Dr Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

Substance use disorder (SUD) is a disorder involving the continued use of substances despite personal, professional, and health-related problems caused by the usage, which negatively affects a person’s day-to-day life. Substance use disorder can lead to short- and long-term negative health effects. These effects can be physical and mental, and can range from moderate to severe.
Generally, drug misuse, or SUD, refers to the use of psychoactive drugs, which are substances that affect the brain. The effects on the body depend on the type of substance a person uses and their health history.

SUD is more common in males. More than 760,000 people have died from opioid overdoses since 1999. In 2018, two out of three overdoses had links to opioid use.
Examples of common psychoactive drugs include:

• Alcohol
• Cannabis
• Cocaine
• Heroin
• Hallucinogens
• Inhalants
• Prescription opioids
• Prescription stimulants
• Methamphetamine
• Tobacco or nicotine

Certain factors may increase an individual’s risk for SUD. These risk factors include:
• Family history of substance use
• Difficulties with parental monitoring
• Parent’s substance use
• Family rejection of sexual orientation or gender identity
• Association with substance-using peers
• Lack of school connectedness
• Academic achievement difficulties
• Childhood sexual abuse
• Mental health issues

Psychoactive drugs are chemical compounds that affect the mind and body. Taking different drugs may cause:
• Changes in coordination
• Blood pressure and heart rate changes
• Feelings of being more awake or sleepy
• Improved sociability
• Pain relief
• Changes in the appearance of a person’s body
When chronic substance use occurs over a long period, these short-term physical effects may cause long-term changes to a person’s brain and body. The specific physical effects of substance use may vary among individuals, and depend on the substance, dosage, delivery method, and length of use. Substance use can sometimes lead to serious health consequences, including overdose and death.

Long-term SUD may affect a person’s memory, behaviour, learning, consciousness, and concentration.
Substances such as alcohol, cannabis, stimulants, and opioids are psychoactive drugs that may change an individual’s brain function and structure after chronic use. This can result in cognitive and behavioural changes and deficits that may remain even after someone stops using. The exact mental or cognitive effects of SUD may vary, depending on the type of drug and the duration of use.
SUD may also exacerbate symptoms of other mental disorders, and early drug use is a strong risk factor for the later development of substance use disorders. It may also be a risk factor for developing other mental illnesses.
For example, frequent cannabis use in adolescents can increase the risk of psychosis in adulthood in individuals who carry a particular gene variant.
To get a diagnosis of SUD, a person has to qualify for 11 criteria that the DSM-5 outlines.
• Using more of a substance than a person intends, or using it for longer than they mean to
• Trying to cut down or stop using the substance, but being unable to
• Experiencing intense cravings or urges to use the substance
• Needing more of the substance to get the desired effects (tolerance)
• Developing withdrawal symptoms when not using the substance
• Spending more time getting and using drugs, and recovering from substance misuse
• Continuing to use even when it causes relationship problems
• Giving up important or desirable social and recreational activities due to substance use
• Using substances in potentially harmful settings that put a person in danger
• Continuing to use despite the substance causing problems to physical and mental health

Finding the right treatment programme may feel overwhelming. Here are a few things a person can consider when seeking treatment for SUD.
• Consider whether inpatient or outpatient services would be most suitable.
• Find local treatment centres using the Substance Abuse and Mental Health Services Administration’s treatment finder tool.
• Know that subsidised treatment centres and programmes may be cheaper.
• Look for programmes that use evidence-based treatment strategies.

SUD is a complex but treatable disease that affects a person’s cognitive function and behaviour. No single treatment is right for everyone. However, effective treatment for SUD should address all of a person’s mental and physical health needs.
Treatment aims to help individuals develop a healthier relationship with drugs, helping them live productive lives in relationships with their families, work, and society. Treatment may involve some of the following components:
• Medications: Can help minimise withdrawal symptoms and prevent the return to unsafe use.
• Behavioural counselling: Helps individuals modify their attitudes and behaviours related to substance use, increase healthy life skills, develop problem-solving skills, and stick to treatment plans.
• Group therapy: Gives people the chance to acknowledge, share, and work through the psychological aspects of recovery with a group of peers under professional guidance.
• Additional support: May include vocational training and other resources that address problems associated with SUD, such as mental health conditions, unemployment, and medical conditions.