Substance Use Disorders

Substance Abuse and Behavior: What Every Lawyer Should Know

substance abuse

21% of the US Population Used Illicit Substances Within the Past Year

Among individuals aged 12 or older, 61.2 million people, approximately 21.9% of the United States population, used illicit substances within the last year.

Substance Use Disorder

Of this group, 46.3 million individuals, approximately 16.5% of the population, met diagnostic criteria for a substance use disorder in the past year, including 29.5 million individuals with alcohol use disorder and 24 million with a drug use disorder (Richesson et al., 2022).

What is a Substance Use Disorder?

According to the American Psychiatric Association (2020), a substance use disorder is defined as a problematic and uncontrolled pattern of substance use that persists despite the resulting harmful consequences. These harmful consequences, which are also described as functional impairments, resulting from substance use impact an individual’s ability to function in their day-to-day life.

Cognitive, Behavioral and Physiological Symptoms

Further, outside of the problematic pattern of use, substance use disorders are often tied to a cluster of cognitive, behavioral, and physiological symptoms including

  • distorted thinking and behaviors
  • changes in brain structure and function
  • personality change, and issues with
  • judgment
  • decision making
  • memory
  • learning, and
  • impulse control

Myths About Substance Use Disorders

There are many factors that contribute to the development of substance use disorders including genetics, peer pressure and curiosity, use as a means to cope with emotional distress, environmental stressors, and mental health issues such as anxiety and depression.

Below are some common myths about substance use:

Substance Abuse Graphic

MYTH: Only “hard” drugs like cocaine and methamphetamine are addictive

  • While the use of drugs such as cocaine and methamphetamine are dangerous and come with many risks, drugs that are consumed more often in a recreational manner such as alcohol and marijuana can lead to addiction as well. Even prescription medications such as opioid painkillers can lead to a pattern of problematic use and eventually addiction.

MYTH: Individuals struggling with addiction can stop anytime they want

  • Staying sober can be a difficult feat. When one becomes dependent on a substance, the person’s body physically needs the drug in order to function. Thus, it is often not as simple as wanting to stop misusing substances.

MYTH: Rehabilitation does not work

  • Many individuals will relapse after receiving treatment. Substance use disorders are a powerful and debilitating disease and often take more than one try or approach to achieve and maintain sobriety. However, treatment and rehabilitation are possible and proven effective.
Substance Abuse Graphic

Substance Use and Effects on the Brain

Before we get into how substances affect the brain, we need to understand how the brain works.

The brain consists of billions of cells called neurons that control everything from breathing to talking to thinking. These neurons are organized into circuits and networks and each neuron acts as a switch, controlling the flow of neurotransmitters, which are chemicals that carry information throughout the brain between cells.

The Brain’s Signals

Neurons communicate with other neighboring neurons through synapses. When a singular neuron reaches an adequate level of electrical charge, it fires off a signal that travels to other neurons in the circuit through axons, which are essentially branches attached to the neuron through which the signal travels (National Institute of Neurological Disorders and Stroke, 2023).

A Substance’s Interference

Substances interfere with how neurons send, receive, and process signals in the brain through neurotransmitters.

For example, substances such as cannabis and heroin are able to activate neurons because their chemical makeup is similar to that of a natural neurotransmitter in the body.

As a result, the substance has the ability to attach to and activate neurons. However, the neuron is not activated in the same manner a natural neurotransmitter would activate it, thus leading to the transmission of abnormal messages (National Institute on Drug Abuse, 2020).

Some areas of the brain affected by substance use are the basal ganglia and the prefrontal cortex:

Basal Ganglia

This structure, also known as the reward circuit, plays an important role in motivation and generating the pleasurable effects of healthy activities such as eating and socializing. It is also important in the formation of habits. When one uses substances, this circuit becomes “over-activated,” resulting in the euphoric feeling associated with a drug high. However, with repeated exposure, the circuit adapts to the presence of the substance and lessens the sensitivity, making it harder to experience pleasure from things other than that substance.

Prefrontal Cortex

This structure is responsible for the ability to think, plan, solve problems, make decisions, and maintain self-control over impulses.

Research shows that this area of the brain is the last to develop and mature.

A person with a substance use disorder seeks the substances compulsively with reduced impulse control which then impairs their ability to appropriately think, plan, and make well-informed decisions.

How to Treat Substance Use Disorders

Substance Abuse Graphic

Now that we understand how substance use disorders impact an individual’s functioning, how do we treat them?

There are several treatment options for substance use disorders including medical interventions and therapeutic or rehabilitation services/programs to assist an individual in reaching and maintaining sobriety.

Often a combination of medical intervention and therapy is the best way to combat and treat addiction. However, despite the mass number of individuals in the United States that need substance abuse treatment, many will never receive it.

Substance Abuse Graphic

Medications

When it comes to opioid use disorders, medication may be an appropriate first line of treatment. These medications can help individuals with an opioid addiction reduce cravings and withdrawal symptoms as well as block the effects of opioids.

Medications approved by the Food and Drug Administration to treat opioid use disorders include methadone, buprenorphine, and naltrexone.

These medications act as either opioid agonists or antagonists by acting on opioid receptors in the brain, blocking the activation of these receptors or mimicking the effects but in a much slower manner that does not produce the euphoric effects that one would experience if they directly used an opioid (National Institute on Drug Abuse, 2021).

Medication-Assisted Treatment (MAT)

MAT is an evidence-based treatment that combines medications and therapeutic interventions most often to treat opioid use disorders in an effort to provide a “whole-patient” approach to treating substance use disorders.

While the medication helps to reduce cravings and withdrawal symptoms, therapy then helps to target the root cause of the substance use and related behaviors in an effort to enact behavioral and lifestyle changes.

Myths About MAT

There are a number of myths about MAT programs such as the belief that if one is still using substances they are not in recovery or that it could be considered trading one addiction for another.

However, when prescribed, monitored, and used appropriately, MAT programs can be very effective in normalizing one’s brain chemistry and physical functions so an individual can focus on changing behavioral and thinking patterns that contribute to addiction (South Dakota Departments of Health and Social Services, n.d.)

Other Treatment Options

Aside from medication-assisted treatments, there are a number of additional treatment options that are considered effective in addressing substance use disorders including

  • 12-step programs
  • outpatient therapy or counseling, and
  • inpatient residential or partial hospitalization treatment programs

Factors that Drive Treatment Decisions

Often the decision about what type of treatment will be most effective depends on the severity of the substance use disorder, the presence of co-occurring mental health issues, one’s support and living situation, and the ability to pay for treatment.

Inpatient Residential Treatment 

Inpatient residential treatment including “Rehab” affords individuals an opportunity to remove themselves from environments in which they may have been exposed to drug use and associated triggers and to live in a facility where they typically stay between 30 and 90 days and receive daily support in the form of group and individual therapy as well as medical intervention as needed, such as for withdrawal symptoms.

Depending on an individual’s insurance, these programs can be costly.

Outpatient Treatment

Outpatient treatment offers similar interventions in a more limited capacity and is often recommended as a transitional step down from inpatient treatment (Kaiser Healthwise Staff, 2023).

Outpatient treatment is a good option as well for those who are unable to leave their home or place of employment for an extended period of time.

With this, an individual will typically participate in individual and group therapy a few times per week while still living in the community.

Many inpatient and outpatient programs will offer and/or recommend that an individual also participate in Alcoholics Anonymous or Narcotics Anonymous meetings, which typically follow the structure of a 12-step program.

12-Step Program

The 12-step program is designed to encourage individuals to accept their addiction as a chronic, progressive disease and to enhance individual maturity and spiritual growth while helping others who are also struggling with addiction (Donovan et al., 2013).

Features of the 12 Steps

The 12 steps cover a wide range of factors including accepting powerlessness over the substance, taking a moral inventory, admitting to one’s wrongs, and making amends with those that have been harmed by one’s addiction.

The draw of 12-step programs is often the social piece in which individuals become involved in a social network and are encouraged to ask for help, get a sponsor, go to meetings, and become actively involved in the 12-step community.

Treatment Perspective

Overall, while there is a multitude of research on substance use disorders, their prevalence, and effective treatment methods, overdoses and other drug-related deaths remain a leading cause of death for individuals in the United States.

Many individuals have been either directly or indirectly impacted by substance abuse at one point in their lives, and unfortunately, as mentioned, many of the individuals that need support and treatment will never receive it due to a complex combination of social, societal, individual, and even cultural factors.

Remaining educated on the issue can serve as a first line of defense in understanding and addressing rampant substance abuse in the United States on an individual level.

References:

Colon-Rivera, H. & Balasanova, A. (2020). What is a substance use disorder? American Psychiatric Association. https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder

Donovan, D.M., Ingalsbe, M.H., Benbow, J., & Daley, D.C. (2013). 12-step interventions and mutual support programs for substance use disorders: An overview. Social Work in Public Health, 28(0), 313-332. doi: 10.1080/19371918.2013.774663

Kaiser Healthwise Staff. (2023, March 22). Inpatient and outpatient treatment for substance use disorder. Kaiser Permanente.

https://healthy.kaiserpermanente.org/southern-california/health-wellness/health-encyclopedia/he.inpatient-and-outpatient-treatment-for-substance-use-disorder.ad1101
National Institute on Drug Abuse (NIDA). (2020). Drugs, brain, and behavior. https://nida.nih.gov/sites/default/files/soa.pdf

National Institute on Drug Abuse (NIDA). (2021). Medications to treat opioid use disorder research report: How do medications to treat opioid use disorder work? https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work

National Institute of Neurological Disorders and Stroke. (2023). Brain basics: The life and death of a neuron. https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-life-and-death-neuron#:~:text=Neurons%20are%20information%20messengers.,cord%2C%20and%20the%20entire%20body.

Penn Foundation. (n.d.). Myths and misconceptions about substance use. St. Luke’s University Health Network and Penn Foundation Behavioral Health Services. https://www.pennfoundation.org/news-events/articles-of-interest/myths-and-misconceptions-about-substance-use/

Richesson, D., Magas, I., Brown, S., & Hoenig, J. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 national survey on drug use and health. Substance Abuse and Mental Health Services Administration (SAMHSA).

https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRRev010323.pdf

South Dakota Departments of Health and Social Services. (n.d.). Facts about medication-assisted treatment.

https://dss.sd.gov/formsandpubs/docs/BH/BHAO10_MAT_Brochure.pdf

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