Substance Abuse

Identifying a Substance Use Disorder

When substance use interferes with daily functioning, or is influencing an individual’s work, parenting, safety, or health, it is a problem and needs to be addressed.

Anyone can develop a substance use disorder to street or recreational drugs, prescription medications, or other toxins. Typically substances are divided into 11 classes:1

FAQs

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.

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.

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.

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

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.

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

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.

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 aboutAlcoholics 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.

Drug Therapy

If people are dependent on certain drugs, such as heroin, nicotine, or alcohol, medications to treat addiction may be effective. Not all medications work the same way for everyone. Talk with your provider to determine which course of treatment is right for you. Medications may also help treat withdrawal symptoms, but treating withdrawal is not the same thing as treating substance dependence.

Psychotherapy Treatment for Substance Use Disorders

Psychotherapy, also known as “talk therapy,” is more than talking about problems, it’s about finding solutions. A good therapist will help individual’s develop skills for coping with overwhelming feelings and symptoms, and help change behavior patterns that may be contributing to symptoms.

Principles of Drug Addiction Treatment: A Research-based Guide
National Institute on Drug Abuse

Information for patients and families about the nature of addiction, how scientifically-based treatments work, and what to expect from treatment.

What Can We Expect From Substance Abuse Treatment?
Academy for Educational Development (AED)

Expectations about the results of substance abuse treatment are often unrealistically high. Greater knowledge about the nature of addiction and the effectiveness of substance abuse treatment can help curb these expectations and lead to a better understanding and compliance of treatment.

What to Expect from Psychotherapy
Association for the Advancement of Behavior

People enter therapy to gain insight and acceptance about themselves and to achieve personal growth. Psychotherapy is for anyone who is unhappy with the way he or she acts or feels, and wants to change.

Guidelines for Choosing a Behavior Therapist
Association for the Advancement of Behavior Therapy

Understand the qualifications and training required of different mental health professionals, with practical questions to ask when deciding on a therapist.

How Do I find a Treatment Program That’s Right for My Child?
From the Partnership for a Drug-Free America, a nonprofit coalition of communication, health, medical and educational professionals

Establishing Substance Use Treatment Goal(s)

One of the first steps in deciding which treatment is right for you is to determine your treatment goal(s). The goal of many treatments is abstinence, which means stopping substance use all together. However, some people will make the choice to use substances. For these individuals the goal of treatment may be to moderate the frequency and/or amount of substance use. A harm reduction approach to substance use attempts to help users reduce the negative impact that drugs and alcohol has on their lives. For example, harm reduction goals may include stopping driving while under the influence. If this goal is achieved, the individual may then target reducing the frequency or quantity of substance use.2 More

Treatment for Alcohol Use Disorders

The American Psychological Associations, Division 12, Society of Clinical Psychology notes that cognitive-behavior therapy is effective. Cognitive-behavioral treatments often focus on identifying maladaptive behavioral patterns related to drug use and implement self-monitoring, psychoeducation, cognitive-restructuring (addressing problematic thinking patterns), and coping skills training. These treatments often include relapse prevention component to help people recognize the situations in which they are most likely to use substances, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with substance abuse (source Marlatt, G.A., & Witkiewitz, K. (in press). Substance Use Disorders. In J. E. Fisher & W. T. O’Dononhue (Eds.), Practice Guidelines for Evidence Based Psychotherapy. New York: Springer Publishing Company). Also, individuals benefit from gradually reducing nicotine intake on a fixed schedule. (sources Cinciripini, P.M., Lapitsky, L.G., Seay, S., Wallfisch, A., Kitchens, K., & van Vunakis, H. (1995). The effects of smoking schedules on cessation outcome: Can we improve on common methods of gradual and abrupt nicotine withdrawal? Journal of Consulting and Clinical Psychology, 63, 388-399. Cinciripini, P.M., Lapitsky, L.G., Wallfisch, A., Mace, R., Nezami, E., & van Vunakis, H. (1994). An evaluation of a multicomponent treatment program involving scheduled smoking and relapse prevention procedures: Initial findings. Addictive Behaviors,19, 13-22.)

Treatment for Illicit Drug Use Disorders

The American Psychological Associations, Division 12, Society of Clinical Psychology notes that cognitive behavioral treatments have been shown to be effective for illicit drug related disorders: Cognitive-behavioral treatments often focus on identifying maladaptive behavioral patterns related to drug use and implement self-monitoring, psychoeducation, cognitive-restructuring (addressing problematic thinking patterns), and coping skills training. These treatments often include relapse prevention component to help people recognize the situations in which they are most likely to use substances, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with substance abuse (source 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).

Self-Help Resources

Substance use information is organized here, with links to additional resources. Individuals receiving treatment for a substance use disorder may also be struggling with depression, PTSD, anger management issues, or any number of other physical and/or mental health conditions. You may find the self-help resources posted under other behavioral health categories on this web site to be helpful.

Twelve-Step Programs

Twelve-step programs are the most commonly utilized and mandated programs for substance abuse and dependence. Alcoholics Anonymous has over 2 million members and 31,000 meetings of Narcotics Anonymous are held daily in over 100 countries (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). More information about Alcoholics Anonymous or Narcotics Anonymous

Fact Sheets and Handouts-Alcohol

A Family History of Alcoholism: Are You at Risk?
National Institute on Alcohol Abuse and Alcoholism
If you are among the millions of people in this country who have a parent, grandparent, or other close relative with alcoholism, you may have wondered what your family’s history of alcoholism means for you. Are problems with alcohol a part of your future? Is your risk for becoming an alcoholic greater than for people who do not have a family history of alcoholism? If so, what can you do to lower your risk?

Harmful Interactions: Mixing Alcohol with Medicines
National Institute on Alcohol Abuse and Alcoholism
Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. You’ve probably seen this warning on medicines you’ve taken. The danger is real. This pamphlet lists medications that can cause harm when taken with alcohol and describes the effects that can result.

How to Cut Down on Your Drinking
National Institute on Alcohol Abuse and Alcoholism
If you are drinking too much, you can improve your life and health by cutting down. Learn how to recognize if you are drinking too much?

Brief Interventions
National Institute on Alcohol Abuse and Alcoholism
Unlike traditional alcoholism treatment, which focuses on helping people who are dependent on alcohol, brief interventions—or short, one-on-one counseling sessions—are ideally suited for people who drink in ways that are harmful or abusive.

Rethinking Drinking
Research-based information from the National Institutes on Health

Alcohol Abuse
Association for Behavioral and Cognitive Therapies

Understanding Your Friend or Relative’s Alcohol or Drug Problem
Association for Behavioral and Cognitive Therapies

How Can I Get Him to Seek Help: Talking Points for Women
Courage to Care Fact Sheet

Fact Sheets and Handouts-Tobacco

Quitting Tobacco: Challenges, Strategies, and Benefits
National Cancer Institute

Series of handouts providing information about coping with stress, anxiety, depression, and irritability related to not smoking, for example coping with lifestyle changes, including how to continue to enjoy activities that were previously associated with smoking (e.g., drinking coffee, riding in a car, or having an alcoholic beverage).

Questions and Answers About Smoking Cessation
National Cancer Institute

A dozen frequently asked questions and answers along with links to agencies and organizations for help.

Guide for Quitting Smoking
American Cancer Society

A comprehensive guide provides smoking cessation recommendations by the U.S. Surgeon General.

Quitting Smoking – Help for Cravings and Tough Situations
American Cancer Society

Things to do to get through rough spots after you stop smoking.

Helping A Smoker Quit: Do’s and Don’ts: General Hints for Friends and Family
American Cancer Society

General hints for families and friends who want to help a smoker quit.

Tobacco Dependence
Association for Behavioral and Cognitive Therapies

Fact Sheets and Handouts-Illicit Drugs

NIDA InfoFacts: Science-Based Facts on Drug Abuse and Addiction
National Institute on Drug Abuse

Science-based facts about drug abuse and addiction.

Other Related Handouts for Substance Use Disorders

Common Questions About Interventions
Partnership for a Drug-Free America

Information about helping yourself or someone you care about through an intervention. Includes tips for bringing up your concerns without making the situation worse.

Books & Workbooks

Controlling Your Drinking: Tools to Make Moderation Work for You
W.R. Miller and R. F. Muñoz

An easy-to-follow, science-based approach to moderation that avoids labels and moralizing.

Kicking Addictive Habits Once & for All: A Relapse Prevention Guide
D.C. Daley

A comprehensive self-help guide for changing addictive habits permanently.

Sober for Good
A. Fletcher

Best-selling author Anne M. Fletcher went to the source, hundreds of men and women who successfully resolved a drinking problem and asked them a simple question: how did you do it? The result: the first completely unbiased guide for problem drinkers.

The Tao of Sobriety
D. Gregson, J. Efran, & G. A. Marlatt

The combination of exercises learning a new way of thinking about oneself and addiction provides a unique framework for recovery.

Resources for Adolescents

Cool Spot for Teens: Resisting Peer Pressure to Drink

Bibliotherapy Resource Guide
Department of Veterans Affairs

Substance Abuse Web Resources

Al-Anon/Alateen
A resource for families and friends of alcoholics.

Military OneSource
This site provides a number of useful resources for recognizing substance abuse, seeking treatment, and overcoming resistance to seeking treatment.

Navy Leader’s Guide
This guide provides substance abuse and rehabilitation information, tips and resources to Navy leaders to enable them to help their Sailors when problems arise.

U.S. Department of Health and Human Services and SAMHSA’s National Clearinghouse for Alcohol and Drug Related Information

Request publications, find facts and statistics, order videotapes and other multimedia, and access additional resources for a number of different drugs. Search by drug, consumer, and media type, to access specific information quickly.

SmokeFree.gov
Tobacco Control Research Branch of the National Cancer Institute, with contributions from other nationally recognized agencies and organizations such as the Centers for Disease Control and Prevention and the American Cancer Society

An online guide for helping anyone quit smoking, with access to experts by telephone or email.

Medline Plus
A service of the U.S. National Library of Medicine and the National Institutes of Health

This website compiles the latest information on alcohol consumptio0n, news, alerts, tips on prevention and screening, research and related issues.

DrugFree.org
The Partnership for a Drug-Free America

This site offers a number of personal stories, news and highlights and other resources related to use and abuse of a number of substances. Help for parents and caregivers, and treatment interventions for adults and teens.

SmartRecovery.org
An addiction-recovery program that offers online meetings, free of charge.

Quit Tobacco—Make Everyone Proud
An educational campaign for the U.S. military, sponsored by the U.S. Department of Defense. The mission of the site is to help U.S. service members quit tobacco—for themselves and for the people they love.

Web Resources

Military Pathways
Screening for Mental Health, Inc.
Take an anonymous mental health self-assessment. At the end of each anonymous screening you will receive results that can be printed and shared with your doctor or other trusted clinician. While this screening tool is not a substitute for a complete evaluation, it can help you identify symptoms that are consistent with depression, and learn how to access help. This assessment tool is designed for individuals aged 17 and older.

Veteran and Military Family Health
U.S. National Library of Medicine and the National Institute of Health

Defense Centers of Excellence
Questions about traumatic brain injury, post-traumatic stress disorder, or other psychological health issues. The DCoE establishes quality standards for: clinical care; education and training; prevention; patient, family and community outreach; and program excellence.

1-866-966-1020

Resources for OEF/OIF Veterans
Department of Veterans Affairs

Real Warriors Campaign
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Self-Assessment Tools

Self-assessment tests and screening tools can be the key to identifying, understanding, and getting support for drug and alcohol dependence. These quick and easy tests can be the simple first step toward getting helpful information for you, your family, your friends, and your colleagues.

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