Substance Use Disorder
Original Editor - Lucinda hampton
Top Contributors - Lucinda hampton, Emily McPherson, Vidya Acharya and Alexandra Stead
Introduction
Substance use disorder (SUD) is characterised by the recurrent need to take a substance despite negative consequences.[1] This can involve the excessive use of nicotine, alcohol, and other illicit substances.[1] The DSM-V lists SUD as a neuropsychiatric disorder.[1]
The specific factors of substance use disorder consist of abuse, intoxication, and physical/psychological dependence.[2] As addiction progresses, the individual can no longer resist their desire to partake in the substance despite potentially severe social, economic, and health consequences.[2]
SUD can cause problems with personal care and physical health.[2] It may put pressure on relationships and cause financial stress.[2] It can also lead to changes in mood or behaviour, such as increased aggression or irritability, depression, anxiety, and lethargy.[2]
Aetiology and Epidemiology
The cause of SUD is multifactorial and includes psychological, biological, socio-cultural, and environmental factors.[2] It is thought that up to 50% of addiction risk can be attributed to genetics.[2] Attention deficit hyperactivity disorder (ADHD), depression, schizophrenia, bipolar disorder, and anxiety are commonly associated with an increased risk of SUD.[2][3] Adverse childhood experiences (ACEs) have been strongly linked with subsequent substance use.[2] [4] These predispositions to SUD are modulated by social factors, such as family or community support, inequality, drug availability, and community attitude towards drugs.[2]
Worldwide, substance use is high. See the table below for estimated numbers of cases of SUD worldwide broken down into substances. SUD is more common in men than in women.[2]
| Substance | Prevalence |
|---|---|
| Opioid | 61.4 million |
| Cannabis | 243.9 million |
| Cocaine | 24 million |
| Amphetamine | 30 million |
| Alcohol | 2.3 billion |
| Nicotine | 1.3 billion |
SUD occurs at a neurobiological level. Humans are predisposed to seek out positive rewarding stimuli and avoid aversive stimuli, with dopamine being the key neurotransmitter for this neuro-adaptation.[2] Drugs utilise this dopaminergic mechanism. Any addictive drug increases dopamine in the nucleus accumbens.[2] This reward system has multiple parts, including motivation and associative learning, or conditioning.[2] The drugs with the largest associated dopamine increases, methamphetamines, have the highest risk for addiction.[2]
COVID-19 Effects
During the COVID-19 pandemic quarantines, an increase in stress, anxiety, and isolation was reported.[7] This increase in mental health challenges found an increase in SUD rates, including relapses.[7] There was an increase in drug overdose deaths as compared to the previous year. Furthermore, treatment options were limited to virtual due to the risk of spreading the virus.[7] Access to other services, such as needle exchanges and naloxone, were also limited, which increased risk of other disease and overdose related deaths.[7]
Symptoms
The primary symptom of SUD is a loss of behavioural control.[8] The diagnostic criteria for SUD are secondary to this loss of control. An individual with more symptoms is considered to have a more severe disorder.[8] Below is a list of symptoms:[8]
- Decreased control of amount or time period of use
- Unable to stop using despite wanting to
- Significant time is spent around using, such as getting the substance, using it, and recovering from use
- A significant desire to use, or craving
- Decreased tolerance for managing commitments
- Using despite negative consequences with personal relationships
- Abandoning important activities due to use of substance
- Using even when it increases danger risk
- Using despite worsening physical or psychological problems
- Tolerance to substance is increased requiring more of the substance
- Symptoms of withdrawal when abstaining from the substance
Many people experience substance use disorder along with another psychiatric disorder.[2] Psychiatric disorders can either precede SUD or be triggered by the use of substances.[2]
Treatment of SUD
Treatment of SUD is multifactorial and unique to the individual. Beginning to decrease or stop use of the substance is the first step in treatment.[9] With cases of physical addiction, detoxification is a necessary step to help manage the symptoms of withdrawal.[9] Even after an individual has detoxed from a substance, the altered brain pathways do not revert back to normal, thus leaving them with ongoing cravings.[9] The risk for relapse at this stage is high.[9]
The use of medications can be very helpful in decreasing or preventing relapse so that an individual can have a longer period of abstinence from the substance.[9] These medications should be used in combination with psychosocial treatments to address altering behaviours and to address any underlying psychologic disorders.[9]
Cognitive behavioural therapy (CBT) has been shown to be useful independently as well as in combination with other treatments.[10] CBT can be provided in either individual or group treatments.[10] While there are many different strategies that can be employed, such as operant learning strategies, cognitive and motivational elements, and skills building interventions, the main focus tends to be on learning how to overcome the powerful reinforcing effect of these substances.[10]
Physical Exercise and Treatment of SUD
Physiotherapists can use their skills to promote physical activity in people with SUD. This would ideally exist within a multidisciplinary setting. See Mental Health, Physical Activity and Physical Therapy.
Evidence suggests that physical exercise can be an effective adjunct treatment method for people abstaining from alcohol, nicotine, and illicit drugs, helping to reduce associated withdrawal and psychological symptoms.[11] Physical exercise not only increases the abstinence rate in subjects with SUD, but also eases withdrawal symptoms, anxiety, and depression symptoms.[12] High intensity exercise has been shown to have the most benefit on withdrawal symptoms, while moderate intensity exercise has been shown to be the most beneficial for symptoms of depression and anxiety.[11] Additionally, mind-body exercises (including Tai Chi and Yoga) have similar treatment effects as to aerobic exercise.[12]
Physical exercise has been proven effective in facilitating drug abstinence, however the effects on alcohol, nicotine and illicit drug abusers are each unique.[12] While there are many positive effects of implementing a physical exercise routine in those with SUD, not all individuals showed a change in cravings outcomes, so having a multidisciplinary approach is best.[13]
Summary
SUD is a widely prevalent disorder that can have widely ranging negative effects on an individual's life.[1] There are many factors that may predispose one to SUD, such as mental health disorders or childhood trauma.[2] SUDs occur due to changes in neuropathways in the brain that cause the persistent cravings, which can cause an individual to pursue using the substance despite negative consequences.[2] Treatment initially involves detoxing from the substance and may involve medications or CBT.[9][10] Exercise has been shown to be a useful tool to combat relapse and physical therapists can assist in an exercise based treatment plan in addition to their conventional therapies for individuals suffering from SUD.[11]
References
- ↑ 1.0 1.1 1.2 1.3 Zou Z, Wang H, d’Oleire Uquillas F, Wang X, Ding J, Chen H. Definition of substance and non-substance addiction. Substance and non-substance addiction. 2017 Nov 3:21-41.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 Volkow ND, Blanco C. Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry. 2023 Jun;22(2):203-29.
- ↑ Deak JD, Johnson EC. Genetics of substance use disorders: a review. Psychological medicine. 2021 Oct;51(13):2189-200.
- ↑ Shin SH, McDonald SE, Conley D. Patterns of adverse childhood experiences and substance use among young adults: A latent class analysis. Addictive behaviors. 2018 Mar 1;78:187-92.
- ↑ United Nations Office on Drugs. World Drug Report 2025. Stylus Publishing, LLC; 2025
- ↑ Bull C, Kisely S, Hutchinson D, Hewlett N, Reid N. Differences in tobacco smoking and alcohol consumption among 57,757 women from early to late pregnancy: A state-representative study in Queensland, Australia. Drug and Alcohol Dependence. 2025 Jul 30:112816.
- ↑ 7.0 7.1 7.2 7.3 Avena NM, Simkus J, Lewandowski A, Gold MS, Potenza MN. Substance use disorders and behavioral addictions during the COVID-19 pandemic and COVID-19-related restrictions. Frontiers in Psychiatry. 2021 Apr 16;12:653674.
- ↑ 8.0 8.1 8.2 McLellan AT. Substance misuse and substance use disorders: why do they matter in healthcare?. Transactions of the American Clinical and Climatological Association. 2017;128:112.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Maqbool M, Dar MA, Rasool S, Gani I, Khan M. Substance use disorder and availability of treatment options: an overview. Journal of research in health science. 2019;1(3):4.
- ↑ 10.0 10.1 10.2 10.3 McHugh RK, Hearon BA, Otto MW. Cognitive-behavioral therapy for substance use disorders. The Psychiatric Clinics of North America. 2010 Sep;33(3):511.
- ↑ 11.0 11.1 11.2 Li H, Su W, Cai J, Zhao L, Li Y. Effects of exercise of different intensities on withdrawal symptoms among people with substance use disorder: a systematic review and meta-analysis. Frontiers in Physiology. 2023 May 10;14:1126777.
- ↑ 12.0 12.1 12.2 Wang D, Wang Y, Wang Y, Li R, Zhou C. Impact of physical exercise on substance use disorders: a meta-analysis. PloS one. 2014 Oct 16;9(10):e110728.
- ↑ Alserihi AR, Abdullah AM, Bashrahil B, Albishry AM, Alansari KW, Khan SN, Binmahfooz A, Alsaleh A, Alharbi MA, Alsalem M. Supervised exercise as adjunctive treatment for substance use disorder: Systematic review and meta-analysis. Medicine. 2025 Dec 26;104(52):e45370.