Addiction & Rehabilitation Medicine - Juniper Publishers
Abstract
Substance use disorder (SUD) has infiltrated all
socio-cultural and economic strata causing loss of productivity. Mental
and substance use disorders are a major public health concern everywhere
and responding to the burden they cause is a challenge for health
systems in both developed and developing regions. Treatment rates for
people with mental and substance use disorders remain low, with
treatment gaps of over 90% in developing countries. Developing countries
are facing an escalating burden of non-communicable disease, with
mental and substance use disorders among the most significant. Many
developing countries spend less than 2% of their health budgets on
mental health. Drug dependence produces significant and lasting changes
in brain chemistry and function. Effective medications are available for
treating nicotine, alcohol, and opiate dependence but not stimulant or
marijuana dependence. Medication adherence and relapse rates are similar
across these illnesses. Studies suggest that long-term care strategies
of medication management and continued monitoring produce lasting
benefits patients with substance use disorder. In this article, we will
give a brief overview about substance use disorder.
Keywords: Substance use disorder; Alcohol; Nicotine
Introduction
Substance use disorders are important health concern
worldwide. Substance use is a chronic disorder which is associated with
significant mortality and morbidity. These disorders also account for
significant health care utilization and medical costs. Substance use
disorders occur when a person’s usage of alcohol, prescription drugs, or
illegal drugs causes problems in his or her life and daily activity
[1]. Treatment of substance use disorder involves detoxification and
prevention of relapse. The major problem in treating patients with
substance use disorders is relapse. Addiction is a chronic disorder that
requires long-term treatment. Anticraving agents play the key role in
the prevention of relapse. These medications generally reduce drug
craving and reduce the likelihood of relapse to compulsive drug use.
Anticraving agents along with other psychotropic drugs are used for
management of the substance use disorders [2]. In India, substance abuse
has infiltrated all socio-cultural and economic strata causing loss of
productivity. Mental and substance use disorders are a major public
health concern everywhere and responding to the burden they cause is a
challenge for health systems in both developed and developing regions.
Treatment rates for people with mental and substance use disorders
remain low, with treatment gaps of over 90% in developing countries
[3,4]. Developing countries are facing an escalating burden of
non-communicable disease, with mental and substance use disorders among
the most significant. Many developing countries spend less than 2% of
their health budgets on mental health [5]. Drug dependence produces
significant and lasting changes in brain chemistry and function.
Effective medications are available for treating nicotine, alcohol, and
opiate dependence but not stimulant or marijuana dependence. Medication
adherence and relapse rates are similar across these illnesses. Studies
suggest that long-term care strategies of medication management and
continued monitoring produce lasting benefits patients with substance
use disorder [6]. Substance abuse causes acute and chronic physical,
psychological and social effects in varying amounts along with serious
social problems in the form of crime, unemployment, family dysfunction
and disproportionate use of medical care. Science has not yet explained
fully the psychological processes leading to drug abuse. Substance abuse
affects above 50 million people worldwide. Abuse of legally prescribed
drugs is also increasing rapidly [7]. In India, the abuse of alcohol,
cannabis and raw opium has been traditionally known. The abuse of
synthetic narcotic drugs and psychotropic substances is comparatively
new. Substance abuse has affected all socio-cultural and economic
classes causing loss of productivity [8]. Family stress, lack of coping
skills, peer pressure, personality disorder, co-morbid psychiatric
illnesses, social stress and market forces act as risk factors [9].
Survey shows that around 20-30% of adult males and 5% of
adult females use alcohol while 57% of the male and 10.8% of
the female drug users consume opiates in some form or other.
Rapid assessment survey on substance abuse shows that the
primary abused drugs are heroin (36%), other opiates (29%) and
cannabis (22%); 75% of addicts start drug abuse before 20 years
of age; in urban areas heroin abuse is more while in other sites
cannabis abuse is more [10,11]. The family remains the primary
source of attachment, nurturing, and socialization for humans
in our current society. Therefore, the impact of substance use
disorders (SUDs) on the family and individual family members
merits attention. Each family and each family member are
uniquely affected by the individual using substances including
but not limited to having unmet developmental needs, impaired
attachment, economic hardship, legal problems, emotional
distress, and sometimes violence being perpetrated against him
or her. For children there is also an increased risk of developing
a SUD themselves.
Thus, treating only the individual with the active disease of
addiction is limited in effectiveness. The social work profession
more than any other health care profession has historically
recognized the importance of assessing the individual in the
context of his or her family environment. Social work education
and training emphasizes the significant impact the environment
has on the individual and vice versa. This topic was chosen to
illustrate how involving the family in the treatment of a SUD
in an individual is an effective way to help the family and the
individual. The utilization of evidence-based family approaches
has demonstrated superiority over individual or group-based
treatments [12]. Substance use disorder (SUD) is a disease
whose social costs are high. The negative effects of drug abuse
go well beyond the health and condition of the person who
suffers from SUD. Research has shown a strong link between
addiction and the disruption of family relationships, including
severe psychosocial and physical effects on family members
described as depression, anxiety, and stress. Parents’ depression
when living with a partner suffering from SUD can contribute to
the mental, physical, and social neglect of the family’s children,
further aggravating the family’s anxiety and stress [13].
Management of substance use disorders
Substance use disorder (SUD) has been conceptualized as a
chronic relapsing medical illness with relapses and remissions
and a strong genetic component similar to diabetes type II and
hypertension [6]. Risk for relapse is heightened because the
neurobiological changes in brain pathways created by many
years of alcohol and/or drug use do not completely revert to
normal after the detoxification process. The intensity and nature
of the behavioral intervention can influence the outcome of
treatment for patients with SUDs. The use of medications in the
treatment of SUD can also play a major role in preventing relapse
and facilitating longer periods of abstinence. More effective
medications have been developed over the past 30 years, and
subsequently, pharmacotherapy has progressively played a
more important role in the treatment of addictions. Medications
are mostly used as adjuncts to psychosocial treatments and the
role of pharmacotherapy in treatment depends on the specific
type of SUD [14]. Pharmacological agents have three broad
objectives: management of acute withdrawal syndromes through
detoxification, attenuation of cravings and urges to use illicit
drugs (initial recovery), and prevention of relapse to compulsive
drug use [2].
Conclusion
Treatment of substance use disorder involves detoxification
and prevention of relapse. The major problem in treating
patients with substance use disorders is relapse. Addiction is a
chronic disorder that requires long-term treatment. Anticraving
agents play the key role in the prevention of relapse. These
medications generally reduce drug craving and reduce the
likelihood of relapse to compulsive drug use. Anticraving agents
along with other psychotropic drugs are used for management of
the substance use disorders.
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