Do You Know the Risk Factors for Substance Use Disorder?

Key Points

• Taking prescriptions as directed to treat a medical condition would be drug use, but deviating from the instructions and using them for unintended purposes would constitute drug abuse.
• Substance use disorder can be defined as a physical and mental health condition characterized by uncontrolled behaviors and frequent and compulsive substance use, stemming from chemical addiction in the brain.
• Not all drugs used by patients with substance use disorder are illegal. Almost any substance you can ingest can lead to a problem if you take too much of it.

People have used mind-altering substances for thousands of years. Archaeologists have discovered cannabis seeds in Asia dating back to 8100 BCE, though their research suggests an even earlier presence of such substances.

Alcohol is ancient as well, with evidence of brewing occurring in 7000 BCE in parts of China.

By 5700 BCE, opium residue was present in Europe.

The indigenous people of the United States have a history of psychedelic use that stretches as far back as 4000 BCE.

Since those early days of experimentation, drugs have come a long way. We now use them for a wide range of purposes, including those that are primarily beneficial for issues with mental, physical, sexual and other health disciplines. However, the utilization of substances comes with a caveat that some people get hooked and can no longer function without them.

This reliance is known as substance use disorder (SUD). 

What is substance use disorder?

First and foremost, there is a distinct difference between substance use and substance use disorder. For example, taking prescriptions as directed to treat a medical condition would be substance use. Deviating from the instructions and using them for unintended purposes, however, would constitute SUD. 

Abusing a drug is the hallmark behavior of SUD.

SUD can be defined as a physical and mental health condition characterized by uncontrolled behaviors and frequent and compulsive substance abuse, stemming from chemical addiction in the brain, according to Olalekan Otulana, M.B.Ch.B., a medical reviewer at Addiction Advocates in Stevenage, United Kingdom.

"The most common and severe form of SUD is substance addiction to alcohol or drugs, as this can have a detrimental effect on health and well-being," he said.

Diagnosis of SUD is contingent on meeting at least two of the 11 criteria within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), during the preceding 12 months, according to David Tzall, Psy.D., a licensed psychologist in Brooklyn, New York.

These criteria can be classified into the following categories:

• Impaired control
• Risk-taking behaviors
• Physical dependence
• Social impairments 

Diagnoses will reveal the abused substance type(s) and degree of illness. Generally, there is a positive correlation between the number of criteria satisfied and one's addiction severity, according to David Deyhimy, M.D., an addiction medicine expert and the medical director of MyMATClinic in Laguna Hills, California.

Risk factors for substance use disorder

Numerous factors exist that put people at an elevated risk of developing substance use disorder.

A strong genetic component is at play, Deyhimy said, with risks increasing if both parents have a history of the condition. Early development can have an influence as well. Childhood neglect and trauma such as physical and sexual violence are associated with SUD. The younger someone is when they start experimenting with drugs, the more likely they are to develop problems in the future.

Another significant risk factor is poor mental health, namely having conditions such as depression, anxiety, schizophrenia and bipolar disorder, Deyhimy said. The effect is exacerbated if those mental health conditions are untreated.

Comorbidities can pose a "chicken or the egg" conundrum because many ailments potentially caused by SUD—such as drug-induced psychosis—may mimic other psychiatric disorders.

Gender has influences on substance use disorder, too. The rates of SUD are lower for females, but their cases tend to be more severe, a 2021 report suggested. This is attributed to elevated incidences of psychiatric comorbidities and being subjected to intimate partner violence (IPV), along with threats to reproductive and sexual health.

Women are also less likely to seek treatment. Only 1 in 5 people receiving help are women.

Protective factors are the antithesis of risk factors. They can counteract poor prognoses and lessen the influence of risk factors. Bolstering protective factors and minimizing risk factors makes SUD prevention possible.

The Substance Abuse and Mental Health Services Administration (SAMHSA) crafted the Strategic Prevention Framework (SPF) to obtain comprehensive knowledge about substance use disorder and related conditions so they can be properly addressed in various settings and demographics.

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Which drugs are under the SUD category?

Not all drugs used by patients with SUD are illegal. Tzall said almost any substance you can ingest can lead to a problem if you take too much of it.

"Legal substances such as nicotine, alcohol and caffeine are part of [substance use disorder] as much as more illicit substances, including cocaine, crack, heroin, meth, LSD, marijuana or inhalants," he said.

Another classification is prescription medication, which isn't inherently illegal but is still susceptible to abuse.

"Some of these medications are more likely to be abused through overuse or obtained when the person does not have a prescription," Tzall added. "Opioids, stimulants and sedatives—for example, Xanax and Valium—fall within this category."

Alternately, drugs can be categorized by their effect on the body. For instance, depressants slow down the central nervous system (CNS), while stimulants do the opposite. This means the brain's ability to send and receive messages from the rest of the body is impaired. Hallucinogens, on the other hand, change your entire perception of reality.

On a fundamental level, manifestations from any substance are dependent on the type of neurotransmitter being stimulated or suppressed.

Bottom line

If you or a loved one has a substance use disorder, speak with your healthcare provider about the steps you should take for treatment and therapy. Talk with your provider about other recommendations for helpful resources, such as joining an online community for peer support.

You can find online resources at the following websites:

• American Addiction Centers. Reach out to their portfolio of websites that aim to educate, empower, and guide individuals struggling with substance use.
• Partnership to End Addiction. Find online support meetings for parents and caregivers of children experimenting with, or dependent on, substances.
• Substance Abuse and Mental Health Services Administration. Call the Disaster Distress Helpline 24/7 at 800-895-5990.
• United States Drug Enforcement Administration. Recovery resources here focus on finding help, treatment and prevention tools.