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What is Substance Use Disorder?

TO UNDERSTAND THE PROBLEM, WE NEED TO UNDERSTAND THE DISEASE

Corey – explain brains

Daisy – There are two types of dependency to alcohol and other drugs: 1) physical – the biological dependency that becomes the new normative for that individual and 2) psychological – the emotional dependency that becomes biologically reinforced (i.e. emotional discomfort coupled with withdrawal without use). Drug use also impacts the hippocampus (part of brain associated with memory) and amygdala (associated with emotions), so people have positive memories and feelings with drug use (hence the psychological dependency).

Substance Use Disorder – a medical, mental health diagnosis, requires both physical and psychological dependency criteria to be met.

There are many medications that people can be physically dependent on for various illnesses (diabetes, blood pressure, asthma) but they are not addictive medications without the psychological dependency.

On that note, someone can take a medication, such as OxyContin, which is known to be highly addictive, as prescribed for pain and not become addicted for the same reason.

Substance Use Disorder is the correct term now, not just for reducing stigma, but because alcoholism and drug addiction are too specific to just the physical dependency and do not encompass the psychological. Now we even have a SUD continuum to bring the disease more in-line with other diagnoses. According to the DSM-V, 1 or fewer criteria met = no SUD, 2-3 criteria is mild SUD, 4-5 criteria = moderate SUD, and 6+ criteria is severe SUD. SUD is a long-term, relapsing brain disease that requires comprehensive and compassionate care.

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How substances affect the brain

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Why drugs are so effective!

Drugs release 2-10x more dopamine than natural rewards!
Overdoses happen when tolerance to the reward system (aka “feel good” center, psychological dependency) develops faster than the tolerance to the suppression the drug has on the body – in order to still feel good they need more drug than the respiratory and central nervous system can handle.

Refer back to dopamine slide - When the drug binds to the receptors a signal is sent to the dopamine terminal to release more dopamine, creating a feeling of bliss, WAY beyond what our brain chemistry would normally allow us to experience. With 2-10x more dopamine in the system compared to natural rewards (like laughing, exercising, listening to music you love, or sex!), it does not take long for one’s hierarchy of needs to be rearranged to place that incredible feeling of euphoria at the top of the list.

With opioids in particular, to begin with the individual uses the substance for the psychological aspects (sometimes referred to as self-medicating), or pain relief, they then quickly become physically dependent, and then the high isn’t the appeal of continuing to use, it’s the fear of the withdrawal. The person continues to use just to maintain. Remember the spikes & dips Corey drew?

Opioids and alcohol are depressants – this does not mean they lower a person’s mood, in fact many people say their mood is improved with drug use. Depressants, like sedatives and tranquilizers, actually slow down activity in the central nervous system and respiratory system. During an overdose, the slowing of these systems is responsible for the person to almost stop breathing and the heart to almost stop beating.

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Anxiety and Depression

These are the most common psychiatric diagnoses that we see in the behavioral health field today.
According to Johns Hopkins:

Approximately 1 in 4 adults suffer from a diagnosable mental health disorder in any given year.
Approximately 9.5% of adults over age 18 will suffer from a depressive episode each year.
Approximately 18% of people age 18 – 54, in any given year, have anxiety disorder (which can come in many different forms).

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Depression basics

Symptoms include: sadness, fatigue, anger, sleep disturbances, anxiety, feelings of guilt, unexplained body aches and pains
How does it happen? Can be several ways:

Faulty mood regulation by the brain
Genetic vulnerability
Stressful life events

How are chemicals involved?

How are neurotransmitters involved?

How can we increase certain chemicals?

How can we support someone struggling with Depression?

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Anxiety – the most fixable psychiatric diagnosis that we have – talk therapy works!

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The NH Doorway System

24/7 system for helping people access SUD services
9 Doorways throughout the state
Welcome | The Doorway (nh.gov)
Began with a federal grant from SAMHSA (Substance Abuse and Mental Health Services Administration)
Staffed with Peer Support Specialists, as well as clinicians.
Call 211 ANYTIME
988 Suicide and Crisis Lifeline

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