Substance Use

What does it look like?

A substance use disorder (SUD) is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. The regular use of alcohol and/or other drugs produces changes in the brain which strongly reinforce the behavior of drug use, teaching the person to repeat it. These behavioral changes are also accompanied by changes in brain function, especially in the brain’s natural inhibition and reward centers.

SUDs are a medical problem, and are often tied in to mental health and co-occurring conditions such as anxiety, depression, and PTSD. In most cases, the initial decision to drink or use substances is a choice. However, after continued use, changes in the brain can seriously impair one’s ability to control their use.

For adolescents, SUD can look different than they do in adults. Symptoms of substance use disorders as laid out by the DSM-5 can be more normative for teenagers. For example, adolescents develop tolerance more quickly than adults. Additionally, withdrawal symptoms typically do not occur within adolescents because they usually appear after years of consistent use of drugs and alcohol. In regard to risky behavior while using, adults have more opportunity and likelihood of engaging in these activities.

People who are addicted to alcohol and/or other drugs have changes in their brain that affect the following areas:

• Judgement
• Decision-making
• Learning
• Memory
• Behavioral Control
• Relationships
• Emotional Regulation
• Activities of daily life (job, education, etc.)

How do I screen for it?

• For adolescent specific screening tools (12-17 years old), please visit The National Institute of Drug Abuse (NIDA) Screening Tools for Adolescent Substance Use webpage for a list of validated online instruments.
• For youth and adolescents (9 to 18 years old), the National Institute of Alcohol Abuse and Alcoholism (NIAAA) Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide is designed to help health care professionals quickly identify youth at risk for alcohol-related problems.

What are the treatment options?

Addiction treatment can be done via methods such as behavioral therapy, medication management, counseling, and detox.

For adolescents, treatment options include outpatient therapy/counseling, group therapy, medication management, detox, residential treatment, inpatient treatment, wilderness programs and boarding schools. Family treatment is more essential for adolescents than adults participating in treatment. Adolescents tend to be less motivated for sobriety than adults. As a result, it is important for the motivated party to be involved in treatment. Additionally, treatment programs are more limited for adolescents than adults. There are limited programs that provide inpatient detox, residential and inpatient treatment. There are also limited intensive outpatient programs for adolescents. It is important for adolescents to be involved in treatment programs that highlight family engagement as well as the incorporation of mental health. Adolescents are welcome at 12 step community meetings, yet it is important for parents to supervise their children during these meetings. Adolescents are not accepted to transitional or sober living homes.

Medication Management

Research shows that medications and behavioral treatment combined have the most success in treating substance use disorders. For example, when treating opioid use disorders, the first line of treatment should be medication which can then be combined with behavioral therapy.

Addiction and drug use have a direct effect on the chemical makeup of the brain, particularly on the areas that involve pleasure and motivation. The medications for addiction treatment work to restore balance among the chemicals in the brain that have been impacted by substance use. Medications can also be used to help individuals during the detoxification process; however, subsequent treatment following detox is necessary to reduce likelihood of relapse and improve recovery outcomes.

Behavioral Therapy

Treating substance use disorders with behavioral therapies involves the modification of behaviors and attitudes. In doing so, the individual should be more equipped to handle triggers or stressful situations without relapse. Additionally, behavioral therapy can increase effectiveness of medications. Universally, treatments must be tailored toward the individual’s unique needs and situation.

Additional Resources

• Telehealth for Opioid Use Disorder Toolkit: Guidance to Support High-Quality Care - The primary goal of this toolkit is to provide clinically relevant information to support high-quality delivery of outpatient OUD care via telehealth, while reducing barriers to starting and maintaining both medication and psychosocial treatments. This toolkit is intended for clinicians, administrators and policymakers who are involved in delivering, managing and considering telehealth for OUD care. Specific tools (e.g. flowchart, checklist, sample note) are included for clinicians.
• NIAAA resources for health care professionals - A list of evidence-based screening tools and assessment resource materials by substance, age group, etc.
• U-M Addiction Center Virtual Recovery Resource Webpage - This resource includes online mutual support meetings, 24/7 crisis helplines, and other helpful virtual resources.
• Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator