Frequently Asked Questions Substance Use/Dependence

Q: What are common substances that people abuse?

A: People can develop Substance Use Disorders to drugs, medications, or toxins. Typically substances are divided into 11 classes:¹

• Alcohol
• Amphetamines
• Caffeine
• Cannabis
• Cocaine
• Hallucinogens
• Inhalants
• Nicotine
• Opioids
• Phencyclidine (PCP)
• Sedatives, hypnotics, and anxiolytics

Learn more about these categories, including street and commercial names, intoxication effects, and potential health effects.

Q: What is the difference between substance abuse and dependence?

A: Both situations refer to unsuitable patterns of substance use that lead to significant impairment or suffering.

Substance Abuse
People who abuse substances may:

• Fail to fulfill major role obligations (e.g., poor work performance or repeated absences from work or school, neglect of children or household)
• Use substances in situations that are physically hazardous (e.g., driving an automobile or operating machinery when impaired by substance use)
• Experience substance-related legal problems (e.g., substance-related disorderly conduct, DUI)
• Continue to use substances despite having persistent or recurrent social or interpersonal problems caused or worsened by the effects of substances (e.g., arguments or physical fights)

Substance Dependence
People who are dependent upon a substance may experience:

• Tolerance, which refers to the need to increase amounts of the substance in order to achieve intoxication or the desired effect. A sign of tolerance is a diminished effect with continued use of the same amount of substance.
• Withdrawal, which refers to when someone develops a substance-specific syndrome when they stop or decrease substance use. The type and length of withdrawal symptoms vary depending upon the substance. A sign of withdrawal is the need to take the same or similar substance in order to avoid withdrawal symptoms.

People who are dependent upon substances may also:

• Take substances in a larger amount or over a longer period of time
• Want to cut down or control substance use, but may be unable to do so
• Spend a lot of time and effort doing whatever is necessary to obtain the substance or recovering from the negative effects of using the substance
• Give up or reduce social, occupation, or recreational activities because of substance use
• Continue to use the substance despite awareness of physical or psychological problems that are either caused or worsened by substance use

In summary, people who abuse substances likely experience negative consequences associated with substance use. People who are dependent upon a substance likely experience tolerance or withdrawal, and exhibit a pattern of compulsive substance use.

Q: What are the consequences of prolonged substance abuse and dependence?

A: Overdose, physiological reactions (e.g., arrhythmia), nausea, paranoia, poor decision making (e.g., risky sex), risk of injury or death, driving-related accidents, and legal consequences are a few of the immediate consequences of substance use.² Substance abuse can have negative secondary effects on others, such as family members and fellow service members (e.g., failure to perform responsibilities and interpersonal conflicts related to intoxication). Even though you might not be experiencing immediate negative consequences, you may experience problems down the road. Some of the long-term consequences of substance use include: social, financial, and legal problems, neurological impairments, cancer, cardiovascular disease, liver disease, and reproductive disorders.² It is important to recognize that the long-term consequences of substance abuse and dependence far outweigh the benefits of the immediate "rewards" of using the substance.

Q: How common are Substance Use Disorders?

A: According the National Institute on Alcohol and Alcoholism, at any given time nearly 14 million American adults abuse alcohol or are considered alcoholic. 71% report lifetime use of tobacco.³ Adult men are more likely to abuse alcohol and tobacco than adult women.² 110 million Americans (45.8% of the US population aged 12 and over) report having used an illicit drug at least once in their lifetime.³ In 2002, men were more likely to abuse illicit drugs than women.² More Over nine percent of Americans meet criteria for a current diagnosis of substance dependence or abuse.³ More

Of military respondents polled 3.4% admitted to using an illicit drug within the past 30 days, 33.85% reported that they smoked cigarettes, and 18.1% reported heavy alcohol use.⁴ Younger military personnel are more likely to abuse substances. More

Q: How do I recognize a substance use problem?

A: When use of a substance interferes with and individual’s functioning, to include their job, parenting and other relationships, safety, and health, substance use needs to be addressed.

Q: What treatments are helpful for Substance Use Disorders?

A: No single treatment is effective for all people. Several different types of psychotherapy can be effective for treatment of addiction to different substances More. Psychotherapy can be conducted individually or within groups. If people are dependent on certain drugs, such as heroin, nicotine, or alcohol, medications may be effective. Medications may also help treat withdrawal symptoms, but treating withdrawal is not the same thing as treating Substance Dependence. It is common for people to have lapses following treatment; therefore people often have to repeat treatment.²

Q: What resources are available to help prevent the development of substance use disorder?

A: A harm reduction approach to substance use attempts to help a user reduce the negative impact of drug and alcohol use. For example, harm reduction goals may include not driving while under the influence. If this goal is achieved, the individual may then target reducing the frequency or quantity of substance use.² Research has shown that a harm reduction approach is effective for helping young adults reduce problematic drinking.

Self-help harm reduction resources.

Q: Where can I find information about drug treatment programs?

A: Veterans can contact their local VA Hospital, or call the VA Health Benefits Service Center toll free at 1-877-222-VETS. Anyone can contact the Substance Abuse and Mental Health Services Administration for help finding a drug treatment program at 1-800-662-HELP, or online.

TRICARE beneficiaries and members enrolled in TRICARE Reserve Select can Find a TRICARE Provider online or call 1-866-284-3743 for assistance.

Q: Do I have to see a specialist in order to get help?

A: No. Your primary care doctor may be able to prescribe medications for your symptoms. You can discuss your concerns with your physician during your general medical appointment. There are also a number of steps you can take on your own to address substance use disorders. Twelve-step treatments are the most commonly utilized and mandated programs for substance abuse and dependence. Alcoholics Anonymous has over 2 million members. Narcotics Anonymous holds 31,0000 meetings daily in over 100 countries.² More information about Alcoholics Anonymous or Narcotics Anonymous. Finally, not all help needs to come from a professional. Often it is trusted family members, friends, or clergy who can be your best sources of support.

References:

¹ American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association.

² Marlatt, G.A., & Witkiewitz, K. (in press). Substance Use Disorders. In J. E. Fisher & W. T. O’Donohue (Eds.), Practice Guidelines for Evidence Based Psychotherapy. New York: Springer Publishing Company.

³ Substance Abuse and Mental Health Services Administration. (2005). Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 05-4062). Rockville, MD.

⁴ Bray, R.M., et al., (2002). Department of Defense Survey of Health-Related Behavior Among Military Personnel. Research Triangle Institute.