The Detection and Treatment of Substance Use Disorder

Key Points

• A person's frequency, intensity and quantity of substance use will help determine their diagnosis; classified into mild, moderate or severe based on the symptoms.
• Different drugs present varied manifestations. Changes in weight, optometry, speech and reflexes are common. Patients may also have needle marks, rashes or secretions around the mouth and nose.
• Substance use disorder can shorten life expectancy as a result of health consequences, including high blood pressure, liver and heart disease, lung, bowel, throat, and stomach cancer, pancreatitis and significant weight loss or gain.

Taking drugs in a way not prescribed can lead to a reliance that can spiral out of control. When people become psychologically or physiologically dependent on drugs for daily functioning and can't operate without them, that's substance use disorder (SUD).

Common symptoms

Most people will encounter a wide range of substances throughout their lives. Some are more prevalent and socially acceptable, such as caffeine, tobacco and alcohol.

Other substances—like hallucinogens, stimulants and opioids—can be safely prescribed by medical professionals for justifiable treatments. But they've earned a notorious reputation for their addictive qualities and detrimental effects on mental, physical and even sexual health.

"Signs that someone might be having a problem with drugs or alcohol include changes in personality or behavior patterns, sudden and often large swings in mood, increased irritability and angry outbursts," said David Deyhimy, M.D., an addiction medicine expert and the medical director of MyMATClinic in Laguna Hills, California.

Giving up pleasurable activities, social withdrawal or isolation, changes in work or school performance, frequent unexplained illness and missing obligations are other common signs, he said.

There are 11 specific diagnostic criteria used to diagnose SUD, according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

David Tzall, Psy.D., a licensed psychologist in Brooklyn, New York, listed important signs potentially signaling substance use disorder. These include the following:

• Engaging in risky activities and behaviors.
• Continuing to use the drug or alcohol despite having persistent or recurrent social or interpersonal problems, such as legal, social, financial and health issues.
• Spending large amounts of time thinking about, acquiring, using or recovering from substance use.
• Taking larger amounts of the drug or alcohol over longer periods than you intended.
• Experiencing withdrawal when you try to cut down or stop using.

A person's frequency, intensity and quantity of substance use will determine the quality of diagnosis, Tzall said. It can then be classified into mild, moderate or severe based on the number of symptoms that match.

The final diagnosis will be performed by a medical practitioner, who will conduct clinical assessments and interviews, observe the patient's behavior and obtain a comprehensive medical history.

Understandably, different drugs present equally varied manifestations. Changes in weight, optometry (pupil contraction or dilation and redness), speech and reflexes are common.

Patients may also have needle marks and rashes or secretions around the mouth and nose.

Infections are another area of concern, especially for those using intravenous drugs or engaging in risky sex acts.

Long-term risks

Substance use disorder is accompanied by an extensive list of repercussions that worsen with time. Substance use disorder can shorten life expectancy as a result of health consequences, said Olalekan Otulana, M.B.Ch.B., a medical reviewer at Addiction Advocates in Stevenage, United Kingdom.

These health issues may include the following:

• High blood pressure
• Liver and heart disease
• Lung, bowel, throat and stomach cancer
• Pancreatitis
• Significant weight loss or gain

Chronic drug users often face renal and urinary system complications. Toxins in the blood—including drugs—and waste are filtered through the kidneys and travel through the urinary tract for expulsion.

If these organs are injured, waste can accumulate and cause kidney failure.

Damage to the urinary tract can lead to recurrent urinary tract infections (UTI). A UTI can make sex painful and potentially add extra strain to relationships.

Psychologically, Otulana reported incidences of broken relationships, job loss and mental health disorders like anxiety or depression. Paranoia is another notable affliction, stemming directly from the substance itself or the fear of discovery by loved ones or authorities.

Shame and desperation surrounding addiction are detrimental to self-esteem, spurring self-harm and even suicide, which have a strong positive correlation to SUD.

Recommended

• Understand the Risks of Substance Abuse: Millions of Americans abuse substances. Don't let that lead to health problems and addiction.
• How Do Opioids Affect the Brain and What Are They?: This broad class of pain relievers is effective but there are long-term effects of opioid use.
• Why Would Anyone Take Fentanyl?: This opioid is capable of a potency up to 100 times that of morphine. Fentanyl poses a real risk.

When should you seek treatment?

Otulana advised getting help for substance use disorder upon displaying any of the relevant DSM-IV criteria. Early interventions save lives.

Look for indicators indicating it's time to get help. These may include:

• Increased tolerance
• Withdrawal
• Widespread subsequent problems
• Neglecting important obligations

Find a doctor specializing in addiction medicine and mental health who practices or advocates evidence-based treatments, Deyhimy said.

SUD is a legitimate disease causing physiological brain changes. A comprehensive understanding of the psychological background of addiction is required to receive the right treatment.

In other words, other medicinal practices are needed in conjunction with therapy. Doctors will then decide on the appropriate level of care based on case severity.

Treatment plans should be individualized, Tzall said.

Outpatient treatment

According to Tzall, outpatient treatment can vary in intensity and duration, but the key to their success is that individuals can attend therapy sessions or programs regularly to receive help while still living at home.

This format works best for patients with less severe symptoms. It's kind of like a step-down schedule for those who've already completed inpatient treatment.

Tzall described intensive outpatient programs (IOPs) providing rigorous, structured care involving several hours of therapy per day, several days a week. IOPs typically offer individual counseling, group therapy, educational sessions and relapse prevention strategies. These programs may include medical and psychiatric support.

Inpatient treatment

The maximum level of care for substance use disorder is inpatient treatment. This schedule of treatment is considered only when outpatient programs haven't worked, the person has comorbid mental health disorders or is a threat to themselves or others.

Patients live at a facility, rehab center or hospital for inpatient treatment where they can receive 24-hour monitoring and support for a designated period.

Many SUD patients undergo a detox period before treatment.

"A detox is required to physically withdraw from the addictive substance to remove tolerance to the drug, which typically takes five to seven days," Otulana said.

When withdrawal reaches a climax, it can be serious and could lead to fatality. Tzall noted that this is especially true for opioids or alcohol, which can lead to opioid withdrawal syndrome (OWS) or delirium tremens (DTs), respectively.

"Medications such as methadone, buprenorphine or naltrexone can help manage complications, reduce cravings and support long-term recovery," Otulana said.

There are various therapies known to target addiction, such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). They can be part of a group or individual session.

"Groups provide peer support, a sense of community and a platform for sharing experiences," Tzall said. "Individual therapy focuses on understanding the underlying factors contributing to substance use, developing coping mechanisms and setting goals for recovery."