Apart from the LSD- and mescaline-like hallucinogens, functional dopamine agonism is the single pharmacological property that all addictive drugs share. 14 The psychology of substance use disorders reflects psychodynamic theories dating back 100 years. Disturbed ego functions, self-medication, and alexithymia (inability to describe feelings) are common among those with substance use. Aside from pharmacologic effects, positive reinforcement is gained from paraphernalia and associated behaviors with drug use. Conditioned responses (similar to Pavlovian phenomena) such as cravings and withdrawal promote relapsing behaviors. Individuals aged 18–24 years have a high prevalence rate for virtually every substance disorder. 15 Implicit Bias and Stigma in Substance Use Disorders Language used by clinicians such as addict can stigmatize individuals with substance use disorders, reflecting misconceptions that these behaviors are choices rather than compulsions. Negative biases can dehumanize individuals, affecting the therapeutic alliance and ultimately the course of recovery. Clinicians who stereotype drug use as a criminal activity marginalize disadvantaged groups and negatively influence treatment plans, which may increase drug use. Fear about disclosing substance use, decreased quality of care, or reduced access to care are impacted by stigma and implicit biases. 16 To this end, the word addiction has been eliminated from the DSM-5 in favor of the more neutral term substance use disorder. 4 Every member of our community may help to lessen stigma and prejudice against those who suffer from drug use disorders by: • Understanding substance use disorders are chronic, treatable medical conditions. • Changing stigmatizing language with more empowering, preferred language that doesn’t equate people with their condition or have negative connotations. • Addressing systemic racism, sexism, and other forms of discrimination, which leads to multiple layers of stigma for many people with addiction. 17 Risk Factors for Substance Use Disorders Risk factors influence a young individual’s likelihood of developing SUD. Some of the risk factors are as follows 18 : • Family history of substance use • Favorable parental attitudes toward the behavior • Poor parental monitoring • Parental substance use • Family rejection of sexual orientation or gender identity • Association with delinquent or substance- using peers
• Childhood sexual abuse • Mental health issues Other risk factors include 19 : • Avoidant coping style • Bereavement • Chronic pain or physical illness/comorbidity • Significant stressful life changes • Social isolation Individuals who demonstrate a chronic loss of control or compulsive use of substances along with a wide range of negative effects (mental, physical, and social well-being) meet the criteria for substance related disorders. 8 Standardized screening is important to determine the stage of substance use, consequences, and functional impairment. 5 The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. To facilitate understanding of the risks of SUD, SAMHSA developed the Strategic Prevention Framework (SPF). The five steps and two guiding principles of the SPF offer prevention planners a comprehensive approach to understanding and addressing the substance misuse and related behavioral health problems facing their states and communities. The SPF includes these five steps 20 : 1. Assessment: Identify local prevention needs based on data (e.g., What is the problem?). 2. Capacity: Build local resources and readiness to address prevention needs (e.g., What do you have to work with?). 3. Planning: Find out what works to address prevention needs and how to do it well (e.g., What should you do and how should you do it?). 4. Implementation: Deliver evidence-based programs and practices as intended (e.g., How can you put your plan into action?). 5. Evaluation: Examine the process and outcomes of programs and practices (e.g., Is your plan succeeding?). The SPF is also guided by two cross-cutting principles that should be integrated into each of the steps that comprise it: 1. Cultural competence. The ability of an individual or organization to understand and interact effectively with people who have different values, lifestyles, and traditions based on their distinctive heritage and social relationships. 2. Sustainability. The process of building an adaptive and effective system that achieves and maintains desired long-term results. Alcohol Use Disorder Alcohol addiction is a chronic relapsing disorder associated with compulsive drinking. Alcohol use is a common disorder that is defined by a cluster of behavioral and physical symptoms and can include withdrawal, tolerance, and craving.
Approximately 69.5% of those ages 18 and older reported drinking alcohol in the past year, with 59.4% admitting to drinking alcohol in the last month. 21 Severity of alcohol use disorder is based on the number of diagnostic criteria in a given individual, along with changes in severity of alcohol use across time, reflected by reductions in the frequency of alcohol consumed. Alcohol use disorder has a variable course characterized by remissions and relapses. Alcohol use disorder is associated with increased risks of accidents and injury, violence, and suicide. Severe alcohol use is associated with comorbid conditions such as depression or other disinhibitions of feelings, which contribute to suicide attempts as well as completed suicides. 4 Other disorders associated with alcohol use disorders include psychosis, bipolar disorders, anxiety disorders, sleep disorders, and neurocognitive disorders. Long-term alcohol use can also cause complications in almost every physiologic system. Addiction Cycle in Alcohol Use Disorder Alcohol consumption is linked to health and social consequences interfering in personal relationships, frequent medical complications including cancer, motor vehicle collisions, and violence. The powerful effects on the brain account for euphoria and pleasurable feelings, increasing the motivation to use these substances despite the risk of harm. The addiction cycle is based on three concepts: (1) binge/intoxication, (2) withdrawal/negative effects, and (3) preoccupation/anticipation. An individual may experience all stages in the course of a day or over weeks or months. 21 1. Binge/intoxication stage is a stage where an individual experiences the rewards including euphoria, anxiety reduction, and easing of social interactions. Repeat activation of the basal ganglia reinforces the likelihood of repeated consumption through motivation and routine behaviors. The repeated activation of the basal ganglia changes the way an individual responds to stimuli, which then triggers powerful urges to consume the substance over time. 2. Negative affect/withdrawal stage occurs when an individual stops drinking and withdrawal symptoms occur. These symptoms can be physical (sleep disturbances, pain, and ill feelings) or emotional (dysphoria, irritability, anxiety, and emotional pain). Negative feelings associated with alcohol withdrawal come from two sources. Diminished activation in the reward system makes it difficult to experience the euphoria associated with everyday living. Increased activation of brain stress contributes to anxiety, irritability, and unease. The individual consumes alcohol to escape the lows of chronic alcohol use. stage occurs when an individual seeks alcohol after a period of abstinence. This stage can be triggered by various factors such as stress, social situations, or environmental associated with previous substance use. 3. Preoccupation/anticipation
• Lack of school connectedness • Low academic achievement
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