Substance Use Disorder

Key Takeaways

• Substance use disorder (SUD) is a pattern of drug or alcohol use that harms physical or mental health (to an individual or others) and interferes with daily functioning. The disorder is a progressive condition that worsens without treatment, potentially leading to permanent brain changes.
• "Addiction" generally refers to moderate or severe SUD, characterized by a loss of control over substance use. Key symptoms include regular use, intense cravings, needing more of the substance for the same effect, using more than intended, neglecting responsibilities, and continuing use despite consequences.
• Effective treatments include medication, behavioral therapies (such as CBT, motivational interviewing, contingency management, and 12-step programs). When an SUD develops into an addiction, it becomes a lifelong disorder requiring ongoing support.

Understanding Substance Use Disorders

Substance use disorder (SUD) is a complicated mental health condition characterized by the uncontrollable use of a specific substance even in the face of serious consequences and a desire to stop using. Individuals with SUD often develop a strong dependence (frequently referred to as an addiction) to substances such as alcohol, tobacco, or other drugs. ^[1]

There are different levels of SUD, ranging from mild to moderate and severe. When substance use disorder is moderate or severe, it interferes with a person’s ability to function in everyday life without fail. Substance use disorder tends to be a progressive condition, meaning that it worsens when left untreated, with prolonged use leading to permanent changes in the brain. ^{[1] [2]}

Using alcohol, which is now recognized as a drug, or other drugs, whether illicit or legal, causes intoxication, which is a short-term sense of calm or euphoria that differs widely depending on the drug. Over time, continued use of a substance leads to tolerance, meaning that larger quantities of the drug are needed to achieve the same effects. ^{[1] [3]}

Depending on the severity of the substance use disorder, if a person who is addicted to drugs tries to stop using, it can trigger physical withdrawal symptoms, emotional instability, and intense cravings. Many addicts describe experiencing a sense of overwhelming anxiety, depression, irritability, hopelessness, apathy, and desperation when not intoxicated. ^{[1] [2]}

Are SUDs the Same as Addiction?

Substance use disorder and addiction exist on a spectrum, with “addiction” generally referring to moderate or severe substance use disorders, where people lose control over their drug use in varying degrees. In the early or mild stages of SUD (sometimes called "pre-addiction"), a person can still choose whether or not to use, making it the perfect time to seek preventative treatment. ^[2]

As substance use disorder progresses from the mild stage into an addiction, it becomes increasingly difficult to resist the urge to use - even when it causes harm to health, relationships, employment, finances, legal status, or daily functionality. The rate at which a mild SUD worsens into full-blown addiction varies from person to person, based on a mix of factors. ^[2]

Ultimately, when substance use disorder is not treated, the progression emerges (sometimes slowly) as a vicious cycle of intoxication, withdrawal, and uncontrollable cravings. The length and intensity of each stage in the cycle depend on the severity of the disorder and the specific drug(s) involved. ^[2]

Other factors that impact the onset of addiction include: ^{[2] [4]}

• Age of first use
• A person’s biological makeup
• Social factors
• Psychological factors (individual history and personality)
• Availability of drugs
• Family dynamics
• Peer dynamics
• Financial resources
• Cultural norms
• Exposure to stress
• Access to social support

As a person continues to abuse alcohol or other substances, the brain undergoes gradual changes, known as neuroadaptations, that affect its structure and function. These changes impair brain function and contribute to the shift from occasional, controlled use to chronic misuse, making it harder to control. ^[4]

How SUDs Affect the Brain

Throughout history, people with SUD were frequently seen as having a moral failing or character flaw and were stigmatized with labels like "junkie," “drunk,” or worse. However, advances in neuroscience have revealed the physical brain changes behind this condition, leading to the recognition of addiction as a long-term disorder that can be treated and managed for recovery. ^[2]

In addition to relentless cravings, addiction can affect a person’s thoughts and behaviors due to physical changes in the brain. Brain scans of people with moderate to severe SUD have shown that areas involved in decision-making, reward, memory, learning, stress response, mood regulation, self-awareness, and self-control are all impacted by the disorder. ^{[1] [2]}

Different parts of the brain are responsible for each stage of the addiction cycle, resulting from disruptions in networks that control: ^[2]

• Reward and motivation (the brain system that drives humans to seek out rewarding experiences, including food and sex)

• Executive function (the brain system that facilitates decision making, impulse control, and planning)

• Salience and emotion networks (the brain systems responsible for mood and stress response)

• Interoceptive and default mode networks (the brain systems that are connected to self-awareness of the body and emotions, including thoughts and behaviors)

These changes may lead to personality changes, impaired judgment, and unusual behaviors or movements in people with an addiction to substances. When dopamine (a brain chemical linked to pleasure) floods the brain during substance use, over time, it eventually rewires the brain's natural reward system so that individuals need the substance just to feel normal. ^{[1] [2]}

Furthermore, these brain changes persist long after a person recovers from the disorder and stops using substances. Unfortunately, many recovering addicts struggle with ongoing cravings that can trigger a relapse, with more than 60% of individuals treated for SUD relapsing within the first year after treatment, and the risk remains high for many years. ^[4]

How Common are Substance Use Disorders?

Globally, substance use disorders are common, though prevalence differs depending on the country, the specific substance, differences between diagnostic systems, and various demographic and socioeconomic factors. SUDs tend to be more prevalent among men than women and are generally higher among younger individuals, with rates declining as people age. ^[2]

In 2021, over 46 million people in the United States of America had a substance use disorder. According to a survey conducted by the National Centre for Drug Abuse, a staggering 50% of people aged 12 and above had used illicit substances at least once in their lifetime. Furthermore, drug overdose-related deaths were nearing 1 million in 2020. Additionally: ^{[5] [6]}

• More than 37 million Americans aged 12 and older reported using illegal drugs in the past 30 days.
• Over 59 million US citizens (more than 20%) reported using illegal drugs or misusing prescription drugs in the past year)
• Around 140 million Americans aged 12 and older consume alcohol, with 20% of those estimated to have an alcohol use disorder.
• More than 25% of people who use illegal drugs meet the criteria for a substance use disorder.
• Among those with SUD, nearly 25% have an opioid use disorder, which includes misuse of prescription painkillers and heroin.

Symptoms of Substance Use Disorders

Whether substance use disorder is considered mild, moderate, or severe depends on how frequently substances are used. Additionally, the amount of harm caused to the person using substances and to others (as a direct consequence of using) is taken into account. Here are some of the key symptoms of SUD:

• Needing to use the drug regularly (every day or night, or multiple times a day).
• Intense cravings for a substance (whether physical or emotional) that consume an individual’s thoughts and become an obsession.
• Gradually requiring more of the drug to achieve intoxication.
• Using larger quantities of the substance or using it for a longer period than planned.
• Ensuring a constant supply of the drug, or providing access to the substance.
• Spending money needed for responsibilities or savings on the substance.
• Failing to meet obligations at school, work, or home due to drug use.
• Lack of interest in social and recreational activities, as a result of an obsession with drug use.
• Continuing to use a substance despite knowing that it causes harm to one’s physical or mental health.
• Engaging in behaviors that go against a person’s values to obtain a drug, such as theft, fraud, violence, or sex work.
• Participating in risky behaviors (such as driving or operating dangerous machinery) while under the influence.
• Spending significant time obtaining, using, or recovering from the drug's effects.
• Failing in attempts to stop using the drug.
• Unsuccessful attempts to quit or cut down, sometimes resulting in withdrawal symptoms.
• Physical health issues (such as lack of energy, weight changes, skin issues, discoloration of teeth, or red eyes).
• Neglecting personal appearance (brushing hair, shaving, makeup, or dressing well)
• Lack of interest in personal hygiene or self-care (cleanliness of self and abode, exercise, diet).
• Avoidance or isolation in order to use in secrecy.
• Significant shifts in relationships with family and friends.

It is worth noting that addiction is not limited to homeless people and that a large number of people struggling with substance use disorder are extremely successful. Due to the varying levels of SUD, some individuals with mild or moderate symptoms may appear well-dressed and could even be “high functioning,” meaning that their lives seem to be in order.

Diagnosing Substance Use Disorder

One of the main barriers to diagnosing substance use disorder is that most addicts tend to hide their issue with substances due to stigma and denial. In light of this, accepting that there is a problem and seeking help is the first and most important step in the journey to recovery. The sooner a person reaches out, the fewer consequences will result from substance use. ^[1]

Treatments for SUD can be effective at any stage of the disorder (whether mild, moderate, or severe), although it is better to seek treatment in the early stages. The International Classification of Diseases, 11th Revision (ICD-11) classifies SUD as three different types. Considering that the disorder is a progressive condition, these can be thought of as stages, with ongoing use leading one to develop into another chronologically: ^{[1] [2]}

• Episode of Harmful Substance Use: A single instance of substance use that causes serious clinical harm to a person’s mental or physical health, or to the well-being of others.

• Harmful Pattern of Substance Use: Repeated or ongoing use of a substance that leads to significant mental or physical health problems for the individual or those around them.

• Substance Dependence: A more severe form of SUD, characterized by a loss of control over substance use. This stage is when a person becomes addicted, prioritizing using over everything, and continuing to use despite clear negative consequences.

The ICD-11 classification helps healthcare providers spot early signs of problematic use and decide whether someone might benefit from brief support or needs more intensive treatment. Similarly, the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) lists 11 criteria for the disorder, and SUD is classified by how many criteria are met : ^[2]

• Mild: 2 to 3 criteria
• Moderate: 4 to 5 criteria
• Severe: 6 or more criteria

In the DSM-5, substance use disorder is diagnosed when a person shows “a problematic pattern of substance use” resulting in at least two of the following criteria within 12 months. This means that even experiencing two episodes of the following criteria is recognized as clinical disorder. ^[2]

• Using more than intended: Using larger quantities of a substance or using for a longer period than initially intended.
• Trying to cut down without success: Ongoing desire to quit using or reduce consumption, with unsuccessful attempts.
• Time spent on the substance: Excessive time is spent getting, using, or recovering from the effects of the substance.
• Intense cravings: There is a powerful desire or urge to use the substance (whether emotionally or physically).
• Neglecting responsibilities: Repeated use of a substance leads to failure in fulfilling duties at school, work, or home.
• Social problems: An individual continues to use a substance despite ongoing issues in relationships or social interactions related to substance use.
• Giving up activities: Important social, work, or leisure activities are reduced or abandoned to prioritize substance use.
• Risky use: The substance is used in situations that could be physically dangerous (e.g., driving while intoxicated or spending time in dangerous places to use).
• Ignoring health issues: Continuing to use substances despite being aware of worsening physical or mental health conditions, directly related to using.
• Tolerance: An individual requires much more of the substance to achieve the same effect, or the same amount no longer causes intoxication.
• Withdrawal: Physical or mental withdrawal symptoms occur when not using, or substances are used to avoid these symptoms. Not all substances cause clear withdrawal symptoms, so this last point may not apply to every case.

SUD Assessments and Tests

Only a small percentage of people with substance use disorders seek help. However, many do visit doctors for other health conditions, such as infections or pain. For this reason, checking (screening) for substance misuse during regular medical or mental health visits can be an effective method of identifying SUD before the disorder progresses even further. ^[2]

Screening aims to identify substance use that poses a health risk and to create an action plan based on severity, co-occurring mental or physical health conditions, and the individual’s motivation for change. While moderate or severe SUDs can lead to more severe consequences, mild SUD is far more common - but still poses a significant threat to health. ^[2]

Healthcare providers have the opportunity to help prevent many of the negative consequences associated with substance misuse, and to halt progression into severe substance use disorder by screening for "pre-addiction." There are existing screening tools available for this purpose, with further efforts underway to validate them. ^[2]

Brief screening tools, which can be used in healthcare settings with limited time, have been proven to be effective. These tools include self-report instruments with high sensitivity and specificity, featuring questions such as, "How many times in the past year have you used an illegal drug or misused prescription medication?" ^[2]

Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)

A widely recommended, evidence-based screening tool for primary care settings is the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization (WHO). ^[2]

• Consists of eight questions covering alcohol, tobacco, and drug use (including injection drug use)
• Helps identify whether an individual’s substance use is hazardous, harmful, or dependent.
• Can be administered by an interviewer or completed by the individual

Tobacco, Alcohol, Prescription medication, and other substances (TAPS)

Another valid and newer screening tool is the Tobacco, Alcohol, Prescription medication, and other Substance (TAPS). This assessment is designed for use in various healthcare settings to help clinicians identify individuals who may be at risk for substance use disorders. ^[2]

• Consists of only four questions, particularly effective when clinicians have limited time.
• Can identify individuals who may require more in-depth assessment or intervention.
• Can be self-administered or used in an interview format, depending on the setting.

Types of Substance Use Disorder

There are many different types of substances, all of which can lead to substance use disorder. While legal substances like alcohol and tobacco are the most prevalent in individuals with SUD, other drugs are far more addictive. This means that users tend to progress from a mild to a severe form of the disorder more rapidly, depending on how each substance affects the brain.

Along with illicit drugs, prescription (and even over-the-counter) medications are among the most dangerous of all substances. These drugs cause severe physical withdrawal symptoms, including pain, vomiting, nausea, and more, which make recovery harder to attain without professional treatment interventions.

Here are the different categories of substances that can trigger substance use disorder: ^{[1] [2]}

Opiods

Opioids are extremely addictive and can cause respiratory depression or failure due to overdose, as well as infectious diseases (e.g., HIV or hepatitis) from injection use. Fentanyl, in particular, is incredibly potent and has been linked to a rise in overdose deaths.

• Fentanyl
• Heroin
• Painkillers (including codeine, oxycodone, morphine)

Stimulants

Stimulants increase the activity of the central nervous system and lead to an increased heart rate, high blood pressure, anxiety, paranoia, insomnia, agitation, and an increased risk of heart attack or stroke.

• Cocaine (including powder, crack, and other forms)
• Meth (methamphetamine)
• ADHD medication (Ritalin, Adderall, etc.)
• Amphetamine-related substances

Nicotine

While nicotine is not psychoactive (mind-altering), the substance is among the most addictive of all drug categories, and is linked to numerous health complications, including lung cancer and heart disease.

• Tobacco
• Cigarettes
• Cigars
• Vapes (Vapourizers)
• Smokeless tobacco products (eg. gum)

Benzodiazepines

Benzodiazepines are highly addictive prescription medications. Abusing these drugs can cause impaired motor coordination, respiratory depression, overdose, memory problems, and even death. These risks increase when benzodiazepines are used with alcohol or other depressants.

• Sedatives: These are substances that can calm or induce sleepiness. Commonly abused sedatives include diazepam (Valium) and lorazepam (Ativan).
• Hypnotics: These are medications used to help induce sleep. Hypnotics such as temazepam (Restoril) are prescribed to treat insomnia.
• Anxiolytics: These medications are used to reduce anxiety but are often misused. Commonly abused anxiolytics include alprazolam (Xanax) and clonazepam (Klonopin).

Alcohol

Alcohol is one of the most addictive drugs, despite being legal and widely available in most countries. Even one episode of abusing this substance can lead to alcohol poisoning, which can cause seizures and other life-threatening symptoms. Long-term alcohol abuse can cause liver damage, cardiovascular disease, cancer, and more.

• Beer
• Wine
• Cider
• Perry
• Spirits
• Liqueurs

Dissociative Drugs

Dissociative drugs distort the user’s perception of reality, causing a sense of detachment from the body and life around them, and frequently leading to hallucinations. These drugs often cause paranoia, dissociation, impaired judgment, and psychosis.

• THC
• DXM
• PCP
• Acid (LSD)
• Ketamine

Synthetic Drugs

Synthetic drugs are man-made substances designed to mimic the effects of natural drugs, often created by altering the chemical structure of existing substances. These substances may cause hallucinations, seizures, psychosis, paranoia, or aggression.

• K2 or spice (synthetic marijuana)
• Synthetic cocaine
• Synthetic opioids
• Bath salts

Causes of SUDs

Personal vulnerability to substance use disorder can be shaped by a variety of factors, including genetic predisposition, biological influences (e.g., assigned male at birth), brain development, the age at which substance use begins, individual personality traits, and the presence of co-occurring psychiatric conditions. ^[2]

These factors are further influenced by broader social circumstances, such as the level of family and community support, societal instability (e.g., high crime rates, widespread unemployment, governmental corruption, poverty, war, and natural disasters), discrimination or marginalization, social acceptability of drug use, and the accessibility and legal status of substances. ^[2]

Not everyone exposed to drugs develops an addiction due to the complex interplay of these personal and social factors. Some individuals are more vulnerable, while others may find it easier to recover from addiction or avoid chronic substance use altogether. The risk is also influenced by the type of drug, which can affect how quickly addiction develops. ^[2]

Biological Influences

In the context of substance use disorder, "biological" refers to factors such as genetics, gender, brain function, hormones, and other physical aspects of the body that create vulnerabilities for SUD. Research has shown that people assigned male at birth have higher rates of substance use and are more likely to engage in risky behaviors such as experimenting with drugs. ^[2]

Brain Development

During childhood and adolescence, brain development plays a key role in risk-taking behaviors, as the prefrontal cortex (which is essential for self-control) does not fully mature until the mid-20s. The timing of drug exposure, especially during fetal or early childhood stages, but even during adolescence, may make the brain more vulnerable to addiction later in life. ^[2]

Social Circumstances

Studies have shown that environments with high stress, little social support, availability of drugs, and few opportunities for healthy recreational activities can increase the risk of drug use and addiction, especially in children and teenagers. Additionally, social circumstances where substance use is normalized can contribute to SUD. ^[2]

Co-Occurring Psychiatric Conditions

Having a mental health condition increases the risk of developing a substance use disorder, and developing SUD is linked to the onset of mental disorders. This is because mental disorders often lead people to self-medicate with drugs, while SUDs can contribute to the development of mental health conditions due to their effects on brain chemistry. ^[2]

Are they Genetic?

Both biological factors (including genetics and developmental stages) and social factors play key roles in determining an individual's vulnerability to developing a substance use disorder.

That said, recent research has revealed that genetic factors are responsible for about 50% of the overall risk of addiction, with different genes being susceptible to different drugs. ^[2]

These genetic factors affect drug metabolism and the process of nerve cells sending signals to each other with brain chemicals. Additionally, genetic factors influence neuroplasticity (the brain’s ability to change thought patterns) and brain development. ^[2]

Preclinical studies in animals have shown that drugs can change the way genes function (epigenetic modification) in brain areas related to addiction. It is thought that these altered genes may contribute to the long-lasting changes in the brains of individuals struggling with addiction. ^[2]

As scientists gain a deeper understanding of the epigenetic markers linked to drug exposure and their role in the development of addiction or SUD, it could lead to new medications for substance use disorder. These markers might also provide insights into addiction susceptibility, as well as how vulnerability to drug use changes over the course of life. ^[2]

Risks and Complications

Substance use disorders have a significant impact on societies, affecting the economy, healthcare, crime, and mortality rates. The high impact on early mortality stems from overdoses, suicide, and the long-term effects of substance use on overall health. ^{[2] [7]}

Addiction is also linked to the onset or worsening of co-occurring mental health conditions, which are further exacerbated by minority stress. Additionally, substance use disorder comes with societal risks, such as poverty or incarceration. ^{[2] [8]}

Societal Risks

Individuals with substance use disorders are less likely to be employed and are more vulnerable to financial hardship. As a result of this, many people with addiction turn to crime to support their drug use. Consequently, even in countries where illicit substances are legal, many individuals with substance use disorder end up in prison. ^[2]

Stigma and Minority Stress

The harmful effects of SUDs are further intensified by societal stigmas surrounding substance use, with many countries criminalizing the use of drugs. Studies have found strong links between minority stress (belonging to a marginalized group that is often discriminated against) and mental health. ^{[2] [8]}

Co-occurring Psychiatric Disorders

In addition to the link between minority stress and mental health, changes in brain chemistry from substance use disorder can also cause co-occurring psychiatric disorders. While a mental health condition may exist before the onset of SUD, it is also possible for substance use to trigger or exacerbate an existing mental health condition. ^[1]

Drug-Related Mortality

Recent research has revealed that 200,000 people die from substance-related deaths each year, with SUD sufferers around 8% more likely to commit suicide than those without the disorder. In addition to suicide, fatal overdoses, and the development or worsening of numerous acute and chronic health conditions contribute to drug-related mortalities. ^{[2] [7]}

Signs of Overdose: When to Seek Emergency Help

When a person has overdosed, it is crucial to take immediate action. Call an ambulance from the nearest hospital or go to the local emergency room without hesitation if you or someone you know experiences any of the following:

• Altered state of consciousness: Any significant change in a person’s awareness or alertness. This could include confusion, extreme drowsiness, difficulty staying awake, hallucinations, or an inability to respond to questions or commands.
• Difficulty breathing: If a person is struggling to breathe, it could be a sign of a serious reaction to a drug, especially if the drug is a depressant (e.g., opioids, benzodiazepines, alcohol). Slowed or labored breathing can be life-threatening.
• Seizures or convulsions: Seizures can cause shaking, twitching, loss of control, or even unconsciousness. Convulsions are intense, involuntary muscle contractions that can occur during a seizure.
• Symptoms of a potential heart attack: Signs of a heart attack include severe chest pain or pressure, pain radiating to the arm or jaw, shortness of breath, sweating, nausea, or dizziness.
• Any other concerning reactions: Drugs can cause a wide range of effects that may be harmful to both the body and mind. Any significant or unexpected physical or psychological reaction should be treated as an emergency.

Suicide Hotlines

Suicide hotlines are confidential phone lines where people in crisis can speak with trained professionals for support, guidance, and assistance during moments of deep distress. These 24/7 hotlines provide immediate help, resources, and referrals to local mental health services.

• American Suicide Hotline: Call 988
• Global Suicide Hotlines: Here is a link to suicide hotlines in various countries around the world. If your country is not on the list, simply Google “24/7 suicide hotline” to find a local phone number.

Treatment Options for SUDs

Since substance use disorders impact several different areas of a person's life, a comprehensive approach to treatment is often necessary. For most people, a combination of medication and individual or group therapy tends to be the most effective approach. However, in severe cases, a 12-step inpatient treatment facility is recommended. ^{[1] [2]}

Treatment plans that are tailored to an individual’s unique circumstances, including any medical, psychiatric, or social challenges, offer the best chance for long-term recovery. For this reason, whether seeking inpatient or outpatient care, it is important to ensure that healthcare providers have experience not only with addiction but oalso with ther physical and mental disorders as well. ^[1]

It is possible to treat SUDs effectively, with substantial evidence supporting the effectiveness of medications, behavioral therapies, and 12-step programs. As SUD is a lifelong disorder, ongoing management is necessary, with groups like alcoholics anonymous and Narcotics Anonymous offering ongoing support. ^[2]

Medications

There is an abundance of research to support the effectiveness of medications for treating opioid, nicotine, and alcohol use disorders. Furthermore, there is one FDA-approved medication for reversing opioid overdose (naloxone) and another for managing acute opioid withdrawal (lofexidine). ^[2]

That being said, emerging research surrounding a medication known as GLP-1 (glucagon-like peptide-1) shows strong and consistent evidence from animal research that the potential addiction treatment can reduce addiction-related behaviors. However, most research has focused on alcohol use, and more studies are needed for other substances. ^[9]

Behavioral Therapies

Behavioral therapies are beneficial for all types of substance use disorders, with or without medication. The most commonly used treatments include cognitive behavioral therapy (CBT), motivational interviewing, contingency management, and twelve-step programs (Alcoholics Anonymous and Narcotics Anonymous). ^[2]

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is one of the most studied behavioral treatments for SUDs. Research has shown CBT to be effective in reducing substance use, with moderate benefits compared to minimal treatment. However, its effects are less significant when compared to other specific therapies, and improvements are mainly seen in the short term. ^[2]

Motivational Interviewing

Around 40% of people with a substance use disorder report not being ready to quit. Motivational interviewing is a collaborative approach to strengthening a person's motivation to change, with strong empirical support. In the short term, it is more effective than not receiving treatment, although its long-term impact is less certain. ^[2]

Contingency Management

Contingency management is based on the idea that rewarding drug abstinence with immediate and predictable rewards, like money or goods, can encourage recovery. This approach has been successful in treating various substance use disorders, with longer interventions generally leading to better outcomes. ^[2]

Twelve-Step Programs

Twelve-step support groups, such as Alcoholics Anonymous and Narcotics Anonymous, can support addiction recovery without other treatments or as part of a more comprehensive plan. The effectiveness of these programs is driven by factors such as peer support, mentorship from sponsors, and role modeling of successful recovery. ^[2]

The sense of belonging to a community with similar challenges helps reduce loneliness, shame, and guilt, while hearing the success stories of other members inspires hope and motivation. These programs also encourage positive changes in social networks, enhancing self-efficacy and decreasing impulsivity and cravings. ^[2]

A recent meta-analysis found strong evidence that for alcohol use disorder, twelve-step interventions are at least as effective as (or more effective than) behavioral treatments like CBT in promoting abstinence. However, the evidence for their superiority in treating other substance use disorders is less conclusive. ^[2]

12-Step Rehabilitation Facilities and Sober Houses

For people with moderate or severe cases of substance use disorder, interventions in the form of an inpatient rehabilitation facility can be highly beneficial, especially in combination with a 12-step program. Addiction recovery centres are safe spaces to begin the journey of recovery without the temptation of easy access to substances.

These facilities are equipped to medically treat withdrawal or psychosis and often offer a combination of therapy, medication, and peer support. After treatment, individuals may benefit from entering into a sober living community, often referred to as a “halfway house,” which assists with the transition from addiction to becoming a responsible member of society.

Barriers to Getting Treatment

Denial is a significant barrier to seeking treatment for people with an addiction. Many people struggling with substance use disorder may minimize their behavior or rationalize substance use, believing they can stop at any time or that their use isn’t causing harm. As a result, most individuals with SUD are not honest with doctors about the quantities they use.

In addition to any self-dishonesty or denial, stigma and shame can further prevent individuals from seeking help due to fear of judgment or discrimination. Additionally, financial constraints, such as the lack of health insurance or high treatment costs, can limit access to necessary services - although it is important to note that twelve-step programs are free.

Another barrier to treatment includes long wait times for treatment programs or a lack of availability in certain areas. Some individuals may also face challenges with co-occurring mental health disorders, which complicate the treatment process. Lastly, a lack of family support or unstable living conditions can create significant obstacles to successful recovery.

Recovering from Substance Use Disorders

Substance use disorders are often referred to as the “disease of forgetfulness” due to the chronic nature of occasional tempting thoughts related to substance use. Because addiction rewires the brain, any stressful life event (whether minor or significant) can instantly trigger the brain to seek reward in ways the mind has previously been exposed to.

For this reason, it is incredibly important to join a support group like Alcoholics Anonymous or Narcotics Anonymous. Regularly attending meetings benefits recovering addicts not only through offering a sense of community support, inspiration, hope, and relatability, but by serving as a continual reminder that “one is too many and a thousand never enough.”

It is not uncommon for recovering addicts to relapse, and when this happens, 12-step programs welcome members back with open arms. Witnessing a relapse of a long-standing member is a powerful reminder that SUD is a chronic disorder. Furthermore, the advantage of social support in recovery is well documented, and may even help to prevent suicide in the event of a relapse.

Recovering from addiction is an ongoing process that requires vigilance, action, guidance, and hope. These factors are supported in 12-step programs, not only through regular meetings, but through the sponsor (or mentor) system. Members of AA or NA are encouraged to find a sponsor early in recovery, to act as a guide and to help in critical situations.

Final Thoughts

Substance use disorder (SUD) is a complex and progressive condition characterized by the uncontrollable use of substances despite harmful consequences. SUD exists on a spectrum, ranging from mild to severe, with moderate and severe diagnoses classified as addiction. The consequences of SUD are far-reaching, but fortunately, effective treatments are available.

Depending on which form of SUD a person has, medications may be of benefit. That said, various behavioral therapies can help in the short term, with 12-step programs (like Narcotics Anonymous or alcoholics anonymous) showing the most efficacy in the long term. In severe cases, an individual may require inpatient treatment at a rehabilitation centre.

In this case, it is best to find a 12-step treatment facility for optimal reintegration into society. Sober living situations can also be of benefit for this, particularly in combination with regular attendance of recovery support groups. Substance use disorder is a lifelong condition, but with a desire to recover, treatment, and ongoing maintenance, it is possible to thrive with SUD.

Author

Star Gorven

Star Gorven is a wellness and mental health writer with a talent for crafting evocative and evidence-based content across a wide range of topics. Her work blends analytical research with imagination and personality, offering thoughtful insights drawn from her exploration of subjects such as psychology, philosophy, spirituality, and holistic wellbeing.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on March 27, 2026 and last checked on March 19, 2026