Substance Abuse

What is substance abuse?

Substance abuse involves the harmful use of alcohol, drugs or other substances. The term substance abuse is often used to refer to a mental health problem that is now contained within the diagnostic category of Substance Use Disorder. This category of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is what mental health professionals refer to for diagnosing problems people experience in relation to substance use.

The misuse of substances like drugs or alcohol is a complex issue, and it’s sometimes difficult to distinguish between use and abuse. For example, drinking alcohol is, to some extent, considered socially acceptable. However, if your drinking is impacting on your health, relationships, or your ability to go about your work or schooling, help should be sought.

You don’t need to have a diagnosis to benefit from therapy for substance misuse, and you certainly shouldn’t wait until the problem is severe before seeking help. Any substance use that causes concern, leads to impairments in your functioning or causes you distress is worth discussing with a doctor or mental health professional. With the right help, it is possible to recover from substance abuse.

Types of substance abuse

Mental health professionals used to talk about substance use problems as falling into two categories: “abuse” and “dependence”. These two categories essentially differentiated the severity of the substance use problem. However, it is now thought of as a single mental health problem, called Substance Use Disorder, in which each person’s unique situation falls on a continuum of severity.

According to the DSM-5, the kinds of mind-altering substances involved in substance use problems can include:

  • Alcohol
  • Caffeine
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Hypnotics
  • Stimulants
  • Tobacco
  • Other substances

Prevalence of substance abuse

Substance Use Disorder is relatively common. According to a survey of American adults, 10% of adults have had a drug use disorder at some point in their lives (1).

The National Survey on Drug Use and Health data shows that around 20 million adults had a substance use disorder in 2014. Of these, around 16 million had an alcohol use disorder, and 6 million had an illicit drug disorder (2).

Symptoms of substance abuse

The particular symptoms of substance use problems vary according to personal factors and the substance in question. However, if you are experiencing any of the following symptoms (as described by the DSM-5) you should seek help:

  • Taking substances in larger quantities than you’re supposed to, or for longer than you’re supposed to.
  • Wanting to stop or cut back on your substance use but not being able to do so.
  • Spending a great deal of time on obtaining the substance, using the substance, or recovering from its effects.
  • Craving or strong desire to use the substance.
  • You find that your substance use repeatedly interferes with your ability to function at work, school, or home.
  • You keep using the substance even when it repeatedly causes problems socially and in your relationships.
  • Giving up or spending less time on important social, work-related, or recreational activities because of substance use.
  • Repeatedly using substances in situations where it is physically dangerous.
  • Continuing to use the substance despite being aware that you have a physical or psychological problem that is likely to have been caused by or worsened by the substance use.
  • Developing tolerance to the substance, finding that you need to use more of the substance to get the effect you want.
  • Experiencing withdrawal symptoms, which can be alleviated by taking the substance again.

You don’t need to be experiencing all of these symptoms to have a substance-related problem. Any time that you are concerned about your substance use or feel that it’s causing problems in your life, it is worth seeking help from your doctor or mental health professional.

Treatment options for substance abuse

Recovery from substance abuse can be a challenging process. The process can be made even more complex if you are also experiencing other mental health problems, like anxiety or depression. This is not uncommon for people with substance use problems. It’s important to be assessed for these other aspects of your experience too so that the best treatment approach can be sought.

It is always best to seek guidance from a mental health professional or doctor when deciding on the best way to recover, as the best treatment approach will depend on your individual circumstances as well as the substance involved. Some suggestions include:

  • Helplines: Call the Substance Abuse and Mental Health Services Administration’s helpline on 1-800-662-HELP (4357).
  • Individual and/or group therapy: Talk therapies targeted at helping you with your substance use are effective in both group and individual therapy.
  • Detoxification: Depending on the substance, it is sometimes helpful or necessary to undertake detoxification (or ‘detox’) in a hospital or at home in your recovery.
  • Support groups: Many people find the social support and strategies from support groups, such as Alcoholics Anonymous, to be very beneficial.
  • Medicine: Depending on the substance, medicine can be a helpful component of the treatment for substance use disorders.

Therapy types for substance abuse

There are numerous effective treatments for substance abuse, and the particular approach taken depends on your individual circumstances and substance/s. Common evidence-based therapeutic approaches include:

  • Cognitive Behavior Therapy (CBT): CBT helps you to understand how your thoughts and emotions impact on your substance use behavior, and learn more helpful thinking patterns and coping strategies.
  • Motivational Interviewing (MI): MI helps build motivation for changing substance use behavior by focusing on personal goals.
  • Family Behavior Therapy (FBT): FBT involves a family member, who assists the individual to use the skills they learn in therapy to support their behavior change outside of sessions.
  • Motivational Enhancement Therapy (MET): This approach incorporates MI and is often combined with CBT to build motivation and a plan for behavior change, and develop coping strategies for high-risk situations.

What to look for in a therapist for substance abuse

  • Look for a licensed mental health professional who has specialized training in substance use disorders and experience working in the area. Some counselors are specialized credentialed Alcoholism and Substance Abuse counselors. Many other therapists have a particular interest in substance use disorders. Therapists often include this information in their biography on their website or online profile.
  • It’s important to find a therapist with whom you feel comfortable working. The trusting working relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy. Addressing substance abuse through therapy is an important but difficult process, and so you want to be sure that you are working with someone you feel comfortable with and trust.
  • The best way to judge how you might feel about your prospective therapist is to ask for a preliminary phone call (you can do this with our vetted Zencare therapists). Most therapists will be happy to oblige. This gives you the opportunity to ask about:
  • Their qualifications
  • Their experience working with people with substance use problems
  • Any ongoing training they are undertaking in the treatment of substance use
  • What therapy with them will be like
  • Their participation in insurance plans
  • Cost of therapy

Try to speak to a few different therapists before making your mind up.

Sources and references