Substance Abuse or Chemical Dependence

What causes substance abuse or dependence?

The cause of substance abuse and dependence is unclear. It probably involves a mix of genetics, environment, and emotional factors. However, while the first use of drugs or alcohol is voluntary, continued use quickly changes how the brain feels pleasure. Using drugs repeatedly changes the structure of the brain so that a person no longer has control. Substance abuse is a disease that results in the compulsive need for the drug.

What are the symptoms of substance abuse or dependence?

The following are the most common behaviors that signal you have a problem with drug or alcohol abuse:

• You get high on drugs or get drunk on a regular basis
• You lie, especially about how much you are using or drinking
• You avoid friends and family members
• You have given up activities you used to enjoy, such as sports or spending time with non-using friends
• You talk or think a lot about using drugs or alcohol
• You believe you need to use or drink to have fun
• You pressure others to use or drink
• You get in trouble with the law
• You take risks, such as sexual risks or driving under the influence of a substance
• Your work performance suffers due to substance abuse before, after, or during working or business hours
• You miss work due to substance use
• You risk your financial security and that of your family to buy drugs or alcohol
• You feel depressed, hopeless, or have suicidal feelings

The symptoms of drug or alcohol abuse may look like other medical problems or mental health conditions. Always consult your healthcare provider for a diagnosis.

How is substance abuse or dependence diagnosed?

A family doctor, healthcare provider, psychiatrist, or qualified mental health professional can diagnose substance abuse. Depending on the substance abused, the frequency of use, and the length of time since you last used, your doctor may note the following:

• Weight loss
• Constant fatigue
• Red eyes
• Little concern for hygiene
• Unexpected problems in heart rate or blood pressure
• Depression, anxiety, agitation, irritability, or sleep problems 
• Seizures and hallucinations seen in delirium tremens related to alcohol withdrawal

How is substance abuse or dependence treated?

Your healthcare provider will figure out the best treatment for you based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you can handle specific medications, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment for drug addiction is serious and complex. People who are addicted can’t simply stop using. Treatment programs involve many different components. You can take part in inpatient or outpatient treatment programs for substance abuse. Programs are usually based on the type of substance abused. Programs include:

• Detoxification, if needed
• Medicines for withdrawal, to lessen cravings, and to restore normal brain function
• Behavioral therapy
• Long-term medical follow-up and support
• Counseling for both you and any family affected

What are possible complications of substance abuse or dependence?

Complications of drug abuse or dependence vary depending of the drug or substance being used. They may include:

• Liver damage
• Heart damage
• Increased risk for infections, such as HIV and other sexually transmitted infections
• Pneumonia
• Tuberculosis
• Injuries to yourself or others
• Weight loss
• Sleep disturbances
• Sexual dysfunction
• Depression
• Thoughts of suicide
• Suicide attempts
• Anxiety
• Psychosis
• Fatal accidental overdoses

Can substance abuse or dependence be prevented?

There are many things you can do to prevent substance abuse or dependence in your home and community, including: 

1. Follow alcohol and drug control laws and policies. This includes maintaining the age 21 minimum legal drinking age and prohibiting the sale of alcohol to intoxicated persons.
2. Empower young people not to drink or use other drugs.
3. Store prescription medicine and alcohol safely.
4. Properly dispose of any medications. Do not share prescription drugs with others.

Key points about substance abuse or dependence

• Substance abuse is a recognized health disorder that refers to the abuse of illegal or legal substances.
• Substance abuse causes serious problems at work, school, in relationships, and with the law.
• Substance dependence describes the abuse of drugs or alcohol that continues even when serious problems related to their use have developed.
• There are many different treatment programs for substance abuse. You may need inpatient or outpatient help or a combination of both approaches.
• Substance abuse is a lifelong condition that requires ongoing attention to manage.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Paul Ballas MD

Medical Reviewer: Marianne Fraser MSN RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.