Struggles with Substance Abuse and Psychological Distress
Substance Use Disorder (SUD) is a complex but treatable disease that affects millions of people in the United States, according to the Centers for Disease Control and Prevention (CDC). SUD is classified as a mental illness under the clinical name "substance use disorder (SUD)" in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).
The repeated use of a substance despite negative effects is a key characteristic of SUD. SUDs can range from mild to severe, and they can have a profound impact on an individual's life. The American Psychiatric Association (APA) defines addiction as physiological or psychological dependence on substances or certain behaviors. The National Institute on Drug Abuse (NIDA) defines addiction as a chronic relapsing disorder with compulsive behaviors despite negative consequences.
The brain is significantly affected by SUD. Drugs and alcohol flood the brain with dopamine at levels far exceeding natural rewards, leading to the brain reducing its own dopamine production and decreasing dopamine receptor availability. This makes natural pleasures less satisfying and increases dependence on the substance just to feel normal. Additionally, SUD affects brain regions involved in decision-making and impulse control, such as the prefrontal cortex, causing impaired judgment and compulsive use despite negative consequences. Memory formation areas like the hippocampus can also be damaged, leading to learning and memory difficulties.
Several factors contribute to a higher risk of developing SUD. Genetic predisposition, environmental exposure, epigenetic changes, and social and psychological factors all play a role. Genetic variations related to dopamine receptors, substance metabolism, and stress response account for 40–60% of vulnerability. A family history of SUD significantly increases risk. Environmental factors such as trauma, chronic stress, peer pressure, and adverse childhood experiences can trigger or worsen susceptibility by priming brain reward systems for substance reinforcement. Epigenetic modifications caused by environmental factors and substance use can alter gene expression related to stress, reward, and learning pathways, further influencing addiction risk. Social and psychological factors like curiosity, social pressure, emotional escape, and performance enhancement motivations can initiate use that escalates over time into compulsive patterns.
Over time, the brain's structure and function adapt in harmful ways, including reduced grey matter volume, impaired cognitive functions, altered emotional regulation, and weakened self-control. However, the brain retains neuroplasticity and can partially recover with sustained abstinence and supportive therapies.
The DSM-5-TR presents an 11-point list of symptoms to help mental health care professionals diagnose SUD, including social or interpersonal problems linked to substance use, psychological or physiological issues linked to substance use, hazardous or dangerous use, neglecting roles in life, cravings, using large amounts for a long time, withdrawal, tolerance, trying to quit repeatedly, spending a lot of time using, and giving up hobbies or activities to use.
Several organizations offer support and resources for those struggling with addiction, including SMART Recovery, Faces & Voices of Recovery, Amy Winehouse Foundation, Substance Abuse and Mental Health Services Administration (SAMHSA), Crisis Text Line, National Drug Helpline, and Partnership to End Addiction.
Reducing stigma can be achieved through providing correct education, creating safe spaces, educating healthcare professionals, reframing addiction as a mental health condition in the media, countering misinformation, treating people with respect and compassion, and being mindful of language used when speaking about addiction.
SUD reshapes the brain’s reward, memory, and control systems, driving compulsive substance use. Genetics, environment, epigenetics, and social factors interact to influence individual risk and disorder development.
[1] National Institute on Drug Abuse. (2020). Understanding Drug Use and Addiction. Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction [2] National Institute on Drug Abuse. (2020). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. Retrieved from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide [3] National Institute on Drug Abuse. (2020). Brain Development and Substance Use During Adolescence. Retrieved from https://www.drugabuse.gov/publications/brain-development-substance-use-during-adolescence [4] National Institute on Drug Abuse. (2018). Genetics of Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/research-reports/genetics/genetics-drug-abuse [5] National Institute on Drug Abuse. (2018). Neurobiology and Behavior of Drug Addiction. Retrieved from https://www.drugabuse.gov/publications/research-reports/neurobiology-behavior-drug-addiction/overview-neurobiology-drug-addiction
- The complex interplay of genetics, environment, epigenetics, and social factors can increase an individual's risk of developing SUD, as suggested by the National Institute on Drug Abuse's research reports on the genetics and neurobiology of drug abuse.
- Impaired decision-making and compulsive use can result from substance abuse affecting brain regions involved in impulse control, such as the prefrontal cortex, a finding supported by scientific literature on the effects of SUD on the brain.
- Addressing addiction as a mental health concern can aid in reducing stigma, including reframing it in the media and educating healthcare professionals, as recommended for reducing stigma by various organizations providing support and resources for those struggling with addiction.
