In this context, a substance is defined as a psychoactive compound - i.e. it affects brain function that can cause health and social problems.
Substance use means many things - it can refer to various “substances” - e.g. tobacco, alcohol, marijuana, improper use of prescription sedatives, etc. It can also refer to different types of use including misuse and substance use disorder or addiction.
Is Substance Use Common?
The 2016 Surgeon General’s Report on Alcohol, Drugs, and Health summarizes some substance use data:
More than 3 out of 5 people over the age of 12 years used alcohol, with 1 out of 4 binge drinking (i.e. having 5 or more drinks for males or 4 or more drinks for females during one occurrence)
Close to 1 out of 5 used marijuana at least once
12.5 million misused prescription pain relievers
Over 300,000 used heroin
What are the Risk Factors and Protective Factors?
Risk factors increase the likelihood of use, while protective factors decrease it. Some of the risk factors for substance use/misuse are:
Genetics - i.e. specific gene variants or changes
Early life stressors
Early negative behaviors (e.g. aggression, lack of self-control, etc.)
Substance use at a young age
Family history of substance misuse
Peer substance use
Use of multiple substances
Presence of mental health disorders
Low socioeconomic level
Availability and favorable view of substances
Some of the protective factors for substance use/misuse are:
Strong interpersonal skills
Possessing self-efficacy, resiliency, and spirituality
Self-efficacy - belief in your ability to confront challenges and accomplish goals (e.g. control or avoid substance use)
Spirituality - connection to something greater than oneself or involvement in spiritual/religious activities
Resiliency - ability to adapt and recover from difficult situations in healthy ways
Community, social involvement
What Do Substance - Use, Misuse, Use Disorder, and Addiction Mean?
Substance use refers to the use, even one time, of a particular psychoactive compound.
Substance misuse refers to use that harms the user or others around them. The misuse may be related to how it’s used, how much, how often, or the situation. Some types of use are always misuse - e.g. use while driving or operating machinery, use during pregnancy, or use of alcohol under the age of 21.
Harmful effects may be short-term (e.g overdose, accident or injury, etc.) or long-term (e.g. heart or liver disease, ongoing relationship problems, etc.). The risk of harm is associated with more frequent misuse.
Substance Use Disorder
The American Psychiatric Association defines substance use disorder as a medical illness related to repeated misuse of one or more substances. Characteristics include major health and social impairment and the inability to control use.
Substance use disorders usually develop over time and may be mild, moderate, or severe (see Addiction). They may also be short- or long-term.
Repeated misuse of substances leads to actual changes in the reward, stress, and self-control functions of the brain. The changes may last a long time, even after stopping use.
Addiction (Severe Substance Use Disorder)
Addiction is a severe form of substance use disorder. It is long-term with return to drug use often occurring.
A person is unable to stop seeking and using the drug even with many unfavorable consequences (e.g. health, relationship, work, finance, legal, etc. problems).
Addiction is classified as a brain disorder. It, too, involves actual brain changes that may be lasting.
Substance Use and Mental Health
Substance use and mental health problems often occur together - it may be at the same time or one may follow the other (This isn’t the same thing as one “causing” the other - that’s more difficult to determine). Experts aren’t sure of the reasons, but three possible explanations are:
Use of certain substances may lessen symptoms of mental health disorders in the short term. That may encourage use. For example, marijuana’s effects may decrease anxiety, thus encouraging its use (see Self-Medication below).
Using certain substances may “trigger” mental health disorders. Two examples from research: alcohol use may increase the risk of posttraumatic stress disorder (PTSD) by changing the brain’s response to trauma; and marijuana, especially if it has a high level of THC, may be a factor in schizophrenia in those with certain genetic variants.
Mental health and substance use disorders may share genetic, brain/nervous system deficiency, or environmental factors.
There is something called the self-medication hypothesis - a person decides they will use a psychoactive substance to lessen difficult mental health symptoms. A person may use alcohol, illegal substances, or prescription medications inappropriately, instead of seeking or following medical treatment.
It is one explanation for the presence of both mental health and substance use disorders in individuals. And, it is quite common - one review of data estimated 1 out of 4 to 5 people with anxiety or depression disorders self-medicated with alcohol and/or drugs.
And it may explain posttraumatic stress disorder (PTSD) and alcohol use disorder occurring together. A person drinks alcohol - i.e. self-medicates to cope with the effects of trauma.
Self-medicating with alcohol and/or drugs is a coping strategy, however an unhealthy one - for many reasons. Short term you may feel like your symptoms have decreased.
However, long-term, self-medication does not address your mental health needs. In fact, it often adds new ones. It may also increase the risk of many short- and long-term health problems, worsening drug misuse, and addiction.
Substance Use and Your Health
Substance use increases the risk of many serious health problems, as well as accidents, injuries, and overdose. Each substance has its unique risks. Information about the substance(s) that is relevant to you is provided through your coach and Goodpath app.
Your assessment answers indicated that continuing your current pattern of substance use may put you at risk of developing health and other problems.
Goodpath and your coaches are here to help. Your coach can provide information, support, and resources. They can help you create a plan to lessen or stop using substances.
The following can also help:
Think about your substance use and your behaviors associated with it.
Track the amount of any substance you use. Is it more than you thought?
What are the positives (“pros”) and negatives (“cons”) of using the substance?
Think about problems that might be related to your use. Work? Home life? Health-related?
Think about your goals related to substance use.
Commit to working with your coach. They can help you hold to your plan and make changes if needed. If you’re working on using less of the substance, talk with your coach about ways to accomplish this.
Use reminders to help you follow your plan. The reminders may be smartphone alerts, written Post-ItⓇ notes, calendar entries, etc.
Limit your use. If you’re working on using less, talk with your coach about ways to accomplish this.
Identify and learn to cope with triggers. They may be people, places, or situations.
Have support in place. In addition to your coach, if you want to use less, share the information with a close friend or family member - they can also provide support.