What they are
Substance Use Disorders are patterns of problematic use of drugs (e.g., opioids, stimulants, cannabis, sedatives, cocaine, methamphetamine) leading to impairment or distress across similar domains as AUD: control, impact, risky use, and physical dependence. SUDs range from mild to severe and are treatable with medications (for some substances), therapy, and harm-reduction strategies.
SUDs often co-occur with mental health conditions; integrated care works best.
Common signs and symptoms
- Using more or longer than intended; unsuccessful cut-down attempts
- Cravings; time spent obtaining/using/recovering
- Work/school/relationship problems; continued use despite harm
- Risky situations (driving, sharing needles); tolerance and/or withdrawal
Substance-specific notes:
- Opioids: high overdose risk, especially with fentanyl contamination and mixing with alcohol/benzodiazepines
- Stimulants (cocaine/meth): cardiovascular strain, anxiety/paranoia, sleep disruption
- Benzodiazepines: dangerous withdrawal; taper with medical supervision
- Cannabis: anxiety, motivational changes, cannabis hyperemesis in some
- Nicotine: highly addictive; health risks but many effective cessation tools
Why they happen
- Genetics, trauma, chronic pain, mental health conditions
- Drug effects on dopamine/reward learning; withdrawal relief reinforces use
- Social context, access, stress, and stigma barriers to care
What helps
- Medications for opioid use disorder (MOUD)
- Buprenorphine or methadone reduce cravings/overdose risk and improve retention
- Extended-release naltrexone is an option after full detox
- Medications for other SUDs
- Alcohol: naltrexone, acamprosate, disulfiram (see above)
- Nicotine: varenicline, bupropion, NRT (patch/gum/lozenge/inhaler)
- Stimulants/cannabis: no FDA-approved meds yet; treat co-occurring conditions; some off-label options may help
- Therapies
- Motivational Interviewing; CBT/Relapse Prevention; Contingency Management (strong evidence, especially for stimulants)
- Community Reinforcement Approach; family-involved approaches (CRAFT)
- Harm reduction
- Naloxone carry and training for anyone at risk of opioid overdose
- Fentanyl/xylazine test strips; never use alone; syringe services programs
- Avoid mixing substances; safe storage to prevent accidental poisoning
- Levels of care
- Outpatient to IOP/PHP; residential; medical detox when needed (especially for benzos, severe alcohol, or complicated opioid withdrawal)
Recovery paths vary: some pursue abstinence, others reduce use and harm; both can improve health and life.
When to seek help now
- Overdose signs: slowed or stopped breathing, blue lips—call 911; give naloxone if available
- Severe withdrawal (alcohol/benzodiazepines), seizures, chest pain
- Suicidal thoughts or inability to care for self—urgent help
How to talk to a clinician
- “I want help with [substance]. Please assess for medications (e.g., buprenorphine/naloxone for opioids, varenicline for nicotine), CBT/Contingency Management, and harm-reduction supports.”
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline; 911 for overdose
- Naloxone: Check state resources or local pharmacies; many states allow purchase without a prescription
- Find treatment: SAMHSA Helpline 1-800-662-HELP; FindTreatment.gov; Psychology Today (filter for SUD, MOUD)
- Harm reduction: Syringe Services Programs (via local public health), NEXT Distro (nextdistro.org) for naloxone access in some areas
- Mutual-help: AA/NA, SMART Recovery, LifeRing, Refuge Recovery
- Low-cost/community: Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Ask about coverage for MOUD, IOP/PHP/residential, detox, therapy, and peer support; copay/coinsurance, deductible, out-of-pocket max
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.