Substance Use Disorders

Substance use disorders (SUDs) are complex mental health conditions marked by the compulsive use of alcohol and other mind or mood-altering substances despite harmful consequences. The condition affects how the brain functions, influencing behavior, decision-making, and emotional regulation, and can disrupt nearly every aspect of a person’s life.

While the causes are multifaceted and often persistent, SUD treatment plays a critical role in stopping problematic substance use and helping people to restore their lives. With time and appropriate care, the brain begins to recover, emotions stabilize, and daily functioning starts to improve. These meaningful changes are possible with comprehensive SUD care.

What Are Substance Use Disorders?

According to the American Psychiatric Association, SUD may involve an intense focus on using substances such as alcohol, nicotine, opioids, stimulants, cannabis, sedatives, or other psychoactive drugs ^[1]. Often described as addiction, people with SUD continue to use the substance even when it leads to relationship strain, health problems, or loss of work or school performance. The condition often develops gradually, with increasing use over time.

People take substances for a variety of reasons: to feel good, relieve stress, numb emotional pain, enhance focus or performance, or out of curiosity, peer pressure, or experimentation. The substances produce temporary, intoxicating effects, such as euphoria, sedation, or altered perception, which can contribute to repeated use and a higher risk of developing a disorder ^[1].

Repeated exposure alters how the brain processes pleasure, stress, and self-control. These neurobiological changes can persist well beyond the period of intoxication ^[1]. As a person’s tolerance builds, larger amounts of the substance are needed to achieve the same euphoric effect. Attempts to cut back often result in withdrawal symptoms, such as irritability, nausea, or anxiety, accompanied by intense cravings to use again ^[2].

SUD affects both the mind and body, often requiring comprehensive care for treatment and recovery ^[2]. Recognizing it as a medical illness, not a moral failing, is essential to reducing stigma and encouraging treatment, and this starts with understanding the underpinnings of its causes. 

Causes of Substance Use Disorders

Substance use disorders develop when a range of biological, psychological, and environmental influences interact over time. Specific gene variations influence personality traits like impulsivity or thrill-seeking, which increase the likelihood of substance use. Additionally, experiences such as stress or trauma can cause biological shifts that turn specific genes on or off. These changes can make the brain more sensitive to the effects of drugs and increase vulnerability to addiction ^[3].

Brain development during adolescence further increases risk, as the part of the brain responsible for decision-making and self-control develops more slowly than the areas that control reward and emotion. When adolescents experience high levels of stress, such as poverty, instability at home, or social pressures, it can slow the brain’s development even more and raise the chances of early drug use ^[3].

Mental health conditions, such as depression, anxiety, ADHD, or psychosis, often occur alongside SUD. In some cases, people turn to substances to cope with emotional pain. In others, the substance itself may worsen or trigger mental health symptoms. This relationship goes both ways and can make recovery more difficult if both issues are not treated together ^[3].

Early exposure to substance use, especially during childhood or adolescence, often leads to greater challenges later in life. Addressing these risk factors early may help prevent the onset or worsening of substance use and improve long-term outcomes.

Recognizing the Symptoms and Seeking Help

Substance use disorder may be diagnosed when someone seeks help to reduce their use, when a family member raises concern, or when a doctor observes warning signs during a routine visit. These signs may include poor hygiene, weight loss, red eyes, visible injection marks, or noticeable changes in mood or behavior.

For an SUD diagnosis, aspects such as level of control over use, level of impairment, risky behaviors, and physiological signs of dependence are considered. At least two of the following criteria must be met within 12 months ^[2][4]: 

• Loss of Control: Using more substances than intended or being unable to stop despite wanting to.
• Intense Cravings: Regular urges to use and spending a significant amount of time obtaining, using, or recovering.
• Impact on Daily Life: Struggles at work, school, or in daily responsibilities due to substance use.
• Use Despite Harm: Ongoing use even when it causes physical, emotional, or social problems.
• Physical Dependence: Developing tolerance or experiencing withdrawal symptoms when use is reduced or stopped.

Denial or lack of insight is common in substance use disorder, so diagnosis may rely on family input, behavioral patterns, or medical complications rather than self-report alone. In some cases, the first signs appear as unrelated medical or mental health issues, such as anxiety, fatigue, or unexplained physical symptoms. Doctors use structured interviews, observation, and patient history, not just lab tests, to make an accurate diagnosis for treatment ^[4].

Treatment Options for SUD

Effective behavioral and medication-based treatments for SUD exist, yet they remain underused. Many people never receive proper care due to limited access, stigma around addiction, and poor integration of treatment. These barriers prevent timely support and contribute to ongoing harm ^[3].

Medication-Based Treatments

Medications are often prescribed to manage withdrawal, reduce cravings, or treat underlying mental health conditions. Methadone, buprenorphine, and naltrexone are proven to lower the risk of relapse in opioid use disorder. For alcohol use disorder, disulfiram (Antabuse) and acamprosate can support recovery by reducing the urge to drink or creating adverse effects when alcohol is consumed. These treatments are most effective when paired with psychosocial support.

Psychological Therapies

Psychological treatments help people change the thoughts and behaviors that drive substance use. These approaches improve emotional regulation, increase motivation to stay sober, and offer strategies to handle high-risk situations. When adapted to individual needs, they play a key role in sustained recovery.

SUD Treatment Supports Brain Function

Repeated drug use alters how the brain communicates, particularly in areas responsible for reward, motivation, and decision-making. All addictive substances increase dopamine levels, which makes the brain link substance use with pleasure and encourages continued use ^[5].

Even a single dose of a drug like cocaine can change how brain cells connect and signal to one another. These changes persist long after the drug leaves the body and can prime the brain for addiction. With continued exposure, these changes accumulate and reorganize neural circuits in ways that make self-control more difficult and cravings more intense. 

The good news is that the brain has its way of repairing itself. Within about a week of stopping substance use, natural repair systems begin working. These systems remove the parts most affected by the drug and start to rebuild healthier connections. Treatment helps this process by giving the brain time and support to heal ^[5].

Brain imaging studies illustrate how the brain begins to recover after someone stops using drugs. Research shows improvements in areas involved in memory, emotions, and decision-making after treatment started. Changes in brain volume appeared early on, while functional improvements, such as how brain regions communicate, took more time. These findings show that stopping substance use gives the brain a chance to heal, creating a more substantial base for long-term recovery ^[6].

SUD Treatment Promotes Emotional Stability

People with SUD experience depression, anxiety, and anger more intensely, increasing the risk of continued use or relapse. Treatments that directly target emotional health, particularly those that integrate support for both mental health and substance use, tend to produce better outcomes than those that focus on substance use alone ^[7].

Two approaches that have shown particular promise in improving emotional stability are:

Cognitive Behavioral Therapy (CBT) 

CBT helps people identify and change unhelpful thought patterns while building practical skills to manage distress and regulate mood. For example, when faced with a craving or trigger, such as walking past a bar or feeling overwhelmed after a stressful day, someone using CBT strategies might recognize the thought “I need a drink to cope,” challenge its accuracy, and instead use a practiced alternative like calling a support person, going for a walk, or using a calming technique to ride out the urge. 

Mindfulness-Based Approaches

These support emotional regulation by strengthening present-moment awareness and promoting nonjudgmental acceptance. For people with SUD, this can be especially helpful during withdrawal, when feelings like anger and irritability are common. For example, rather than reacting impulsively to a surge of frustration, a person practicing mindfulness may pause, acknowledge the emotion without judgment, and use a grounding technique such as deep breathing or body scanning to let the feeling pass without acting on it. These skills help people respond more flexibly to stress and reduce the emotional triggers that often lead to substance use, ultimately improving quality of life ^[7].

Moving Toward Recovery

Recovery from substance use disorder is not just about stopping use; it’s about rebuilding a life that feels stable and connected. A key part of this process is forming supportive relationships and stepping away from environments that encourage substance use. Having people to lean on, especially those who support sobriety, can make all the difference. Social support isn’t just helpful, it’s often essential to healing and moving forward.

Therapies like CBT and mindfulness-based care offer practical tools to cope with stress and regain a sense of balance. With time and the right support, many begin to feel more confident, rebuild trust in themselves and others, and find clarity in where they want to go next. Recovery is not easy, but it is possible, and no one has to go through it alone.