What Is Substance Use Disorder?

Many adults can enjoy an occasional alcoholic drink or two safely and without ill effects on their health, ability to function at work or home, or mental state. Tobacco use is also common, and while the negative health effects of tobacco are well-documented, most people who use these substances do not have a mental health disorder.

Substance use disorders – which can be mild, moderate or severe – occur when a person’s recurrent use of alcohol, tobacco and/or drugs causes health problems, disability, or failure to meet major responsibilities at work, school or home. Someone with a substance use disorder exhibits impaired control, problems with social interactions and risky behaviors, among other symptoms.

Signs and Symptoms

The most commonly diagnosed substance use disorders are alcohol use disorder, tobacco use disorder and drug use disorder, which can be further broken down into disorders associated with cannabis; stimulants; inhalants; hallucinogens; opioids; or sedative, hypnotic or anxiety-reducing drugs. 

For a diagnosis of alcohol, tobacco or drug use disorder, a person must exhibit a problematic pattern of alcohol, tobacco or drug use leading to clinically significant impairment or distress, characterized by at least two of the following symptoms, occurring within a 12-month period:

• Drinks alcohol/uses tobacco or drug in larger amounts, or over a longer period, than was intended
• Shows a persistent desire or unsuccessful efforts to cut down or control alcohol/tobacco/drug use
• Spends a great deal of time on activities necessary to obtain alcohol/tobacco/drug, use it or recover from its effects
• Craves or shows a strong desire to use alcohol/tobacco/drug
• Fails to fulfill major obligations at work, school or home due to frequent alcohol/tobacco/drug use 
• Continuously uses alcohol/tobacco/drug despite persistent or recurrent social or interpersonal problems caused or exacerbated by its effects
• Gives up or reduces important social, occupational or recreational activities because of alcohol/tobacco/drug use
• Regularly drinks alcohol/uses tobacco or drug in situations in which it is physically hazardous
• Continues alcohol/tobacco/drug use despite knowledge of persistent or recurrent physical or psychological problems likely caused or exacerbated by it
• Exhibits tolerance, as defined by either of the following:
• A need for markedly increased amounts of alcohol/tobacco/drug to achieve desired effect
• A markedly diminished effect with continued use of the same amount of alcohol/tobacco/drug
• Withdrawal, as manifested by either of the following:
• The characteristic withdrawal syndrome for alcohol/tobacco/the specific drug (withdrawal not typically associated with hallucinogens or inhalants)
• Uses alcohol/tobacco/drug or related substance to relieve or avoid withdrawal symptoms

Diagnosis

Diagnosing substance use disorder requires a thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for alcohol, tobacco or a specific drug use disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

Diagnostic tests include:

Lab or imaging tests: Certain drugs can be detected in the blood or urine, and certain patterns of lab test abnormalities may strongly suggest chronic use or overuse of alcohol, tobacco or drugs. Imaging tests may be ordered if organ damage from one of these disorders is suspected.

Physical examination: Your provider will perform a physical exam and ask questions about your health. There are physical signs and health problems that indicate alcohol, tobacco or drug overuse.

Psychiatric evaluation: Your behavioral health provider will ask you questions about your symptoms, thoughts, feelings, behavior patterns, relationships, social life, and functioning at home, work or school. Your provider will also ask questions about your alcohol, tobacco or drug habit(s), such as when it began, if and when it increased, and when you (or others) began to notice significant life impacts. 

Causes

The exact cause of substance use disorder is unknown, but researchers believe a person’s genes, emotional distress, peer pressure, coexisting mental or behavioral disorders, environmental stress, and the substance’s physical and emotional effects all play a part.

Risk Factors

Risk factors that could contribute to substance use disorder include:

Difficult family situations: Strained familial bonds, neglect, lack of parental supervision or other issues at home can make a person more likely to start using alcohol, tobacco or drugs as a coping mechanism. Over time, this can lead to the development of a substance use disorder.

Family history: In some families, there appears to be a genetic predisposition for developing a substance use disorder. Witnessing a parent or close family member’s substance use can also be a factor.

Gender: Men seem to develop substance use disorders more often than women, but women may experience a faster progression.

Mental or behavioral health conditions: Post-traumatic stress disorder (PTSD), anxiety disorder, depression, attention deficit hyperactivity disorder (ADHD) and other conditions may put a person at a higher risk of developing a substance use disorder.

Peer pressure: Many people start drinking alcohol, smoking or taking drugs because of intense social pressure.

Substance addictiveness: Some drugs, like stimulants, cocaine or painkillers, may result in faster development of dependency and a substance use disorder.

Prevention

The likelihood of developing a substance use disorder is greatest when a person begins using alcohol, tobacco or drugs at an early age (often in his or her early teen years). Prevention strategies to limit experimentation and early intervention at the first signs of substance use are most effective.

Parents, teachers, school officials and primary care physicians should be on the lookout for symptoms that might indicate substance use, such as:

• Physical signs like bloodshot eyes, slurred speech, coordination problems, bad breath, significant lethargy or restlessness
• Mental and emotional signs like memory lapses, concentration problems, mood changes and irritability, defensiveness and/or loss of interest in previously enjoyed activities
• Declining grades at school or poor work performance/absenteeism
• Difficulties or changes in relationships with friends and family
• Changes in appetite or sleep patterns
• Neglect of personal grooming
• Frequent requests to borrow money, or – in severe cases – stealing money
• Increased demand for constant privacy

As a parent, caregiver or other trusted adult, you can help prevent a young person from developing a substance use disorder, or intervene early, by:

• Setting a good example by drinking alcohol responsibly, not smoking and avoiding drugs
• Speaking openly with the child about alcohol, tobacco and drugs; peer pressure; stress; relationships and other issues he or she may be facing
• Spending quality time together and staying actively involved in the child’s life
• Telling the child your/your family’s behavioral expectations and the consequences for breaking the rules
• Offering support – including getting the child/teen medical or psychological help – if he or she is struggling with substance use

If you recognize signs of a developing substance use problem in yourself, seeking immediate medical and psychological help can help you get the disorder under control.

Prognosis

People with substance use disorders have a better prognosis if they are motivated and engaged in their recovery and receive intensive, and early, medical and psychological interventions. Support groups, family and/or group therapy, and long-term rehabilitation programs can be very helpful as well. Inpatient or residential rehabilitation programs can help people with severe or longstanding drug or alcohol use disorders. 

Treatment

Most people with substance use disorder benefit from a combination of medication, psychotherapy and support services. Treatment may include:

Medication

Medication can be effective when prescribed in combination with counseling and behavioral therapies. Medications can help reduce cravings and/or withdrawal symptoms by occupying receptors in the brain associated with use of alcohol, tobacco or certain drugs – blocking the rewarding or pleasurable sensation or inducing negative feelings when that substance is taken. 

Psychotherapy and Counseling

Psychotherapy and counseling can be provided at the individual or group level. Individual therapies often focus on reducing or stopping use of the substance, building coping and avoidance skills, adhering to a recovery plan, improving social and family relationships, and reestablishing educational or professional stability. Group therapy can help provide social reinforcement as a person pursues recovery.

Common therapies include:

• Cognitive behavioral therapy, which teaches individuals to recognize and stop negative patterns of thinking and behavior
• Reinforcement of positive behaviors
• Motivational enhancement therapy, which helps people build motivation and commit to specific plans to engage in treatment and seek recovery
• 12-step facilitation therapy, which guides and supports engagement in 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous
• Treatments for children and teenagers often involve a family component, such as family counseling, home-based treatments and frequent follow-ups.
• Inpatient or Residential Rehabilitation

Some people with substance use disorders benefit from treatment in inpatient or residential settings. These include specialty substance use disorder treatment facilities, behavioral health facilities or specialty hospital units. These programs can help people change their behaviors in a highly structured setting, focus on detoxification and intensive treatment, and prepare them to return to work, school, social settings and community activities. 

Complications

Complications of substance use disorder can be mild to severe and may depend on the substance used. They include:

• Depression
• Fatal overdose
• Infections with HIV or hepatitis B or C through shared needles
• Illness, such as cancers associated with drug or alcohol overuse
• Job loss
• Legal problems
• Memory and concentration problems
• Poor grades/dropping out of school
• Relationship problems
• Social isolation
• Unsafe sexual practices, which can result in infections or unplanned pregnancy 

We're Here with the Care You Need 

Our facilities offer a variety of substance-abuse treatment programs that vary in setting and intensity. These programs include assessment, stabilization, and therapy services, all personalized to meet individual needs, but all focused on helping patients regain sobriety in an atmosphere of dignity and respect. Patients can benefit from our programs if they commit to working toward abstinence from mood-altering substances and making healthy choices in life. 

Below is an overview of substance-abuse treatment options available at Baptist Health facilities in Kentucky and Southern Indiana:

Baptist Health Louisville

The Intensive Outpatient Program (IOP) at Baptist Hospital Louisville provides a structured environment for patients with chemical dependency to regain and maintain their sobriety. The IOP includes: 

• Stabilization and assessment services, resulting in an individualized treatment plan overseen by a social worker or case manager.
• A 20-day intensive outpatient program offering education classes, group therapy, art therapy, and mindfulness-based therapy from psychiatrists, social workers, counselors, clinicians, and other fully licensed practitioners
• The 20-day program meets daily Monday-Thursday, and includes Family Days and random drug screenings.
• A continuing care program for graduates of the 20-day program, for additional support in maintaining sobriety.

Call the Access Center at 502.896.7105 or toll-free at 800.478.1105 with questions or to schedule an evaluation. 

Baptist Health Floyd

Outpatient Program

Baptist Health Floyd offers treatment and support as part of a broader program in outpatient behavioral care. Services include: 

• Psychiatric evaluation and assessment.
• Individualized treatment plans.
• An outpatient psychiatric practice and medication management treatment options.
• A physician’s assistant specializing in addiction medicine. He or she will provide Vivitrol for alcohol abuse, as needed. 

For more information on the outpatient behavioral health program at Baptist Health Floyd, you may contact us at 1919 State Street, Suite 248, New Albany, Indiana, 47150 or call 812.949.5767.

Baptist Health Corbin

Dedicated to hope, help, and healing, Baptist Health Corbin offers a complete range of substance abuse treatment options in both inpatient and outpatient settings:

Inpatient Medical Detoxification Program

• The Detoxification Recovery Program at Baptist Health Corbin’s Trillium Center provides medically assisted detoxification from alcohol, opiates, and benzodiazepines. Patients undergo a safe and medically supervised transition through the acute phases of withdrawal.
• Program includes diagnosis, managed withdrawal, and aftercare components.
• Affiliated medical personnel include psychiatrists, clinical social workers, psychiatric nurse practitioners, and licensed professional counselors.

For more information about the inpatient detoxification program at Baptist Health Corbin’s Trillium Center, please call 800.395.4435 or 606.523.5900.

Adult Chemical Dependency Intensive Outpatient Program

The Intensive Outpatient Program (IOP) at Baptist Health Corbin provides a structured environment for patients with chemical dependency to regain and maintain their sobriety. The IOP includes: 

• Stabilization and assessment services, resulting in an individualized treatment plan.
• Treatment options, including medication management and outpatient therapy. 
• IOP Group three times a week up to three hours per session, for a maximum duration of six months.

For more information about the Intensive Outpatient Program at the Briscoe Clinic, please call 606.523.8521. 

Baptist Health Richmond 

Baptist Health Richmond offers substance-abuse treatment options in an outpatient setting.

Adult Chemical Dependency Intensive Outpatient Program

The Intensive Outpatient Program (IOP) at Baptist Health Richmond provides a structured environment for patients with a chemical dependency to regain and maintain their sobriety. The IOP includes: 

• Stabilization and assessment services, resulting in an individualized treatment plan.
• Treatment options, including medication management and outpatient therapy. 
• IOP Group four times a week for three hours per session, for a maximum duration of six months.

For more information about the Intensive Outpatient Program at The Behavioral Health Clinic, please call 859.544.8171. 

Casey’s Law

Casey’s Law provides a way for concerned friends and family members to assist their loved one in getting the substance abuse treatment they need despite their loved one’s lack of willingness to seek treatment. Learn more about Casey’s Law in Kentucky.