psychiatric disorders
Substance Use Disorders
Etiology of Substance Use Disorders
People with a substance use disorder usually progress from experimentation to occasional use and then to heavy use and sometimes a substance use disorder. This progression is complex and only partially understood. The process depends on interaction between the drug, user, and setting. Drugs in the 10 classes vary in how likely they are to cause a substance use disorder. The likelihood is termed addiction liability. Addiction liability depends upon a combination of factors including Route of administration Rate at which the drug crosses the blood-brain barrier and stimulates the reward pathway Time to onset of effect Ability to induce tolerance and/or withdrawal symptoms In addition, substances that are legally and/or readily available (eg, alcohol, tobacco) are more likely to be used initially and thus increase the risk of progression to problematic use. Further, as perception of the risk in using a particular substance diminishes, there may be subsequent experimentation and/or recreational use of the drug, increasing exposures to substances of abuse. Fluctuations in perception of risk are influenced by multiple factors, including findings regarding medical and psychiatric sequelae of use and social outcomes. During treatment of medical illness or following surgical or dental procedures, patients may be prescribed Opioid Use Disorder and Rehabilitation . A substantial portion of these drugs go unused but may remain in the home, representing a significant source for children, adolescents, and adults who wish to use them for nonmedical purposes. In response, there has been increased emphasis on the need to Prescribe opioid drugs in lower amounts more appropriate to the likely duration and severity of pain Promote safe storage of leftover drugs Expand prescription take-back programs Predisposing factors in users include the following: Psychologic characteristics Circumstances and disorders Psychologic characteristicsare not clearly a strong factor, although people with low levels of self-control (impulsivity) or high levels of risk-taking and novelty-seeking may have an increased risk of developing substance use disorder. However, the concept of the addictive personality that has variously been described by some behavioral scientists has little scientific evidence to back it. appear to increase risk. For example, people who are sad, emotionally distressed, or socially alienated may find these feelings are temporarily relieved by a drug; this can lead to increased use and sometimes a substance use disorder. Patients with other, unrelated psychiatric disorders are at increased risk of developing a substance use disorder. Patients with Chronic Pain (eg, back pain, pain due to sickle cell disease, neuropathic pain, fibromyalgia) often take opioid drugs for relief; many subsequently develop a substance use disorder. However, in many of these patients, nonopioid drugs and other treatments can adequately relieve pain and suffering. Addiction is likely a polygenic disorder. There are a number ofgenetic and epigenetic factorsthat impact addiction progression. Research regarding specific genetic abnormalities varies by the specific substance. The concept of the addictive personality has little scientific evidence to back it. Cultural and social factors are very important in initiating and maintaining (or relapsing to) substance use. Observing family members (eg, parents, older siblings) and peers using substances increases risk that people will begin using substances. Peers are a particularly powerful influence among adolescents (see Drug and Substance Use in Adolescents ). People who are trying to stop using a substance find it much more difficult if they are around others who also use that substance. Physicians may inadvertently contribute to harmful use of psychoactive drugs by overzealously prescribing them to relieve pain or stress. Many social factors, including mass media, contribute to patients' expectation that drugs should be used to relieve all distress. 