Substance use disorders (SUDs) currently affect over 19 million people in the United States over the age of 18. SUDs result in significant individual and societal costs, resulting in medical and psychiatric complications, lost employment, criminal justice system involvement, social impairment, and an estimated 13.2 billion dollars per year in hospital admissions attributed to medical complications of substance use.
The prevalence of SUDs has been increasing, and the number of overdose-related deaths has skyrocketed in the past several decades, with an estimated 92,000 individuals dying from an illicit drug overdose in 2020.
Individuals with SUDs persist in addiction despite mounting adverse consequences. Their chronic use is maintained through neurobiological brain changes caused by recurrent substance exposure that leaves the individual in an uncomfortable and unstable state in the absence of the drug. The individual becomes dependent on the drug and becomes caught in a spiral of intoxication, withdrawal, and preoccupation with obtaining the substance. Social factors also influence substance use, although these tend to predominate primarily in early decisions around substance use before physical dependence develops. Many patients with SUDs also have pre-existing psychiatric conditions predisposing them to recurrent substance use and addiction. Ultimately, treatment of the comorbidity is needed to treat SUD successfully.
Ideal substance use treatment, therefore, requires a multimodal, multidisciplinary approach incorporating both medication and psychosocial interventions to address multiple risk factors contributing to ongoing use.
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