Substance use disorder

Understanding Substance-Related Disorders 

Substance use disorder is a serious condition where the repeated use of drugs, from alcohol and caffeine to opioids and unknown substances, repeatedly triggers the brain’s reward system. This disorder often leads individuals to disregard their normal activities and responsibilities in pursuit of intense pleasure through the use of drugs. 

Substance use disorders involve 10 different types of drugs:

• Alcohol
• Caffeine
• Cannabis
• Hallucinogens (including phencyclidine and other hallucinogens)
• Inhalants
• Opioids
• Sedatives
• Hypnotics
• Anxiolytics (drugs used to relieve anxiety) 
• Stimulants (such as amphetamines and cocaine)
• Tobacco
• And unknown substances. 

All of these drugs share a common feature: they activate the brain’s reward system, which reinforces behaviors and creates memories. This can cause people to avoid or ignore their normal activities and responsibilities. Instead of engaging in healthy pleasurable behaviors, individuals use drugs to directly stimulate the reward system. Although each type of drug uses different ways to produce this feeling, they all typically make users feel a sense of pleasure or “high.”

Moreover, people with lower self-control, possibly due to problems with brain function, are more likely to develop substance use disorders. This suggests that signs of these disorders can appear in a person’s behavior long before they actually start using drugs.

Substance-related disorders are categorized into two main groups: substance use disorders and substance-induced disorders. Substance-induced disorders include conditions such as intoxication, withdrawal, and other mental disorders caused by substance use or medication. These can involve: 

• Psychotic disorders
• Bipolar disorders
• Depression
• Anxiety
• Obsessive-compulsive disorders
• Sleep disorders 
• Sexual dysfunctions 
• Delirium
• And cognitive problems.

Substance Use Disorder

A substance use disorder is marked by a combination of mental, behavioral, and physical symptoms showing that a person keeps using a substance despite facing serious problems because of it. A key feature of these disorders is that they cause permanent changes in the brain, especially in severe cases, which can continue even after abrupt withdrawal. These brain changes often lead to repeated relapses (deterioration after a period of improvement) and strong drug cravings when exposed to drug-related triggers. Because of these persistent effects, long-term treatment approaches may be necessary.

Prevalence of Substance-Related Disorders 

An article from 2009 examined the prevalence of substance-related disorders among young adults in Finland. The study found that about 14.2% of young adults have experienced either abuse or dependence on substances at some point in their lives. Specifically, 13.1% of the young adults had issues related to alcohol, while 4.4% dealt with illicit substance disorders (drugs that are illegal to own or consume). These findings suggest that substance-related issues are quite common among young adults, particularly regarding alcohol.

Furthermore, another study from 2019 explores the prevalence of substance-related disorders in Germany. It finds significant use of legal substances like alcohol and tobacco, as well as illegal drugs among the German population. Approximately 13.5% of Germans aged 18 to 64 have at least one substance-related disorder. Specifically, 3.1% of the population suffers from alcohol dependence, and an even higher percentage, 8.6%, show tobacco dependence. The use of illegal drugs such as cannabis and amphetamines (a synthetic, addictive, mood-altering drug) is also notable, with 7.1% using cannabis and smaller percentages for other drugs like cocaine and amphetamines.

Both studies show that there is a high prevalence of both legal and illegal substances. The studies also point to the need for effective prevention and intervention strategies to manage this significant public health issue.

Diagnosis of Substance Use Disorder 

The diagnosis of a substance use disorder is based on a harmful pattern of behaviors related to substance use. To make it easier to understand, the criteria are grouped into four categories: impaired control, social impairment, risky use, and pharmacological criteria.

Impaired Control

Impaired control over substance use implies taking the substance in larger amounts or for a longer time than intended, wanting to cut down or control use but failing repeatedly, and experiencing intense cravings for the substance. Cravings can be powerful, especially in places where the substance was previously used, and are linked to brain areas responsible for reward. Cravings are also often monitored during treatment as they can indicate a potential relapse.

Social Impairment 

The second group of criteria for diagnosing a substance use disorder is social impairment. This includes repeatedly failing to meet important responsibilities at work, school, or home due to substance use. The person might keep using the substance even though it causes ongoing social or relationship problems. They may also give up or reduce important social, work, or recreational activities because of substance use. This can lead to withdrawing from family activities and hobbies to use the substance instead.

Pharmacological Criteria

The last group of criteria for diagnosing substance use disorders is pharmacological. Tolerance means needing a much higher dose of the substance to get the same effect or experiencing a much weaker effect with the usual dose. Tolerance levels can vary widely among individuals and substances, affecting different parts of the central nervous system (the body’s processing center, brain and spinal cord). It can be challenging to identify tolerance based on history alone, so lab tests can be useful (e.g., high blood levels with minimal signs of intoxication suggest tolerance). It’s important to distinguish tolerance from natural differences in how individuals initially react to a substance. For example, some people might not show signs of intoxication after several drinks, while others of the same weight might display clear symptoms like slurred speech and lack of coordination.

Withdrawal

Withdrawal occurs when the levels of a substance in the blood or tissues drop after an individual has been using the substance heavily and regularly. When symptoms of withdrawal appear, the person retakes the substance to feel better. These symptoms can vary widely depending on the substance, and each drug class has its own set of criteria for withdrawal. Noticeable and measurable withdrawal symptoms are common with:

• Alcohol
• Opioids
• Sedatives
• Hypnotic,
• And anxiolytics.

Stimulants (like cocaine and amphetamines), tobacco, and cannabis may cause withdrawal symptoms as well, but usually, they are less visible. Significant withdrawal symptoms haven’t been documented for phencyclidine, other hallucinogens, and inhalants, so this criterion isn’t used for these substances. Tolerance and withdrawal are not required to diagnose a substance use disorder, but a history of withdrawal often indicates a more severe condition.

Severity

Substance use disorders can vary in severity from mild to severe, depending on the number of symptoms present. Mild disorders are indicated by two to three symptoms, moderate by four to five symptoms, and severe by six or more. The severity can change over time, reflected by how often or how much the substance is used, based on self-reports, reports from others, clinical observations, and biological tests.

Gender and Ethnicity Differences of Substance Use Disorders 

A study published in 1999 argues that there are significant gender differences in substance use disorders. Men are more likely to have substance use disorders than women. For example, men are over five times more likely than women to have an alcohol use disorder and two to three times more likely to have a drug use disorder. Despite these differences, the gap between men and women is smaller for tobacco use, with only a slightly higher percentage of men having tobacco dependence compared to women. The article also discusses how societal attitudes towards substance use vary by gender. Women with substance use disorders face more social stigma than men. This societal response impacts women more severely, affecting family life and increasing the likelihood of being separated or divorced.

However, an article from 2004 suggests that the gap between men and women in substance-related disorders is getting smaller worldwide, particularly as societal roles for women evolve. Historically, men have been more likely to develop these disorders, but recent trends show that women are catching up, especially in younger age groups. This shift is attributed to several factors including changes in social roles, earlier initiation into substance use among women, and differences in how men and women progress to dependence. This finding has significant implications for prevention and treatment, suggesting that interventions should be adapted to address the rapid progression of substance dependence in women.

Moreover, ethnicity may play a significant role as well. According to a study from 2011, Native Americans exhibited the highest prevalence of substance use (47.5%) and substance-related disorders (15.0%) among adolescents in the United States. The study suggests that cultural and community-specific factors might influence these trends, emphasizing the need for targeted intervention strategies to address these differences effectively.

The Efficacy of Cognitive-Behavioral Therapy (CBT) in Substance-Related Disorders

A study published in Psychiatric Clinics claims that CBT is effective for treating substance-related disorders. Research shows that CBT helps people reduce their substance use and maintain these changes over time. It includes a range of strategies, such as understanding the triggers for substance use, learning new coping skills, and changing thoughts related to substance use. These techniques can be applied in individual or group settings and are helpful for various substances, including alcohol and drugs.

Similarly, a study conducted in 2020 states that CBT effectively helps individuals learn to manage their substance use through skill-building and changing behavior. It notes that while CBT can be delivered in person or through computer programs, both methods focus on teaching skills like coping with cravings, managing triggers, and avoiding high-risk situations. Crucially, the article points out that the continuous use of these skills after treatment can lead to continued improvement, emphasizing the lasting impact of CBT.

Furthermore, an article published in 2021 describes CBT as a versatile approach that helps change the harmful patterns of thinking and behavior associated with substance use. It indicates that CBT is effective for a wide range of substances, including alcohol and drugs, and that it can be adapted for individual or group therapy settings.

CBT is thus a proven way to help people deal with substance abuse problems. This therapy helps individuals understand what triggers their substance use and teaches them new ways to cope and change harmful thinking patterns related to their addiction. As mentioned, one of the most important benefits of CBT is that the skills learned continue to help individuals improve over time, making it a powerful tool for long-lasting recovery.

How the Sintelly App can Help 

The Sintelly app offers a range of innovative features designed to support individuals struggling with substance-related disorders. 

Sintelly features psychodiagnostic tests that use AI-driven analysis to provide valuable insights into users’ mental and emotional health. These tests help identify specific issues related to substance use. The tests are designed to accurately assess the seriousness of addiction symptoms and provide a clear picture of the user’s current state. After completing the tests, results are immediately available, along with detailed analyses and recommendations.

Sintelly allows users to track their addiction severity levels over time. By regularly taking these tests, users can observe changes in their condition, helping them recognize patterns, evaluate the effectiveness of therapies, and adjust their treatment strategies as needed. This continuous evaluation is crucial for long-term success in overcoming addiction.

The app includes various CBT exercises analyzed by AI, which offers personalized summaries, insights, and advice. Users can track their progress and receive customized recommendations, making it easier to stay committed to their recovery journey. The exercises focus on building skills such as managing triggers, avoiding high-risk situations, and changing harmful thought patterns.

Sintelly’s advanced CBT therapy chatbot engages users in dynamic, interactive conversations and provides personalized, context-aware responses that adapt to each user’s unique situation. The chatbot offers immediate support and guidance, helping users manage cravings, identify triggers, and develop healthier coping mechanisms.