People in all cultures across time have used psychoactive substances as part of their social and religious rituals. In North America, people use a variety of substances to commune with others, celebrate, relax, recreate, and de-stress. Some psychoactive substances are legal and socially acceptable (alcohol) and some are not (heroin, cocaine, crystal meth) and others are somewhere in between (tobacco, cannabis).
Although some substances (such as crack cocaine and tobacco) are more addictive than others, substance use by itself is generally not a problem. Substance use becomes a problem when it results in a pattern of impaired control of substance use, social impairment, and risky use.
Signs of impaired control of substance use include:
Signs of social impairment include:
Signs of risky use include:
In addition to the behaviours, substance use problems are associated with changes in brain chemistry and physiology that result in tolerance and withdrawal. Tolerance is observed when a person requires more and more of the substance to achieve the same effect. Withdrawal is what happens when people use a lot of a substance over a long period of time and then stop using. As the substance leaves the body, people experience a variety of distressing physical symptoms that often drive them to use the substance again.
Controlled withdrawal from serious substance use (detoxification) often requires medical management in an inpatient setting. An important feature of serious long-term substance use disorders are a variety of changes in brain chemistry and physiology that can persist beyond detoxification. These changes in physiology result in repeated relapse and intense drug craving. Understanding these long-term effects is important in effectively managing substance use problems in the long-term.
In addition to legal drugs and illegal street drugs, people can become addicted to prescription medications. Indeed, prescription medications such as opioid pain medications and stimulants are sold as street drugs. People who have substance use problems with prescription medications have the same problems as people who have problems with street drugs. Substances that can cause problems include alcohol, tobacco, caffeine, cannabis, cocaine, stimulants, hallucinogens, inhalants, sedatives, hypnotics, and anxiolytics.
Substance use problems are very common. People often use substances in an attempt to cope with a mood, anxiety or relationship problem. In fact, it is estimated that approximately 25% of people seeking treatment for a mood or anxiety problem also have a significant substance use problem. Substance use problems are very treatable and, for many, cognitive behavioural therapy (CBT) is an important part of the solution. However, because substance use problems often mask an underlying mood or anxiety problem and require intense intervention including medically-managed withdrawal in an inpatient setting, the first step towards appropriate and effective treatment is a thorough and proper diagnostic assessment from a physician or psychologist.
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