What is a substance use problem?

From Chapter 1: Introduction in Improving our Response to Older Adults with Substance Use, Mental Health and Gambling Problems: A Guide for Supervisors, Managers and Clinical Staff

Substances that can cause problems include alcohol, prescription and over-the-counter medications and illegal drugs, such as marijuana. When people have a substance use problem, they may:

• experience additional or worsened health problems (e.g., falls leading to hospitalization); they may also experience ongoing tension with family and friends or housing problems (e.g., eviction)
• have problems fulfilling obligations (e.g., caregiving, keeping appointments, paying bills)
• have legal difficulties as a result of drinking and driving, alcohol-related disorderly conduct or spousal abuse
• be unable to stop or reduce use despite experiencing serious health problems or social consequences
• engage in substance-seeking behaviour such as doctor shopping (asking for care from many different doctors) or “double doctoring” (seeking prescriptions for the same medication from different doctors)
• have difficulty accessing needed services because of substance-use related behaviours.

What are substance dependence and addiction?

The term substance dependence can be confusing because it has both psychological and physical components. The term addiction is also often misunderstood.

Psychological dependence occurs when a person feels he or she needs a drug to function or feel comfortable, for example, needing to drink alcohol to feel comfortable in social situations or needing to take a sedative to be able to sleep. Eventually some people may feel they need a substance just to be able to cope with daily life.

Physical dependence occurs when a person’s body has adapted to the presence of a drug. Tolerance has developed, which means that the person needs to use more of the drug to get the same effect. When drug use stops, symptoms of withdrawal occur.

Addiction always involves psychological dependence, but it may or may not involve physical dependence.

People often think that psychological dependence on a substance is not as serious as physical dependence. This is not necessarily true. While physical dependence can result in uncomfortable and even dangerous symptoms of withdrawal (e.g., nausea, tremors, seizures) when substance use is stopped, these symptoms usually disappear fairly quickly, that is, within hours, days or weeks. The cravings, triggers and compulsive behaviours associated with psychological dependence can take much longer to fade after substance use stops. They can last for several months or even years. Overcoming psychological dependence is often the greater challenge.

Some substances produce psychological dependence without physical dependence (e.g., cocaine); others can produce both psychological and physical dependence (e.g., alcohol, benzodiazepines, nicotine, opioids). It is also possible to become physically but not psychologically dependent on a substance. This is sometimes seen in people who take opioid medications such as Tylenol 3, Percocet or morphine for the treatment of severe pain. Once the body heals and the pain subsides, they are able to stop taking a pain-relieving drug gradually, without feeling a further need for it. Others, however, do develop a psychological dependence on prescription pain-relieving drugs and may require support, either to ease off these medications, or in the form of a longer-term methadone or other opioid replacement maintenance treatment.

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