainable recovery or life-long sobriety. My advice for families and friends is: Don’t rescue them. Don’t take them home to dry out; instead, take them to the ER. You’re rescuing your loved one by letting them be, letting them become so uncomfortable that they’re willing to seek help.

Let your loved one know that the goal of treatment and ongoing recovery is having the life they deserve, with work or school, community, friends and family. It’s a lifelong process, and they need all the support they can get.

• Bonnie Lane, M.S., is principal consultant with Family Support Services in Northbrook, specializing in supporting families whose loved ones suffer from severe mental illness or substance addiction. Daily Herald readers can contact her at (847) 651-1554 or bonnielane@thefamilysupportservices.com.