What Is Substance
Use Disorder?

Psychoactive substances affect the central nervous system and alter brain function, resulting in changes in perception, mood, consciousness, behavior, and sensory experiences. These substances, which include certain medications, may give rise to a range of substance-related disorders, even following a single use. Disorders due to substance use are not limited to psychoactive substances alone. The classification also includes disorders associated with the harmful non-medical use of certain non-psychoactive substances and medications that carry a risk of addiction. As such, disorders due to substance use encompass a range of conditions arising from the single or repeated use of psychoactive substances, including certain medications, as well as disorders related to the harmful non-medical use of non-psychoactive substances.

Substance use activates the brain’s reward system. The pleasurable effects associated with substance use can alter dopamine-related processes in the brain, reinforcing repeated use over time. Repeated substance use may eventually lead to the development of substance use disorder and can result in a wide range of harms affecting both physical and mental health.

According to the American Psychiatric Association’s Desk Reference to the Diagnostic Criteria From DSM-5, substance use disorder is defined as follows:

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following within a 12-month period:

1. The substance is often used in larger amounts or over a longer period than intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control use.
3. A great deal of time is spent in activities necessary to obtain the substance, use it, or recover from its effects.
4. Craving, or a strong urge to use the substance.
5. Recurrent use resulting in failure to fulfil major role obligations at work, school, or home.
6. Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by its effects.
7. Important social, occupational, or recreational activities are given up or reduced because of use.
8. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem likely caused or exacerbated by the substance.
9. Tolerance, as defined by either:

a. A need for markedly increased amounts to achieve intoxication or the desired effect.
b. A markedly diminished effect with continued use of the same amount.

10. Withdrawal, as manifested by either:

a. The characteristic withdrawal syndrome for the substance.
b. The substance (or a closely related substance) is used to relieve or avoid withdrawal symptoms.

What Is Substance Withdrawal?
According to the American Psychiatric Association’s Desk Reference to the Diagnostic Criteria From DSM-5, substance withdrawal is defined as follows:

A. Cessation of prolonged and heavy substance use, typically involving daily or near-daily use over a period of at least several months.

B. Following cessation of the substance use described in Criterion A, three (or more) of the following signs or symptoms develop within approximately one week:

1. Irritability, anger, or aggression.
2. Nervousness or anxiety.
3. Sleep disturbances (e.g., insomnia or disturbing dreams).
4. Decreased appetite or weight loss.
5. Restlessness.
6. Depressed mood.
7. At least one physical symptom causing significant discomfort, such as abdominal pain, tremors, sweating, fever, chills, or headache.

C. The signs and symptoms described in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs and symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal related to another substance.

What Are the Health Problems Associated with Substance Use Disorder?
Substance-related disorders are broadly classified into substance use disorders and substance-induced disorders. Substance-induced conditions include intoxication, withdrawal, and substance- or medication-induced mental disorders, such as psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders.

Individuals experiencing substance use disorder may develop a range of cognitive and behavioral difficulties. Changes in brain structure and function can contribute to intense cravings, personality changes, unusual behaviors, and other difficulties. Brain imaging studies have shown that substance use can affect areas of the brain involved in judgement, decision-making, learning, memory, and behavioral control. In addition, infants born to mothers with substance use disorder may experience neonatal withdrawal syndrome.

People with substance use disorder are also more likely to experience a range of physical and mental health conditions, including lung disease, cardiovascular disease, stroke, cancer, and mental health disorders. They may also be at increased risk of infectious diseases such as HIV and hepatitis C, as well as premature mortality.

The frequency of substance use, the amount used on a given occasion, the method of administration, risk-taking behaviors associated with substance use, the circumstances in which substances are used, and the interaction of these factors can all contribute to an increased risk of physical and mental health problems.

What Are the Effects of Substance Use on Children and Adolescents?
According to the Health at a Glance: Europe 2020 report, published on 19 November 2020 by the European Commission and the Organisation for Economic Co-operation and Development (OECD) as part of the State of Health in the EU initiative:

• Cannabis use is relatively common among adolescents.
• Frequent cannabis use during adolescence:

o Increases the risk of developing substance use disorders later in life.
o Is associated with impairments in cognitive functioning.
o May contribute to memory problems.
o May lead to attention difficulties.

Did You Know?
According to the 2021 World Drug Report:

• Approximately 275 million people aged 15–64, or around 1 in every 18 people in this age group, used drugs at least once during 2019. This represents approximately 5.5% of the global population aged 15–64.

• Drug use is generally more prevalent among males than females.

• Drug-related deaths have doubled over the past decade. In 2019, approximately 500,000 deaths were attributed to drug use. More than half of these deaths were attributable to liver cancer, cirrhosis, and other chronic liver diseases associated with hepatitis C.

According to the 2021 European Drug Report:
• Cannabis is the most commonly used illicit drug.
• Cannabis use is approximately five times more prevalent than the use of other illicit drugs.
• An estimated 83 million adults aged 15–64 in the European Union, or 28.9% of the adult population, have used an illicit drug at least once in their lifetime.

What to Do
Substance use disorder is a treatable health condition, but recovery can be challenging. Because substance use disorder is a chronic disease, stopping substance use for a short period is usually not sufficient for recovery. Many individuals require long-term and repeated support to stop using substances completely.

Treatment and intervention should help individuals to:

1. Stop using substances.
2. Remain substance-free.
3. Function productively within their family, workplace, and community.

What to Avoid
When parents learn that their child is engaging in substance use, they may experience a range of emotions, including denial, shock, sadness, disappointment, anger, or confusion. These reactions can influence their expectations, attitudes, and behavior toward their child. However, certain responses may make the situation more difficult rather than supporting recovery and should be avoided.

Examples include statements such as:
1. My child would never do such a thing.
2. This is all your fault.
3. We have failed as parents.
4. Is this what I raised you for?
5. You cannot be my child.
6. You will never amount to anything.

Instead, it is important to listen and seek to understand without judgment, while maintaining open communication. Parents may also benefit from professional guidance to help them respond effectively and navigate the challenges associated with substance use.

Protective Factors
There are several protective factors that may reduce the risk of developing substance use disorder. These include:

1. Providing age-appropriate and accurate information to children and adolescents about the harmful effects of substances and the nature of addiction.

2. Strengthening positive family relationships and emotional bonds within the family.

3. Ensuring parental awareness of children’s peer groups and social environments.

4. Establishing clear and consistent family rules, and ensuring that all family members adhere to them.

5. Maintaining contact with schools, non-governmental organizations, and community-based organizations such as clubs and similar organizations.

Recovery Is Possible!
Substance use disorder is a treatable health condition. With appropriate treatment and intervention, recovery is possible, although it is often a gradual process that requires time and sustained effort. The most important step is the individual’s willingness and readiness to engage in treatment. During this process, maintaining healthy communication between individuals and their families is important. It is also important for individuals to share their experiences with their family members in a supportive environment. Treatment and intervention approaches vary depending on the type and duration of substance use. In most cases, stopping substance use without professional support is difficult, and professional help is often required.

Risk Factors for Substance Use Disorder
There are multiple risk factors associated with the development of substance use disorder. The most commonly identified include:

1. Having parents with mental disorders or a history of substance use disorders.
2. Insecure attachment and parental neglect, particularly during critical stages of development.
3. Behavioral difficulties, including internalizing symptoms such as excessive shyness and externalizing behaviors such as aggression in school settings.
4. Lack of clear family rules or inconsistent enforcement of rules within the household.
5. Decline in academic performance.
6. A combination of biological and environmental factors.

Prevention Matters!
Prevention efforts aim to prevent the use of psychoactive substances, reduce their availability in communities, minimize the individual and societal harms associated with their use, and promote healthy behaviors across society. Substance use disorders do not typically develop overnight and often emerge gradually over time. Once a substance use disorder has developed, treatment can be challenging.

Recovery is a gradual process that takes time. In addition to medical treatment, psychosocial support plays a critical role in recovery. Psychosocial support can help individuals gain a better understanding of addiction and strengthen protective factors to reduce the risk of relapse. Medical treatment alone is not sufficient to support recovery.

Substance use also places a significant burden on public health systems and increases healthcare costs. Evidence shows that the cost of prevention programs is significantly lower than the cost of treatment.

For more information:

tbm.org.tr
yedam.org.tr
birakabilirsin.org

References / Further Reading
For further information, please refer to the following sources:

• American Psychiatric Association (2014). Desk Reference to the Diagnostic Criteria From DSM-5 (DSM-5 Tanı Ölçütleri Başvuru El Kitabı, Turkish translation by E. Köroğlu). Ankara: Hekimler Yayın Birliği.

• 101 Questions About Addiction (2019). [Link: 101 Soruda Bağımlılık | Yeşilay (yesilay.org.tr)]

• American Psychiatric Association (APA) (2021).

• European Drug and Drug Addiction (EMCDDA), 2021 European Drug Report, European Drug Report Trends and Developments, (2021).

• National Institute on Drug Abuse (NIDA) (2021).

• Organisation for Economic Co-operation and Development (OECD) (2020). Health at a glance: Europe. [Link: https://ec.europa.eu/health/state/glance_en]

• The United Nations Office on Drugs and Crime (UNODC) 2020. World Drug Report, Booklet 2: Drug Use And Health Consequences.

• The United Nations Office on Drugs and Crime (UNODC) (2021). World Drug Report Booklet 1: Executive Summary Policy Implications. [Link: https://www.unodc.org/res/wdr2021/field/WDR21_Booklet_1.pdf]

• The United Nations Office on Drugs and Crime (UNODC), 2021 World Drug Report, Booklet 2: Global Overview of Drug Demand and Drug Supply (2021). [Link: https://www.unodc.org/unodc/en/data-and-analysis/wdr-2021_booklet-2.html]

• World Health Organisation (2020). ICD-11 for mortality and morbidity statistics last version. [Link: https://icd.who.int/browse11/l-m/en]