Patient Education:

What is Substance Use Disorder?

Many people mistakenly believe that addiction results from a lack of willpower or moral principles. In reality, addiction is a complex disease that alters the brain, making it hard to quit even for those who want to stop. However, research has uncovered effective treatments that can help people recover and lead fulfilling lives.

Drug addiction is a chronic disease where people compulsively seek and use drugs despite harmful consequences. Repeated drug use changes the brain, making it hard to resist intense cravings. These changes can persist, which is why addiction is considered a “relapsing” disease—people may return to drug use even after long periods of sobriety. Relapse is common, but doesn’t mean treatment failed. Like other chronic illnesses, addiction treatment must be ongoing and adapted to fit the person’s needs.

How Drugs Affect the Brain

Drugs target the brain’s reward system, flooding it with dopamine and creating feelings of pleasure. Normally, this system motivates healthy behaviors like eating or spending time with loved ones, but drugs hijack this system, reinforcing unhealthy behaviors.

Over time, the brain adapts by reducing its response to dopamine, leading to tolerance—needing more of the drug to achieve the same high. This often diminishes the ability to enjoy other activities as well.

Drug use also disrupts areas of the brain involved in:

• Learning
• Judgment
• Decision-making
• Stress management
• Memory
• Behavior

Why Do Some People Become Addicted While Others Don’t?

Addiction risk varies based on three key factors:

• Biology: Genetics account for about half of a person’s risk. Other factors like gender, ethnicity, and mental health also play a role.
• Environment: Family, friends, economic conditions, and life experiences, such as peer pressure, abuse, or early exposure to drugs, can influence addiction risk.
• Development: Drug use during key stages of life, especially adolescence, increases the risk. Teen brains are still developing in areas that control decision-making and self-control, making them more likely to engage in risky behaviors like drug use.

Can Drug Addiction Be Treated or Prevented?

Addiction can be effectively managed. Combining medications with behavioral therapy is the most effective approach. Treatment must be tailored to the individual’s needs and updated as they change.

Drug use and addiction can often be prevented. Education and outreach programs that involve families, schools, and communities are effective. When young people understand the risks of drug use, they are less likely to start. Parents, teachers, and healthcare providers play a critical role in educating youth and preventing drug use.

Co-Occurring Disorders and Other Health Conditions

Mental health and substance use disorders affect people from all walks of life and all age groups. These illnesses are common, recurrent, and often serious, but they are treatable and many people do recover. Mental disorders involve changes in thinking, mood, and/or behavior. These disorders can affect how we relate to others and make choices. Reaching a level that can be formally diagnosed often depends on a reduction in a person’s ability to function as a result of the disorder. For example:

• Serious mental illness is defined by someone over 18 having (within the past year) a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.
• For people under the age of 18, the term “Serious Emotional Disturbance” refers to a diagnosable mental, behavioral, or emotional disorder in the past year, which resulted in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities.
• Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

What are Co-Occurring Disorders?

The coexistence of both a mental health disorder and a substance use disorder (SUD) is referred to as co-occurring disorders. Co-occurring disorders may include any combination of two or more SUDs and mental disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR). Importantly, no specific combinations of mental and substance use disorders are uniquely defined as co-occurring disorders.

According to SAMHSA’s 2022 National Survey on Drug Use and Health, approximately 21.5 million adults in the United States have a co-occurring disorder. People with mental illness are at a higher risk of developing an SUD compared to those without mental illness. Similarly, individuals with substance use disorders are particularly vulnerable to developing primary conditions or chronic diseases.

It is important to note that combining medications used for treating SUDs with anxiety treatment medications—such as benzodiazepines—can have serious adverse effects. Common benzodiazepines include Xanax, Valium, and Klonopin, among others.

The most common mental disorders:

• Anxiety and mood disorders
• Schizophrenia
• Bipolar disorder
• Major depressive disorder
• Conduct disorders
• Post-traumatic stress disorder
• Attention deficit hyperactivity disorder

Patients being treated for mental disorders often misuse the following types of substances:

• Alcohol
• Tobacco
• Opioids
• Stimulants
• Marijuana
• Hallucinogens
• Prescription drugs

HIV, AIDS, and Viral Hepatitis

HIV, AIDS, and viral hepatitis are important public health concerns for both patients and health professionals in substance use disorder treatment programs. Use of medications for SUD treatment typically involves HIV and hepatitis antibody testing at admission, or a referral for antibody testing.

HIV and hepatitis prevention and reduced transmission are key goals of OTPs and other programs designed to treat substance use disorders. In addition, HIV testing and risk-reduction counseling, have been shown to stop or decrease drug use and related risk behaviors, including risky injection practices and unsafe sex.

HIV and AIDS in Treatment

Drug use is an important driver of the HIV epidemic. According to the CDC’s HIV and Injection Drug Use, about 1 in 10 new HIV diagnoses in the United States are attributed to injection drug use (2,492 cases) and male-to-male sexual contact and injection drug use (1,372 cases). CDC reports that in 2018, adult and adolescent people who inject drugs in the US accounted for 10 percent of all new HIV diagnoses.

HIV is transmitted by contact with the blood or other body fluids of an infected person. This can occur during unprotected sex or through the sharing of needles. In addition, untreated infected women can pass HIV to their infants during pregnancy, delivery, and breastfeeding. Alcohol and drug misuse can also worsen the symptoms of HIV, causing greater neuronal injury and cognitive impairment.

Hepatitis in Treatment

There are three major strains of hepatitis virus infection: hepatitis A, hepatitis B, and hepatitis C. People at high risk for infection can be protected by vaccination against hepatitis A and hepatitis B. Currently, there is no vaccination against hepatitis C.

• Hepatitis A – A self-limiting foodborne pathogen, can induce severe liver disease in drug users already infected with another hepatitis virus.
• Hepatitis B – Can be spread through sexual contact, blood transfusions, or by the re-use of contaminated needles.
• Hepatitis C – Injection drug use is the major source of hepatitis C infection in the United States, and a risk factor for contracting and spreading hepatitis C.

What is Opioid Overdose? Treatments & Preventions

Substance use disorders (SUDs) impact the lives of millions of Americans. More than 100,000 people died from drug overdoses from April 2020 to 2021, an increase of 28.5% from the prior year, according to a report by the Centers for Disease Control and Prevention (CDC).

Opioid Overdose Causes

An opioid overdose can occur when a person:

• Overdoses on an illicit opioid drug, such as heroin or morphine
• Overdoses on methadone
• Accidentally takes an extra dose
• Deliberately misuses a prescription opioid or opioid-based pain medication in way that was not as prescribed by their physician
• Mixes opioids with other prescriptions, alcohol, or over-the-counter medications. Overdoses can be fatal when mixing an opioid with anxiety treatment medications or derivatives of Benzodiazepine, such as Xanax or valium.
• Uses medication prescribed for someone else. Children are particularly vulnerable to accidental overdoses if they take medication not intended for them.

How to Prevent Opioid Overdose

Opioid overdose can occur even with prescription opioid pain relievers and medications used in treating SUD such as methadone and buprenorphine. In addition, individuals using naltrexone for MOUD have a reduced tolerance to opioids, and therefore, using the same, or even lower doses of opioids used in the past, can cause life-threatening consequences.

Always follow the instructions you receive with your medication. Ask your practitioner or pharmacist if you have questions or are unsure of how to take your medication.

The following tips can help you or a loved one avoid opioid overdose:

• Take medicine as prescribed by your practitioner
• Do not take more medication or take it more often than instructed
• Never mix pain medicines with alcohol, sleeping pills, or illicit substances
• Never take anyone else medication
• Prevent children and pets from accidental ingestion by storing your medication out or reaching it. For more information, visit CDC’s Up and Away educational campaign.
• Dispose of unused medication safely. Talk to your MOUD practitioner for guidance, or for more information on the safe disposal of unused medications, visit FDA’s disposal of unused medicines or DEA’s drug disposal webpages.

How to Recognize Opioid Overdose

Opioid overdose is life-threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives.

Call 911 immediately if a person exhibits ANY of the following symptoms:

• Their face is extremely pale and/or feels clammy to the touch
• Their body goes limp
• Their fingernails or lips have a purple or blue color
• They start vomiting or making gurgling noises
• They cannot be awakened or are unable to speak
• Their breathing or heartbeat slows or stops

How to Treat Opioid Overdose

Family members, caregivers, or the people who spend time with individuals using opioids need to know how to recognize the signs of an overdose and how to administer life-saving services until emergency medical help arrives. Individuals experiencing an opioid overdose will not be able to treat themselves. Naloxone was approved by the Food and Drug Administration (FDA) as the first over the counter medication to prevent opioid overdose. Check with your healthcare provider, pharmacy, community-based distribution programs, local public health organizations or the local health departments on how to obtain naloxone in your state.

If you suspect someone is experiencing an opioid overdose, take action immediately:

• Call 911
• Begin CPR if the person has stopped breathing or if breathing is very weak (best performed by someone who has training)
• Treat the person with naloxone or nalmefene to reverse opioid overdose (if available)