Substance Use and Abuse Overview

Substance use refers to the use of alcohol, tobacco, drugs, and other substances that can cause dependence or harm. Unchecked or uncontrolled substance use leads to substance abuse. Because currently there is no universally accepted definition of substance abuse, it is generally seen as an early form of a disease characterized by dependence criteria.

This terminology has often led to confusion, both within the medical community and with the public. However, it can be generalized to say that it is the overindulgence in and dependence on a drug or other chemical leading to effects that are detrimental to the individual’s physical and mental health, and/or the welfare of others.

The fourth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-IV) issued by the American Psychiatric Association, defines substance abuse as a “maladaptive pattern of substance use leading to clinically significant impairment or distress.”

Substance Abuse Types

  • Abuse — Substance abuse may lead to addiction or substance dependence. Abuse reflects a complex interaction between the individual, the abused substance, and society.
  • Dependence — Medically, physiological dependence requires the development of tolerance leading to withdrawal symptoms. Dependence almost always implies abuse, but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance.
  • Addiction — Involves a compulsion to continue using the substance, despite the negative consequences, and may or may not involve chemical dependency.

Substance Abuse Signs and Symptoms

  • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
  • Repeated absences or poor work performance related to substance use
  • Substance-related absences, suspensions or expulsions from school
  • Neglect of children or household
  • Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
  • Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct, DUIs, etc.)
  • Continued substance use, despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, and/or physical fights)

Substance Abuse Risk Factors

Veteran populations are at increased risk for using alcohol or drugs in problematic ways. More than one in ten veterans have been diagnosed with a substance use disorder, slightly higher than the general population. This is due to a variety of experiences linked directly to military service:

  • Military culture
  • Exposure to stressors
  • Combat-exposure
  • Trauma related to service or combat
  • Hospitalization or combat injury
  • Development of mental health disorders including post-traumatic stress disorder (PTSD)
  • Chronic pain or physical health issues
  • Homelessness

Substance Abuse Treatment

Recovery is possible for everyone. Substance use disorder is a mental health condition, and VA offers evidence-based treatments for the disorder that are proven to be effective for most people and may include therapies, medication, or both.

Therapies

  • Cognitive behavioral therapy (CBT)helps Veterans with substance use disorder develop more balanced and helpful thoughts about themselves, others, and the future. It can help Veterans manage the urge to drink or use drugs, refuse opportunities to use substances, use a problem-solving approach to deal with substance use disorder, and achieve personal goals.
  • Motivational interviewing (MI)involves conversations between the Veteran and their provider to detect and strengthen personal motivations for change. In this therapy, Veterans look at the reasons they want to make a change and the potential benefits of that change.
  • Motivational enhancement therapy (MET)is a version of MI that focuses specifically on changing unhealthy alcohol or substance use.
  • Contingency management (CM)is a therapy in which the patient receives incentives for completing recovery behaviors such as abstinence verified by urine drug screens. The incentives increase in size with consistent performance of the recovery behavior.

Medications

Help to manage withdrawal symptoms, reduce cravings, prevent a return to use, and reduce the risk of death related to substance use disorder.

  • Opioid Use Disorder —Options include methadone, buprenorphine and buprenorphine combination products like Suboxone, and injectable, extended-release naltrexone.
  • Alcohol Use Disorder —Options include acamprosate, disulfiram, naltrexone and topiramate.
  • Tobacco Use Disorder —Options include nicotine replacement therapy, bupropion and varenicline.
  • Also, if you or someone you care about uses opioids or nonprescribed stimulants, you should have naloxone on hand. When used after an overdose from an opioid or drug laced with an opioid, naloxone can temporarily block the effects of the opioids and help prevent death.

Note: Researchers have discovered that a large percentage of those who have substance abuse problems also suffer from other mental-health or personality disorders; this is known as a co-occurring disorder.

Other Resources and Support

https://www.cdc.gov/nchs/dqs/health-topics/substance-use-abuse.html

https://www.mentalhealth.va.gov/substance-use/treatment.asp

https://nida.nih.gov/publications/drugfacts/substance-use-military-life