What Is Substance Abuse?

by National Institute of Health

Alcoholism and drug dependence and addiction, known as substance use disorders, are complex problems. People with these disorders once were thought to have a character defect or moral weakness; some people mistakenly still believe that. However, most scientists and medical researchers now consider dependence on alcohol or drugs to be a long-term illness, like asthma, hypertension (high blood pressure), or diabetes. Most people who drink alcohol drink very little, and many people can stop taking drugs without a struggle. However, some people develop a substance use disorder - use of alcohol or drugs that is compulsive or dangerous (or both).

Why Do Some People Develop a Problem but Others Don't?

Substance use disorder is an illness that can affect anyone: rich or poor, male or female, employed or unemployed, young or old, and any race or ethnicity. Nobody knows for sure exactly what causes it, but the chance of developing a substance use disorder depends partly on genetics - biological traits passed down through families. A person's environment, psychological traits, and stress level also play major roles by contributing to the use of alcohol or drugs. Researchers have found that using drugs for a long time changes the brain in important, long-lasting ways. It is as if a switch in the brain turned on at some point. This point is different for every person, but when this switch turns on, the person crosses an invisible line and becomes dependent on the substance. People who start using drugs or alcohol early in life run a greater risk of crossing this line and becoming dependent. These changes in the brain remain long after a person stops using drugs or drinking alcohol.

Even though your family member has an illness, it does not excuse the bad behavior that often accompanies it. Your loved one is not at fault for having a disease, but he or she is responsible for getting treatment.

Q: My husband says that he is an addict. How can this be possible when he still has a good job? A: Understanding how a person can be dependent on alcohol or drugs and still keep a good job is difficult. The media often portray people with substance use disorders as unemployed, unproductive, criminal, and homeless. However, many people who are dependent on alcohol or drugs do not fit this stereotype; they have jobs and live with their families. The disease does tend to worsen over time. Eventually, your husband's drug use may increase, and, with no help, he may begin to experience more serious problems. The earlier your husband can get treatment, the better chance he has of recovery.

What Are the Symptoms of Substance Use Disorders?

One of the most important signs of substance addiction or dependence is continued use of drugs or alcohol despite experiencing the serious negative consequences of heavy drug or alcohol use. Often, a person will blame other people or circumstances for his or her problems instead of realizing that the difficulties result from use of drugs or alcohol. For example, your partner may believe he was fired from jobs because his bosses didn't know how to run a business. Or your daughter may believe she got a ticket for driving under the influence of alcohol because the police were targeting her. Perhaps your loved one has even blamed you. People with this illness really may believe that they drink normally or that "everyone" takes drugs. These false beliefs are called denial, and denial is part of the illness.

Other important symptoms of substance use disorders include:

Tolerance - A person will need increasingly larger amounts of alcohol or drugs to get high.

Craving - A person will feel a strong need, desire, or urge to use alcohol or drugs, will use alcohol or a drug despite negative consequences, and will feel anxious and irritable if he or she can't use them. Craving is a primary symptom of addiction.

Loss of control - A person often will drink more alcohol or take more drugs than he or she meant to, or may use alcohol or drugs at a time or place he or she had not planned. A person also may try to reduce or stop drinking or using drugs many times, but may fail.

Physical dependence or withdrawal symptoms - In some cases when alcohol or drug use is stopped, a person may experience withdrawal symptoms from a physical need for the substance. Withdrawal symptoms differ depending on the drug, but they may include nausea, sweating, shakiness, and extreme anxiety. The person may try to relieve these symptoms by taking either more of the same or a similar substance.

Q: My mother says there is no cure for this disease, so she doesn't need treatment. Is that true? A: Perhaps your mother does not understand the purpose of treatment. She is correct to some degree; a substance use disorder is often chronic - but it is treatable. This is also true of many other long-term illnesses, such as diabetes and hypertension. Treatment for substance use disorders is designed to help people stop alcohol or drug use and remain sober and drug free. Recovery is a lifelong process. Staying in recovery is a difficult task, so your mother will need to learn new ways of thinking, feeling, and acting. Treatment can help your mother accept, manage, and live with her illness.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.