When does substance use become substance use disorder?
For the past 25 years, the international community has come together on Aug. 31 to promote International Overdose Awareness Day. This annual campaign aims to end overdoses, remember without stigma those who have died and acknowledge the grief of family and friends.
In 2024, more Americans died from overdoses than from traffic accidents — over 53,000, according to the Centers for Disease Control and Prevention substance use database.
About 20% of the individuals who overdosed in 2024 had been diagnosed with substance use disorder (SUD), the CDC reports, but in my experience, SUD, diagnosed or not, is at the root of many overdoses. I’m taking the next two columns to discuss substance use disorder, its causes, signs and effective treatments.
First, what do we mean by “substance”?
“Substance” means alcohol or other psychoactive products that we drink, smoke, swallow, snort, inject or inhale, such as opioids, marijuana, hallucinogens, inhalants, cocaine, amphetamines or benzodiazepines.
Many people partake in recreational substances. It’s estimated, for example, that 70% of Americans drink alcohol at least on occasion. Legalization has caused the daily use of cannabis to rise considerably. Tens of millions of people worldwide take opioids.
What is substance use disorder (SUD)?
SUD is a diagnosable, treatable brain disorder characterized by a recurrent, compulsive use of a substance (whether legal or illegal) despite harmful consequences. It can range from mild to severe and can respond to appropriate support and interventions.
Individuals can develop an SUD from alcohol, recreational drugs or prescription medications such as Xanax, Valium, morphine and oxycodone, which are typically used for short-term relief of anxiety and pain, and stimulants like Adderall, a treatment for ADHD.
Street drugs are particularly dangerous because they can be laced with other substances, such as fentanyl, a synthetic opioid that is 100 times more powerful than morphine. Aerosols and other inhalants are another substance to be aware of; they are especially popular with teens.
Notice we’re not calling SUD “substance abuse.” Nancy Reagan considered addiction a moral failing that could be overcome by willpower — “just say no.”
But now we have come to understand that addicts are struggling with a medical disorder that causes significant, measurable changes in brain chemistry and structure, especially in areas regulating reward behavior, stress and self-control. This is why political approaches, such as the so-called “war on drugs,” don’t work.
What causes SUD?
As with other mental illnesses, a predisposition for substance use disorder is inheritable. That’s why we often see alcoholism, for example, run in families. It can be triggered by other mental health conditions, such as depression, anxiety, stress or a mood disorder such as bipolar disorder.
People drink alcohol or take drugs because they perceive that it makes them feel better in some way — happier, calmer, more sociable, less in pain, more creative, more productive. The problem is that they have to consume more and more of the substance to achieve the same effect because of tolerance, the body gradually adjusting to it.
This can cause people to overuse substances despite harmful consequences and impaired ability to function in their daily responsibilities: hygiene, getting to work or school, interacting socially and emotionally with peers and family. They become drug-seekers, taking risks and buying on the street or online.
An addict needing more and more drugs to get the same high doesn’t know their limit until they’ve hit it. So overdoses are rarely intentional. It looks like a death by suicide but it’s not. It’s an accidental occurrence in a person who is an addict.
People also continue using substances because it keeps them from feeling the physical and psychological effects of withdrawal, which vary in intensity but are invariably unpleasant — delirium tremens (the shakes), sweats, vomiting, anxiety, irritability, insomnia, hallucinations, seizures. In some cases, withdrawal symptoms can be life-threatening.
How can you tell whether you or someone you love is struggling with SUD? What does treatment look like, and how can you sustain your recovery? My next column will discuss the signs and symptoms of SUD and paths to recovery.
Meanwhile, please take care. Using dangerous substances when you’re alone is a risk factor in overdoses. SafeSpot is a free, 24/7 service that provides support for individuals using drugs alone. Call (800) 972-0590 or go to an emergency room.
• 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.