Substance Use Disorder

We have witnessed many things that have been said about substance use in both the media and our social environment. For example, smokers say, “I can quit if I want, but I don’t want to!” They often express such discourses excessively. “Is cigarettes a substance too?” You may be thinking. However, anything that has a stimulant or inhibitory effect is considered a substance. Is he really willing to leave? Or is it just for cigarettes? In today’s article, let’s examine substance use disorders in order to answer these questions.

Substance use dates back to ancient times in human history. For example, opium (poppy) has a known history of 5000 years. Despite the cultural differences, it continues to be used intensively in most societies today. While some substances are legalized by the state (alcohol, nicotine, caffeine), even the production of some substances is prohibited. Most substances that act on the central nervous system are addictive. Substance use disorders have been named in various ways in the past, such as addiction, addiction, and junkie. Let’s take a look at what are the items defined after the short history of items.

What are addictive substances?

Addictive substances are divided into 10 subgroups in DSM’5. Alcohol, caffeine, cannabis (marijuana), hallucinogens, inhalants, opiates (heroin, morphine), sedative-hypnotic and anxiolytics, stimulants (amphetamine, cocaine and other stimulants), nicotine and other (unknown substances). You can review DSM 5 for defined diagnostic criteria for all these substances. Here we will only consider the symptoms.

Substance use disorder symptoms according to DSM 5;

A) Inability to limit substance use despite causing significant clinical deterioration
B) An intense desire to use the substance and the development of compulsions (repetitive behavior)
C) Repetitive substance use to achieve the desired effect (tolerance development)
D) Development of withdrawal symptoms such as intolerance, restlessness, anxiety, nausea, sweating, palpitations after efforts to quit the substance
E) As a result of substance use, deterioration in social relations, work and family life, and deterioration in psychological and general medical conditions are observed.

Substance use phases
According to studies by the American Academy of Pediatrics, there are 5 stages for substance use.

Stage 1: It is the period of curiosity. And it is the most important period especially in terms of prevention.

Stage 2: It is the trial period. At this stage, the substance is often used for fun or for peer acceptance. No significant behavioral change is observed.

Stage 3: This is the period in which more tolerance develops. More time is given to look for the substance. Various problems at home and at school begin during this period. The escape route from these problems is often substance use.

Stage 4: Control is now lost. Matter begins to occupy a constant place in the mind. Legal problems may arise.

Stage 5: This period is called the addiction period.

People with substance use disorder experience great difficulties in their social lives. There are disruptions in professional and social activities, their control over the use of the substance disappears, and most importantly, people spend most of their time obtaining and using these substances. As tolerance develops to the substance used, these experiences turn into a vicious circle. Substance use disorders begin especially in adolescence and appear at younger ages. Identifying risk groups, especially at these ages, can provide great benefits in terms of preventing addictions.

What are the risk factors for substance use?

Many factors are effective in the formation of substance addiction. It would not be right to say that the same factor applies to everyone. However, determining risk groups, especially in adolescence, can provide great benefits in terms of preventing addictions. Risk groups are generally determined according to family characteristics, circle of friends, school, personal factors and social factors.

Family: Genetic factors have been found to be important in terms of substance use. In addition, the parent’s excessive authoritarian or liberal attitude was found to be associated with substance use. In addition, parental substance use or possession of substances in the home creates a high-risk environment.

Friend: Peer pressure is one of the most important factors. In addition, since the need for care and belonging is met in substance-used groups, these groups carry a high risk. Social isolation or constant boredom can trigger these circles of friends.

School: Low school success and therefore loss of ties with school were associated with addiction. However, the absence of future plans is one of the factors that pose a high risk.

Personal Factors: Factors such as the desire to feel better, the desire to be free that emerges with adolescence, and the admiration for people in the entertainment world in the media are handled personally. In addition, the tendency to risk oneself, which is one of the obvious characteristics of adolescence, poses a high risk for substance use.

Social and environmental factors: A low socioeconomic level environment, a chaotic society structure, an environment with easy access to substances, and an environment with high crime rates are among the factors with high risk.

Substance use disorder treatment

The treatment process usually takes place in the psychiatry clinics of hospitals and AMATEM (Alcohol and substance addiction treatment center) services. In this process, the focus is on the use of antagonist (reducing effects) drugs to eliminate the low withdrawal effects, and also on increasing the tolerance level. After the person using the substance has made progress at a certain level, this person should be reintegrated into society. Psychosocial support plays an important role in this process. Some psychotherapy methods and family therapies can help to get through this process more easily. It should not be forgotten that people with substance addiction are in danger of re-starting the substance used throughout their lives. For this reason, preferring only drug treatment in the treatment process will not be very effective in the reintegration of these people into the society.

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