What is alcohol and substance use disorder? How is it treated?


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What initially begins as a social, casual, or experimental use of alcohol or other substances (illegal drugs, over-the-counter drugs, and/or cigarettes) can develop into a substance use disorder. However, over time, repeated substance use affects impulse control and decision-making in the brain. These changes in the brain impair a person’s ability to make rational and responsible decisions about substance use. What started out as a way to party or try to feel the effects of different substances can lead to abuse and “addiction” that we now call substance use disorder.

In its most serious form, a substance use disorder causes significant disruptions in school, life, and relationships and can have serious, sometimes life-threatening effects on a person’s physical and emotional well-being.

Signs and symptoms

Substance use disorder symptoms include:

  • Strong desire for substance
  • Inability to control or reduce usage
  • Continuous use despite negative consequences
  • Use of larger amounts over time
  • Tolerance/dependence development (see below)
  • Spending a lot of time obtaining and using substances
  • withdrawal symptoms

Tolerance occurs when larger and larger amounts of a substance are needed to achieve the same effect – it takes more time to get high or feel the desired effect of a particular substance. Often, withdrawal symptoms lead to the need for more and more specific substances to avoid “falling out” again. When a person develops addiction, they cannot resist using a substance even if they want to quit; they can’t avoid overuse when they want to cut back. Tolerance, withdrawal, and dependence are symptoms of physical addiction and are an indication that a person has a serious substance use disorder.

Here are some observable behaviors (signs) that can be seen when a person has a substance use disorder:

Change in Mood

  • Sudden apathy (not paying attention to things)
  • Feeling depressed or overly happy or feeling “up”
  • Increase in irritability and anger attacks; hostility when confronted with substance use
  • Unexplained frequent mood changes

Behavior Change

  • Absenteeism and poor school performance
  • Change in sleep patterns – sleeping too much or not being able to sleep
  • Change in appetite with sudden, unexplained weight gain or loss
  • More covert and suspicious behavior; increase in lying and deception
  • Change in effort to pay attention to physical appearance and poor hygiene
  • Sudden change in friends or favorite places to hang out
  • Change of motivation to do fun or pleasurable things that used to be
  • acting stupid for no reason

Decision Change

  • Using substances in dangerous situations, such as while driving
  • Choosing to hang out with people who are in trouble or are known to use and abuse substances
  • Continued use of substances despite problems in relationships, significantly reduced activities of daily living (dropping out of school, losing a job), legal consequences, or serious medical problems
  • Using illegal substances or obtaining prescriptions illegally

Change in Appearance / Physical Changes

  • Weight change – gain or loss
  • Poor hygiene, lack of maintenance – looking messy and messy
  • Lack of eye contact – blank stare
  • Hair and skin changes – thinning, brittle hair, weak skin


Rates of alcohol and drug intake are increasing rapidly in Turkey and in the world. Alcohol-related health problems are in third place after heart disease and cancer. 30-45% of adults have encountered a problem (legal, traffic, work, school) related to excessive alcohol consumption at least once in their lifetime. Still, 200,000 people a year die from an alcohol-related problem. Alcohol was held responsible for 75% in automobile accidents, 50% in accidental deaths, 50% in murders, and 25% in suicides. Alcohol, which shortens the average life expectancy by at least 10 years, also leads other addictive drugs. but their age is decreasing in a chilling way.

In the “Turkey Mental Health Profile” study conducted in 1995, (CIDI) was applied. The prevalence of alcohol dependence was reported as 0.8% in the last 12 months according to ICD-10. The prevalence of alcohol dependence was 1.7% in men and 0.1% in women.

Risk factors for substance use disorders in teenagers and young adults:

Teens and young adults with substance use disorders are at greater risk for academic and relationship difficulties, unwanted accidents and injuries; Young people and university students with substance use disorders are at risk of being victims of legal problems, unplanned sexual activity and sexual assault. The use of substances can lead to unintended death due to accidental injury (especially car accidents) or overdose, and by causing potentially fatal diseases such as heart disease, HIV/AIDS, and cancers. Substance use disorders affect all age groups and cultural groups and cause significant pain, suffering and loss of productivity in individual lives, families and communities.

  • Family history of substance use disorder
  • Family problems – an unstable or abusive family environment
  • Other mental health issues such as anxiety, sleep disorders, depression, bipolar disorder, stress
  • Social difficulties – not feeling like you fit in with your peers
  • Hanging out with a peer group where substance use is the norm
  • low self esteem
  • Academic failure – pressure to do better in school can influence a student’s decision to use performance-enhancing medication


The main causes of substance addiction can be listed as follows.

– Carelessness and ignorance : The media plays an important role in this regard. Young people may become addicted to drugs by pretending to the lives of people in the media. The youth, who does not know what substance addiction means, begins to use substances by taking the lifestyle shown in the media as an example.

– Substance use by anyone in the family: A young person who sees someone in the family using substances may be affected and want to use it. Especially the people he loves will affect the young person more.

– Curiosity: “Nothing happens once and for all.” In this process, which starts with the motto and continues with the idea of ​​quitting, the young person is already accustomed to the substance.

– Indifference of parents:The young person who wants to attract the attention of parents or to react against them sees the substance as a savior or friend.

– Excessive tolerance of parents to alcohol or other substances: The laxity of the family in this matter is very effective in distinguishing the right and wrong. The young person perceives and does correctly what his parents allow or over-tolerate.

– Low socioeconomic level:Sometimes he starts using the substance to make money by selling the substance, and sometimes to forget about his economic problems.

– Failure in school:The young person who cannot show himself at school may see the substance as a tool to prove himself.

– Exposure to sexual harassment or physical abuse:He may see the solution as a substance to forget what he has been through or to relax.

– Fashion:It prefers young matter to adapt to the degraded environment.

– Genetics:In the research, it was seen that genetics was also among the causes.

– Behavioral disorders

– Individual’s inability to control himself

– Individual’s lack of self-confidence

– Environmental impact: The availability and availability of the substance in the environment is one of the important factors that increase substance use. If there is no substance in the environment, the possibility of using it decreases or disappears.

Of course, none of these reasons justify substance use. However, knowing the causes is necessary to prevent substance abuse. substance abuse; disappears after prolonged treatment. However, if the causes are not eliminated or minimized, the treatment does not give results, and even if it does, it may recur. substance abuse; it is a serious problem. Therefore, the reasons should be taken seriously and addressed.

What are Alcohol and Substance Use Disorders in DSM-5?

(Percentage Usage Report)

Alcohol 51.9

Smoking 27.7

Marijuana 6.6

Non-Medical Psychotherapeutics 2.8

Cocaine 0.7

Hallucinogens 0.5

Inhalants 0.01



Phencyclidine and similar effects,

Sedatives, hypnotic and anxiolytics,

Anabolic steroids and nitrous oxide



Alcohol use disorder (which includes a level sometimes referred to as alcoholism) is a pattern of alcohol use that includes problems controlling your drink, preoccupying with alcohol, continuing to use alcohol even if it causes problems, having to drink more to get the same effect. You experience withdrawal symptoms when you reduce or stop in some way.

Unhealthy alcohol use includes alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking, in which a man consumes five or more drinks in two hours or a woman consumes at least four drinks in two hours. Excessive drinking poses significant health and safety risks.

If your drinking pattern causes recurrent significant distress and problems functioning in your daily life, you likely have an alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.


The prevalence of alcohol dependence was 1.7% in men and 0.1% in women.

Alcohol use disorder is a very common condition. According to the 2015 National Survey on Drug Use and Health, approximately 16 million Americans have alcohol use disorder, which affects approximately 8 percent of adult men, 4 percent of adult women, and 2.5 percent of adolescents ages 12 to 17. 38 million people in the United States are considered by public health experts to drink too much alcohol consumed by high weekly use (average 15 or more drinks per week for men and 8 for women), binge drinking, and pregnant women


  • family history : Having a family member with a diagnosis of substance use disorder increases a person’s risk of being diagnosed with alcohol use disorder (or any substance use disorder). The closer the relationship, the greater the risk. For example, having a first-degree relative, such as a parent or sibling, is a more pronounced risk factor than having a more distant relative, such as a cousin, diagnosed with alcohol use disorder. Family history usually means assigning a genetic component to some disease or disorder; however, in the case of mental health disorders, family history may represent genetic factors, learning factors, or a combination of both. Although many genetic associations have been identified for the development of substance use disorders, there is no single genetic factor that can be identified as the cause of any substance use disorder.
  • Diagnosis of certain mental health disorders :This interaction, or comorbidity, is used by many to explain the relationship between mental illness and substance abuse. self medicine It cannot be easily explained, even if it tries to use the concept of . As a result, many individuals develop alcohol use disorders before they develop certain types of mental disorders. The presence of a pre-existing substance use disorder is an increased risk factor for later being diagnosed with another type of mental health disorder.
  • Trauma and/or stress experience : Some traumatic event, stress, etc. Living people are at risk for using substances such as alcohol and developing substance use disorders. This may or may not be related to the self-medication hypothesis, depending on the situation. Any traumatic or stress-related condition appears to increase the risk of alcohol abuse; However, physical or sexual abuse, loss of a parent (even through divorce) at a young age, victim of a violent crime, etc. Certain experiences, such as
  • Lack of family supervision or involvement: FamilyRelationship problems within an individual, especially those that occur early in the individual’s development, are often considered significant risk factors for alcohol abuse.
  • peer pressure :from peer groups oppression It is an important factor in driving behavior, especially at a young age, but it can occur at any age. In addition, societal pressures and influences, such as the impression through the media that alcohol use is a normal way of coping with stress, can also increase individuals’ risk of alcohol abuse.
  • Age of first use : The sooner a person starts drinking, the more likely they are to continue drinking. Continuous or regular use of alcohol is associated with an increased risk of developing alcohol use disorder in anyone.
  • Other factors : There are numerous other risk factors that can interact to increase someone’s risk of developing an alcohol use disorder. For example, men are more likely than women to develop substance use disorders, particularly alcohol use disorders, so gender may be a significant risk factor. The social environment may also increase the risk of developing alcohol use disorder, such as living in an environment where alcohol use is considered acceptable and a standard approach to coping with stress. All of these risk factors can interact in ways that are not well understood.

Essentially, it should be understood that the potential causes of alcoholism are not well understood. Instead, certain risk factors that represent intrinsic (eg, genetic) and environmental (experience) factors in ways that researchers do not fully understand contribute to the development of any substance use disorder, including alcohol abuse problems.

Alcohol Use Disorder shows withdrawal symptoms (such as sweating, shaking, vomiting) when a person is unable to control their alcohol consumption, continues to use alcohol despite problems caused by drinking, develops tolerance, drinks even if it leads to risky situations, and/or stops drinking.

Alcohol use in teenagers and young adults:

  • Excessive drinking:
    Teens, young adults, and college students are more likely to drink than adults. Binging is a drinking pattern that brings a person’s blood alcohol concentration (BAC) to 0.08 grams or higher.
    • As a rule of thumb, binge drinking is for men to consume 5 or more drinks and for women to consume 4 or more drinks in about 2 hours. It is important to remember that the effect of alcohol on a person varies with gender, weight, how much food is eaten before drinking, and even the amount of sleep a person has.
    • According to the NIAAA, the first 6 weeks of college is a vulnerable time for binge drinking and alcohol-related consequences due to peer and social pressure.
    • 90% of alcohol consumed by people under the age of 21 is binge drinking
  • Alcohol poisoning:
    This occurs when a person drinks so much that their body’s brain and vital functions begin to shut down. Alcohol poisoning is an overdose of alcohol.
    • Signs and symptoms of alcohol poisoning include inability to wake up (stupor or coma), slow or irregular breathing, vomiting, seizures, and cold, clammy skin that is pale or bluish in color
    • Alcohol poisoning is a medical emergency and can lead to death if not treated promptly.

Clinical Table:

Alcohol use disorder can be mild, moderate, or severe, depending on the number of symptoms you experience. Signs and symptoms may include:

  • not being able to limit the amount of alcohol you drink
  • Making unsuccessful attempts to reduce how much you drink or to do so
  • Spending a lot of time drinking, drinking or recovering from alcohol use
  • Feeling a strong craving or urge to drink alcohol
  • Failure to meet major obligations at work, school, or home due to repeated alcohol use
  • Continuing to drink alcohol even if you know it is causing physical, social, or interpersonal problems
  • Giving or reducing social and work activities and hobbies
  • Using alcohol when it is not safe, such as while driving or swimming
  • Developing a tolerance to alcohol so you need more to feel its effects or have less of the same amount of effect
  • Experiencing withdrawal symptoms such as nausea, sweating, and shaking when you don’t drink or drink to avoid these symptoms

Cognitive Behavioral Therapy:

In the treatment of alcohol and drug addiction;

  • Teach the person to recognize the situations in which they are most likely to drink or use medication.
  • Avoid these conditions if possible.
  • Deal with other problems and behaviors that may lead to substance addictions.

In its use in the treatment of alcohol and drug dependent individuals, CBT has two main components: functional analysis and skills training.

Functional Analysis : The therapist and individual work together to identify the thoughts, feelings, and conditions that lead to and follow the drinking or use. This helps identify possible risks of relapse.

Functional analysis can also figure out why they were drinking or using drugs in the first place. This helps identify situations that the person has difficulty coping with.

Skill Training : If someone is at the point where they need professional treatment for their addiction, there is the possibility of using alcohol or drugs as the main means of coping with the problems. The purpose of CBT is to enable the person to learn or relearn better coping skills.

The therapist tries to help the individual learn old habits and learn to develop healthier skills and habits. The main goal is to educate them on ways to change their thinking about their substance addiction. They can then learn new ways of coping with situations and conditions that have led to their drinking or drug attacks in the past.

Treatment Time: Because cognitive behavioral therapy is a structured, goal-oriented educational process focused on pressing issues, the process is usually short-term. It is usually completed in 12 to 16 sessions with the therapist, although other forms of therapy and psychoanalysis can take years.

Conclusion: Substance and alcohol use disorders are difficult to overcome without support and treatment. Substance and alcohol use disorders (and the consequences of what people call addictions) can be a chronic struggle throughout a person’s life, but treatment can restore emotional and physical well-being and enable a person to live without substances.


The Psychology of the Abnormal, Ann M. Kring, Sheri L Johnson, Gerald Davison, John

Translation from the 12th Edition by Neale (trans. ed. Muzaffer Şahin), Nobel Publishing House 2015

Onan N, Kaplan H, Yalçın B, Erbap S, Yıldırım D, Barlas G, Karaca S, Öz Y. Examination of University Students’ Substance Use and Personality Traits

Ögel K, Taner S, Yılmazçetin C. Guide to Approach to Substance Use in Adolescents

Yalçın M, Evsizoğlu A, Akkoç H, Yaşan A, Gürgen F. Risk Factors Determining Substance Use in Dicle University Students.

Arıkan Z (1998) Alcohol use disorder treatment in the field and hospitals. From the book Alcohol and non-alcoholic substance abuse. Ed: Dilbaz N.

Ceylan E, Turkcan A (2003). Biological Psychiatry 2: Alcohol and Substance Use Disorders. Istanbul

Ogel K (2000). Approach and treatment of substance abusers. IQ publications, Istanbul

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