Addiction and Substance Use Disorders

What is addiction?

Addiction — clinically called substance use disorder — is a medical condition in which a person continues to use alcohol or drugs despite harmful consequences. It involves changes in brain systems related to reward, motivation, stress and self-control. It is treatable, and many people recover.

Signs

Signs of a substance use disorder can include:

• Using more, or for longer, than intended
• Wanting to cut down but being unable to
• Spending a lot of time obtaining, using or recovering from a substance
• Cravings
• Continuing to use despite problems at work, school, home or with health
• Needing more to get the same effect (tolerance), or withdrawal symptoms when stopping

These signs can occur with substance use disorders, but only a qualified professional can provide a diagnosis.

Causes and risk factors

Genetics, early exposure to substances, trauma, chronic stress and other mental health conditions are associated with a higher risk. Substance use disorders commonly occur alongside anxiety, depression and PTSD, and treating both together tends to work best.

Treatment

• Behavioral therapies such as CBT, motivational interviewing and contingency management.
• Medications for some substance use disorders, including opioid and alcohol use disorders.
• Medically supervised withdrawal when needed.
• Peer and family support, including mutual-help groups and family therapy.

Care can be outpatient, intensive outpatient, residential or inpatient depending on needs. See our guide to addiction treatment options.

General online mental health services are not substitutes for addiction treatment, but therapy through a service such as BetterHelp can help with co-occurring anxiety or depression once you are connected with specialist care.

Addiction as a health condition, not a moral failing

For decades, addiction was framed as a failure of willpower or character. Research now shows that substance use disorders involve changes in brain circuits that govern reward, motivation, memory and self-control, and that these changes can persist long after someone stops using. Using the language of health, such as “person with a substance use disorder” rather than “addict,” helps reduce stigma, which is itself a barrier to seeking care. Many people recover, often after more than one attempt, and relapse is a common part of a chronic condition rather than proof that treatment has failed.

A spectrum, not a switch

Clinicians describe substance use disorders as mild, moderate or severe, depending on how many criteria a person meets. Substance use itself exists on a spectrum, from occasional use to patterns that cause harm. Worth noticing are:

• Using to cope with stress, sleep problems, anxiety or low mood
• Needing more of a substance to feel the same effect
• Hiding or minimizing use
• Neglecting responsibilities or relationships
• Using in risky situations, such as driving
• Feeling unwell when you try to stop

Many people with substance use problems also have mental health conditions such as depression, anxiety or PTSD, and each can make the other harder to treat. This is why integrated care, which treats both at the same time, tends to work best.

Withdrawal and safety

Stopping some substances suddenly can be dangerous. Alcohol and benzodiazepine withdrawal can cause seizures and other life-threatening complications, and opioid withdrawal, while rarely life-threatening on its own, is intensely uncomfortable and carries a high risk of relapse and overdose afterwards. Don’t stop abruptly if you have been using heavily or for a long time without speaking to a healthcare professional. Medically supervised withdrawal, sometimes called detox, can make the process safer. Detox is a first step rather than a treatment in itself, and ongoing care afterwards lowers the chance of relapse.

How treatment works

Treatment is most effective when matched to the person and the substance. Common elements include:

• Behavioral therapies that build coping skills, change thinking patterns and strengthen motivation, such as CBT, motivational interviewing and contingency management.
• Medication for some conditions. Medicines are available for opioid use disorder and alcohol use disorder, and nicotine replacement and other medicines can help with tobacco. These are prescribed and monitored by a clinician and work best alongside psychosocial support.
• Mutual-help and peer groups, such as 12-step programs and other recovery communities, which many people find valuable for connection.
• Treatment of co-occurring conditions, including anxiety, depression, trauma and sleep problems.
• Family involvement. Family therapy can help repair relationships and teach families how to support recovery without enabling use.

The intensity of care ranges from brief outpatient counseling to residential programs. See addiction treatment for how to choose a program and questions to ask.

Supporting someone you care about

Watching a loved one struggle is painful. It often helps to:

• Learn about substance use disorders so you can respond with understanding rather than blame.
• Express concern calmly, using “I” statements about what you’ve noticed, at a time when the person is sober.
• Avoid ultimatums you won’t enforce, and set boundaries that protect your own wellbeing.
• Encourage professional assessment and offer practical help, such as researching options or going to a first appointment.
• Look after yourself; support groups for family members can help.
• In the US, keep naloxone, a medicine that can reverse an opioid overdose, accessible if someone you care about uses opioids, and learn how to use it.

When to seek help urgently

Call your local emergency number if someone has taken a substance and is unresponsive, has trouble breathing, has seizures, has chest pain, or seems at risk of harming themselves or others. If you are having thoughts of suicide, which are more common in people with substance use disorders, reach out to a crisis line; see Get Help Now. In the US, you can also contact the national helpline for substance use and mental health services (SAMHSA, 1-800-662-4357), which is free, confidential and open all day, every day.

Recovery is possible

Recovery is more than not using. For many people it means rebuilding health, relationships, work and purpose, and it often involves setbacks. Having a plan for cravings and high-risk situations, staying connected to support and continuing treatment for as long as it’s helpful all improve outcomes. If you’re ready to take a step, speaking with a primary care clinician or an addiction specialist is a good start. You don’t have to be at a crisis point to ask for help, and you don’t have to figure it out alone.