Spot—and Fight—Substance Use Disorder in Your Loved One

Addiction touches millions of lives around the world. In the United States, it's estimated that more than 20 million people ages 12 and older have a substance use disorder (SUD). In a 12-month period ending in April 2021, this resulted in overdose deaths topping 100,000 for the first time. This appalling record high is attributed to a multitude of factors, including the opioid epidemic and COVID-19's effects on mental health.

Despite the continuing crises with opioids and new strains of COVID-19, people with SUD can find hope as long as family, friends and colleagues can decipher the signals and encourage them to seek help.

What is SUD?

It's important to distinguish the difference between someone who abuses substances and someone with substance use disorder.

The former is someone who habitually consumes psychoactive substances, including:

• Opiates, narcotics and painkillers (heroin, fentanyl, codeine)
• Stimulants (cocaine, amphetamines)
• Depressants (barbiturates, alcohol, benzodiazepines)
• Hallucinogens (psilocybin, LSD, PCP)
• Cannabis/marijuana

"Addiction is a family disease, and the whole family will be affected by it and suffer," said Natalie Faladova, a certified alcoholism and substance abuse counselor trainee (CASAC-T) in New York. "SUD is a physiological disorder like, for example, diabetes. It might start as a choice—no one has ever had a dream for themselves to become addicted and to battle SUD."

Someone who misuses substances should not automatically be classified as having a substance use disorder. The difference between the two is someone with SUD is wholly dependent on these substances, or the substance causes significant impairments in their daily functioning, whereas this may not be the case for everyone. Substance use disorder often begins with recreational or experimental drug use that then progresses into a full-blown addiction.

"The one thing that comes first in an active addiction is figuring out how you're going to get high, and when you're not figuring out how you're going to get high, you're actually getting high," explained Geri-Lynn Utter, Psy.D., a licensed clinical psychologist in Philadelphia who specializes in SUDs and wrote the autobiographical "Mainlining Philly: Survival, Hope and Resisting Drug Addiction."

Utter pointed out that dopamine—one of the brain's "feel good" chemicals—is released throughout the drug use process. Thus, a person with substance use disorder becomes addicted to the ritual of acquisition as well as consumption of the substance.

Warning signs

"SUDs have physical and behavioral signs that are important to recognize," said Rich Jones, a licensed clinical addiction specialist with more than 20 years of experience in behavioral health, and executive director of the Heritage CARES virtual support program, based in Texas. "Once you notice the signs, it is time to intervene since the path to recovery is more manageable if addressed when recognized."

He added that someone with SUD is typically resigned and not present with friends and family, making it challenging to identify the signals of substance use disorder.

Warning signs span all areas of life. Faladova noted that in the early stage of addiction, a person may experience loss of interest in previously enjoyed activities, along with shifting peer groups, self-isolation and changes in both sleeping habits and appetite. These manifestations vary based on substance category, though Jones said physical and behavioral changes are easiest to identify.

"A person using stimulants, like cocaine, will have high energy and happiness," he explained. "Depressants, like heroin, cause depression, slowed functions and fatigue. Substances like opioids can cause symptoms like depression, mood swings, lowered motivation and anxiety attacks."

Utter emphasized the significance of patterns that deviate from the norm.

"If you had a friend who was normally reliable and dependable, showed up on time, and now you're starting to see they're not showing up or changing the way they used to interact with you—that's a very general sign," she said.

Lying, manipulating, cheating and stealing are also behaviors she identified as indicating substance use disorder.

How you can help

All three experts recommended early intervention as the best course of action. The key to success is compassion—not confrontation—interlaced with healthy boundaries and professional input. Faladova said a qualified interventionist should have a degree in psychology, social work or a similar field, with experience in addiction.

"Interventions require a serious commitment from those involved, from preparing meetings, rehearsing and following through on promises made," Jones said. "Programs like Heritage CARES provide peer coaching and educational content as an extra means of support. Every case is different and requires a unique approach."

For relatives of individuals diagnosed with SUD, it's imperative to take care of yourself and avoid enabling the abuse.

"I don't believe in [the approach of] 'These are the rules you have to follow,'" Utter said. "You have to do what's most healthy for your heart and your head. It's important to let the individual know that their habit will not be supported or tolerated."

However, it's important to remember quality care is not always instantly accessible.

"Timely and affordable access to treatment is not efficient and is very difficult, no matter what drug it is, but especially with opioids, which can have severe withdrawal symptoms," Utter added.

The key to success is compassion—not confrontation—interlaced with healthy boundaries and professional input.

She also believes there has been a decline in quality of care since the COVID-19 pandemic began, with the drug epidemic taking a back seat as a result.

Another crucial point is that the patient has to want to get better for treatment to work.

"We can't help someone who doesn't want help or is not ready to be helped," Faladova noted.

Many people diagnosed with SUD also face its stigma, which can often prevent them from seeking help due to embarrassment or shame. This is where hotlines can be supremely important as they offer a way to get immediate one-on-one advice and information while allowing a degree of anonymity.

"Addiction does not discriminate—it doesn't care about social class, gender or age. It can happen to anyone," Faladova noted.

Utter agreed that people shouldn't worry about stigma.

"Addiction doesn't look a certain way," she said. "Don't feel ashamed to talk about it, because you'd be surprised that every person you know has been touched by it in some way."

"What we need, as a society, to slow the addiction epidemic is a paradigm shift; a change in attitude and philosophy that moves away from a one-size-fits-all model predicated on client willingness," Jones explained. "Instead, we should move toward a model predicated on assertive engagement, professional outreach, early intervention and long-term retention."