Alcohol use disorder

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Like many other substance use disorders, alcohol use disorder is a chronic and sometimes relapsing condition that reflects changes in the brain. This means that when people with the disorder are abstaining from alcohol, they are still at increased risk of resuming unhealthy alcohol consumption, even if years have passed since their last drink.  

People who have Alcohol Use Disorder may continue to use alcohol even though they know it is causing social, health, economic, and possibly even legal problems in their life.  

It is important to remember that AUD is not due to an individual’s lack of self-discipline or resolve. Rather, it is a brain disease that can be inherited. Long-term alcohol use can produce changes in the brain that can cause people to crave alcohol, lose control of their drinking and require greater quantities of alcohol to achieve its desired effects. It can also cause people to experience withdrawal symptoms if they discontinue alcohol use. 

Early stages of alcohol addiction have an increased chance of successful recovery if treatment is sought out. Unfortunately, most people take great care to hide their drinking habits, so recognizing the symptoms of an alcohol use disorder can be challenging.

A person who regularly consumes alcohol who has two or more of the following signs and symptoms within a period of one year may be diagnosed with AUD:

• Consuming alcohol in greater quantities or for longer than planned
• Unsuccessful attempts to reduce or manage alcohol use
• Expending a lot of time acquiring, using, or recovering from alcohol
• Feeling compelled to consume alcohol
• Alcohol use recurrently hinders ability to successfully complete important tasks at home, work, or school
• Continuing alcohol use despite problems it causes in interacting with others
• Foregoing or limiting participation in important activities at home, work, or school
• Repeated use of alcohol in physically dangerous circumstances (e.g., while operating a motor vehicle)
• Continuing to use alcohol despite knowing that it is the cause of or exacerbates mental or physical problems
• Developing tolerance to alcohol, meaning that greater quantities of alcohol are required to become intoxicated
• Experiencing symptoms of withdrawal if alcohol use is stopped, or consuming alcohol to alleviate symptoms of withdrawal

People may experience:

Whole body: blackout, dizziness, shakiness, craving, or sweating

Behavioral: aggression, agitation, compulsive behavior, self-destructive behavior, or lack of restraint

Mood: anxiety, euphoria, general discontent, guilt, or loneliness

Gastrointestinal: nausea or vomiting

Psychological: delirium or fear

Also common: physical substance dependence, problems with coordination, slurred speech, or tremor

Opioids are a class of drugs that include synthetic opioids such as fentanyl; pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine; the illegal drug heroin; and many others.

Opioid use disorder is a chronic disease of the brain—sometimes called an addiction—characterized by the persistent use of opioids despite harmful consequences caused by their use. Patients typically have both physical dependence and loss of control over their opioid use and may experience serious consequences related to their use. It is a relapsing disorder, which means that if people who have OUD stop using opioids, they are at increased risk of reverting to opioid use, even after years of abstinence. 

Use of opioids, either by themselves or in combination with other drugs, is a major driver of the drug overdose crisis in the United States. The vast majority of overdose deaths in recent years involved illicitly manufactured fentanyl and other potent, synthetic opioids, which may be added to other drugs and consumed unknowingly.

 
Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in the U.S.

A diagnosis of Opioid Use Disorder is made when a person who regularly uses opioids has experienced at least two of the following signs and symptoms within the past 12-month period:

• Physical dependence:
  • Developing tolerance to opioids, meaning that larger quantities are required to attain the desired effect of the drug
  • Experiencing withdrawal symptoms if stopping opioid use, or using opioids to alleviate symptoms of withdrawal
• Loss of control:
  • Taking opioids in greater quantities or for longer than planned
  • Inability to quit or reduce use of opioids despite wanting to do so
  • Devoting a lot of time to acquiring, using, or recovering from opioids
  • Feeling compelled to use opioids
• Consequences:
  • Opioid use repeatedly interferes with completing duties at home, work, or school
  • Continuing use of opioids even when they cause problems interacting with others
  • Skipping important occasions and events at work, school, or in personal life
  • Repeatedly taking opioids in circumstances that could cause physical harm (e.g., while operating a motor vehicle)
  • Continuing use of opioids even when they cause or exacerbate mental or physical problems

Stimulants encompass a wide range of substances that include both legal and illicitly used drugs with a host of effects and purposes. While some stimulants are predominantly used illegally (e.g., cocaine, methamphetamine, MDMA), others serve a medical purpose (e.g., Adderall, which is used to treat symptoms of attention deficit hyperactivity disorder). However, stimulant misuse can lead to negative health outcomes, which may include addiction, overdose, withdrawal, and death. 

Stimulants increase central nervous system activity through their interaction with various neurotransmitter systems—including norepinephrine and dopamine. This can ultimately lead to an increase in attention, alertness, and energy, among other effects. That said, misuse of certain stimulants can generate a host of adverse effects such as psychosis, paranoia, and anger, and may increase the risk of overdose toxicity and severe physiological outcomes such as heart attack, seizure, and stroke. 

Available in various forms such as pills/capsules, injectable liquids, and powder, stimulants can be taken orally as well as smoked, injected, and snorted. Aside from their intended therapeutic effects, stimulants are sometimes misused to enhance self-esteem, reduce appetite, produce a sense of exhilaration, extend wakefulness, improve physical and mental performance, increase activity, and get high. 

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person has a stimulant use disorder when use leads to significant impairment, as manifested by exhibiting at least two of the following criteria within a 12-month period:

• Use of the drug in larger doses or for a longer period than had been intended
• A persistent desire to use or repeated unsuccessful attempts to decrease or cease use
• Spending an inordinate amount of time attempting to procure the drug, use it, or get over its effects
• Cravings, urges, or a desire to use
• Recurrent use resulting in failure to fulfill obligations at school, home, or work
• Continued use despite negative effects on social life and interpersonal relationships
• Reduced recreational, work, or social activities reduced or abandoned
• Repeated use in environments or situations where it could cause physical harm
• Ongoing use even with the knowledge that physical and/or psychological problems. are likely to have either been caused or worsened by use
• Tolerance (This criterion doesn’t count toward diagnosis if a prescription stimulant such as Adderall is being used as prescribed.)
• Withdrawal (This criterion doesn’t count toward diagnosis if a prescription stimulant such as Adderall is being used as prescribed.)

Stimulant effects vary depending on factors such as the route of administration, potency, dosage, combination of substances used, and level of prior use.

Some of the sought-after or desirable effects of stimulants include:

• Sense of exhilaration
• Enhanced self-esteem
• Improved mental and physical performance
• Increased physical activity
• Appetite reduction
• Extended wakefulness

However, adverse effects can also occur, especially if you misuse/abuse stimulants by taking them in large quantities or, in the case of prescription stimulants, taking them more often than therapeutically needed.

Serious adverse effects of stimulant misuse can include:

• Dangerously elevated body temperature (i.e., hyperthermia)
• Increased cardiovascular risks from persistently accelerated heart rate, vasoconstriction, and increased blood pressure
• Panic attacks
• Hostility
• Paranoia
• Psychosis
• Violent behavior
• Seizures

Anxiolytic use disorder is a substance-related disorder involving abuse or dependence on a sedative, hypnotic, or anxiolytic medication. Treatment requires medical detoxification and psychotherapy. 

Benzodiazepines, sometimes called benzos, are a type of medication known as tranquilizers. Familiar names include Valium and Xanax. These drugs slow down your central nervous system, cause sedation and muscle relaxation, and lower anxiety levels. Often used to treat anxiety or insomnia, they're some of the most commonly prescribed medications in the U.S. But they can be addictive, especially if you take them every day or use them long-term.  

What are some other names for benzos?

You might hear them called Valium, Xanax, Ativan, Librium, xannies, vallies, roofies, tranks, downers, goofballs, Mexican, roach, heavenly blues, valo, stupefi, anxiety drugs, date rape drugs, or club drugs.

Benzodiazepines can lead to both physical and psychological dependence. If you become dependent on the drugs, you can have withdrawal symptoms and even seizures when you suddenly stop taking them. 

It can be hard to tell the difference between withdrawal symptoms and anxiety. Withdrawal symptoms usually show up anywhere from 3-4 days to 2 weeks after you last use the drug. But they can appear earlier with shorter-acting types of benzodiazepines.

Taking too much and running out of your prescription, being overly focused on when you can take the next one, and feeling you can’t live without it could be signs that you're developing a benzodiazepine use disorder. 

Signs of chronic misuse or dependence can be hard to spot in others. They may include changes in appearance and behavior that affect relationships and work performance. In children, you might notice sudden changes in mood or a decline in school performance. Long-term (chronic) misuse of benzodiazepines can lead to these symptoms:

• Anxiety
• Insomnia
• Appetite loss (anorexia)
• Headaches
• Weakness

Repeated use of anxiolytics causes physical dependence, or tolerance, within the body. Tolerance means the body adapts to the medication, requiring larger amounts of the drug to achieve effects.

When someone stops taking sedative, hypnotic, or anxiolytic medications, the body will go into withdrawal. Symptoms may include:

• Anxiety
• Tremors, shaky hands
• Sleep disturbances: nightmares or insomnia
• Changes in appetite, nausea, or vomiting
• Rapid pulse and respiratory rates
• Changes in blood pressure
• Fever, sweating
• Delirium
• Seizures 

The timeframe for withdrawal symptoms depends on the medication and the level of use before stopping. It is recommended that people wanting to detoxify from sedatives, hypnotics, or anxiolytics work closely with a medical professional, as these withdrawal symptoms can be life-threatening.