An Overview of Substance Use

Substance abuse is typically defined as a pattern of harmful use of any substance for mood-altering purposes. Substances can include alcohol, prescription and over-the-counter drugs, illegal drugs, inhalants and solvents, nicotine, and even coffee.

'Abuse' can result from using a substance in a way that is not intended or recommended, or from using more than prescribed. To be clear, someone can use substances and not be addicted or even have a substance use disorder, as defined in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text-Revision" (DSM-5-TR).

What Is Substance Misuse?

Health officials consider substance use as crossing the line into substance misuse if that repeated use causes significant impairment, such as:

• Disabilities
• Failure to meet responsibilities
• Health issues
• Impaired control
• Risky use
• Social issues
  

What Causes Substance Misuse?

Substance use is a complex problem that is influenced by a number of factors. There is no way to predict who will become addicted to drugs, but a combination of influences can increase a person's risk of developing an addiction.

"People who drink alcohol or use drugs often initially get started to enhance their sense of well-being, relationships, and social enjoyment. Unfortunately, the downsides to substance use can emerge relatively quickly, depending on which substance and how much and how often it is used," says Paul Linde, MD, the medical director for psychiatry and collaborative care at Ria Health.

Dr. Linde notes that family history often plays a significant role, which can include both biological factors and learned behaviors. A person's susceptibility to substance misuse has a partial genetic basis, but environmental factors play an important role as well. 

Illegal Substance Use

Generally, when people talk about 'substance abuse,' they are referring to the use of illegal drugs. Drugs of misuse do more than alter mood. They can cloud judgment, distort perceptions, and alter reaction times, increasing the risk of accidents and injury.

These drugs were declared illegal in the first place because they are potentially addictive or can cause severe negative health effects. Some believe that any use of illegal substances is dangerous and, therefore, abusive.

In the United States, some of the most commonly used illegal drugs are:

• Marijuana
• Methamphetamine
• Cocaine
• Hallucinogens
• Ecstasy or molly
• Heroin

Recreational Drug Use

Some people argue that casual, occasional use of some drugs is not harmful and is merely use, not abuse. The most vocal of the proponents of recreational drug use are those who smoke marijuana. They argue that marijuana is not addictive and has many beneficial qualities, unlike the "harder" drugs.

But recent research has shown that even marijuana may have more harmful physical, mental, and psychomotor effects than first believed. Research has found that marijuana can have serious short-term and long-term health risks.

Cannabis use disorder is associated with effects such as memory loss, difficulty concentrating, reduced problem-solving skills, decreased emotional regulation, and problems making decisions. Marijuana use is also associated with an increased risk for psychosis.

Prescription Substance Misuse

Prescription substance misuse has risen substantially over the last few decades. The National Institute on Drug Abuse estimates that between 8% to 12% of U.S. patients who are prescribed opioid pain relievers develop a substance use disorder.

According to the Centers for Disease Control and Prevention (CDC), the number of opioid-related deaths increased by 16% between 2019 and 2020, with an average of 44 people dying each day from prescription opioid overdoses in 2020.

In the U.S., three main classes of prescription drugs are commonly misused: Opioids, central nervous system depressants, and stimulants. These include:

• Amphetamines
• Barbiturates
• Benzodiazepines
• Codeine
• Fentanyl and analogs
• Methadone
• Methylphenidate
• Morphine
• Oxycodone
• Sleep medications
  

Other Commonly Abused Substances

Alcohol, prescription, and over-the-counter medications, inhalants and solvents, and even coffee and cigarettes can all be used to harmful excess. Many children have their first encounter with substance misuse by using inhalants, simply because they are found in many common household products and, therefore, readily available.

Alcohol

Alcohol is legal for adults over the age of 21 in the United States. However, it doesn't take much alcohol to reach a harmful level of drinking, and that is when alcohol use can turn into alcohol abuse.

Nicotine

Nicotine is the single most abused substance in the world. Although smoking has declined in recent years, it is estimated that 28.3 million Americans still smoke cigarettes despite the well-publicized harmful effects.

Again, just because it is legal, doesn't mean it can't be abused. The fact that the negative health effects of nicotine take a long time to manifest probably plays a role in the widespread abuse of tobacco.

Caffeine

Whereas nicotine is the most abused drug, caffeine is the most commonly used mood-altering drug in the world. And yes, too much caffeine can be harmful to your health.

Studies have also found a link between caffeine use and several psychiatric syndromes, including caffeine-induced sleep disorder and caffeine-induced anxiety disorder.

Synthetics

So-called 'designer drugs' and synthetic drugs, such as bath salts and synthetic marijuana, can be abused and can possibly be more dangerous than other drugs.

Other designer drugs that are commonly misused include:

• Amphetamines
• Ecstasy
• LSD
• GHB
• Ketamine
• Rohypnol (date rape drugs)
• PCP

Anabolic Steroids

Anabolic steroids have no mood-altering or intoxicating properties, but they can still be misused. Using anabolic steroids to enhance performance or develop muscles and strength is abusive because of the negative side effects of steroid use.

These can range from merely annoying to life-threatening in some cases. If using a substance can cause you harm, it is substance abuse. Theoretically, almost any substance can be abused.

Risks of Substance Misuse

When society determine that using certain substances is harmful, it places legal prohibitions on their use. This is to protect individuals' well-being and shield society from the costs involved with related healthcare resources, lost productivity, the spread of diseases, crime, and an increased risk of becoming unhoused (although the impact of criminalization has been open to considerable controversy).

The line between use and abuse is unclear for many legal substances. Is having a couple of drinks every day after work to unwind use or misuse? Is drinking two pots of coffee in the morning to get your day started use or misuse? It also is not uncommon for people to not recognize the impact that their substance use has on their life.

If you are concerned about your substance use, Dr. Linde suggests it can be helpful to ask yourself questions about the negative medical, psychosocial, legal, and financial consequences of drinking and using drugs.

Understanding these risks may help you recognize the signs of a serious problem and improve your motivation to seek treatment.

• Physical health problems: Substance misuse can increase the risk of physical health issues, including heart disease, stroke, and cancer.
• Mental health problems: Substance use often co-occurs with mental health problems, but it can also worsen or contribute to the onset of some conditions as well.  
• Risky or dangerous behavior: Substance use can increase the risk of risky behaviors, such as driving while intoxicated and engaging in unprotected sex.
• Legal risks: Using illegal substances means an increased risk of legal consequences, including arrest and incarceration.

How to Identify Substance Misuse

Has your substance use become harmful? If you think this may be true for you, you are certainly not alone. According to the latest statistics, 21.8% of Americans over the age of 12 (or 61.8 million) have used illicit drugs in the past year, and 8.9 million people over the age of 12 have misused opioids.

Symptoms of a substance use disorder include:

• Developing a tolerance to the substance so that you need to take more to achieve the same effects
• Being unable to control your substance use
• Needing to use the substance daily
• Spending a great deal of time obtaining, using, and recovering from substance use
• Taking substances in risky settings
• Missing school or work due to substance use or performing poorly
• Skipping social or recreational activities due to substance use
• Continuing to take a substance despite the negative consequences
• Experiencing withdrawal symptoms when you stop taking a substance
• Changes in sleep, appetite, and hygiene
• Attempting to hide your substance use from others
  

Treatment for Substance Use Problems

Are you hesitant to seek help for your substance use? Again, you are not alone. In 2023, only around 23.6% received any treatment.

Treatment for substance use disorders may involve behavioral therapies, medications, or a combination of different approaches. Cognitive behavioral therapy (CBT), contingency management, and motivational enhancement therapy are a few types of therapy that may be used. Medications can also help people with opioid, nicotine, or alcohol addiction.

How to Prevent Substance Use

Family history, peer pressure, and recreational drug use are all risk factors for substance use. Being aware of these risks can help you take steps to avoid using substances in the first place. Seeking treatment for mental health conditions can also play a role in prevention.

If you use substances for recreational purposes, misuse prescription medications, or take substances for the purposes of becoming intoxicated, talk to your doctor about your treatment options.