Substance Use Disorder (Addiction), Recovery, and Sober Living

This article is written to inform and educate members of the sober living community, including recovery residence operators and those who live in or work in a sober house. This information is offered as an introduction to a vast and convoluted subject and is not presented as an authoritative document.

Substance use disorder (SUD) is a complicated condition in which a person uses a substance without thinking about the consequences. People with SUD have a strong desire to use a certain substance(s), such as alcohol, cigarettes, or illegal drugs, to the point that their ability to work in daily life is harmed. People continue to use the drug despite knowing that it is causing or may cause problems. Addictions are a term used to describe the most serious SUDs.

In a sober living environment, it is important to remember that addictive behavior is limited to substance use. Residents may also have behavioral addiction such gambling, sex, shopping, etc.

People who are addicted to drugs or alcohol can have skewed thinking and behaviors. People with extreme cravings, personality changes, erratic movements, and other actions are caused by changes in the structure and function of the brain. Changes in the areas of the brain related to judgment, decision-making, learning, memory, and behavioral regulation have been seen in brain imaging research.

Repeated drug abuse can alter the way the brain works. These changes will last long after the substance’s immediate effects have worn off, or after the intoxication period has ended. The extreme pleasure, euphoria, calm, increased vision and meaning, and other feelings induced by the drug are known as intoxication. Each drug has its own set of intoxication symptoms.

People who suffer from drug abuse or behavioral addictions may be aware of their problem but unable to quit, no matter how hard they try. Physical and psychological problems, as well as interpersonal issues with family and friends or at work can arise. The use of alcohol and other drugs is one of the leading causes of preventable diseases and death in the United States. Assuming that a sober living resident is refusing to “do the right thing” or is lacking “common sense” can lead to unnecessary confrontations and inappropriate consequences.

Signs and Symptoms of Substance Abuse

In a sober living environment, it is important to look for warning signs of possible substance abuse. Sober living is designed to be a safe place in which to reside during early substance use recovery so active use/abuse cannot be tolerated.

1. Symptoms of Substance Abuse

 Symptoms or habits associated with drug addiction include, but are not limited to:

• Feeling compelled to use the medication on a regular or several times daily basis.
• Having strong cravings for the medication that prevent you from thinking about something else.
• Over time, you need more of the medication to achieve the same result.
• Taking more of the medication than you wanted for a longer time.
• Ensuring that you have a steady supply of the medication.
• Spending money on a medication that you cannot afford.
• Due to substance use, people are unable to fulfill their commitments and job duties, as well as cutting back on social and leisure activities.
• Continuing to use the medication while knowing that it is causing you complications or harming your physical or mental health.
• Doing something you would not usually do to get the drug, such as stealing.
• Investing a significant amount of time in obtaining the medication, using the drug, or recovering from the drug’s effects.
• You have tried and failed to quit using the drug.
• When you try to stop taking the medication, you may experience withdrawal symptoms.

2. Recognizing Unhealthy Drug Use in Family and Friends

 It can be difficult to tell the difference between typical life problems and symptoms of drug use. The following are possible signs that your friend or family member is abusing drugs:

• School or work problems — repeated absences from school or work, a sudden lack of interest in school events or work, or a decline in grades or work performance.
• Lack of energy and motivation, weight loss or gain, or red eyes are all physical health problems.
• Lack of concern about one’s appearance — lack of interest in clothes, hygiene, or appearance.
• Exaggerated attempts to keep family members out of his or her room, or secrecy about where he or she goes, or dramatic changes in actions and relationships with family and friends.
• Financial problems — unexpected demands for money with no explanation; or the finding that money is missing or has been robbed, or that things have vanished from your home, meaning that they might be sold to fund drug use.

Recognizing Signs of Drug Use or Intoxication

 Depending on the type of drug, the signs and symptoms of drug use or intoxication can differ. Bear in mind that other factors may also be affecting a resident’s behavior or appearance. Those who work in sober living should always be receptive to listening to residents when they are willing to self-disclose about medications or medical diagnoses. It is essential that when listening, you remain non-judgmental and leave personal opinions unvoiced. Several examples of signs of intoxication are given below.

1. Marijuana, hashish, and other cannabis-containing substances

Signs and symptoms of recent use can include:

• A sense of euphoria or feeling “high”
• A heightened sense of visual, auditory and taste perception
• Increased blood pressure and heart rate
• Red eyes
• Dry mouth
• Decreased coordination
• Difficulty concentrating or remembering
• Slowed reaction time
• Anxiety or paranoid thinking
• Cannabis odor on clothes or yellow fingertips
• Exaggerated cravings for certain foods at unusual times

Long-term (chronic) use is often associated with:

• Decreased mental sharpness
• Poor performance at school or at work
• Reduced number of friends and interests

2. Barbiturates, benzodiazepines, and hypnotics

 Prescription central nervous system depressants include barbiturates, benzodiazepines, and hypnotics. These drugs are often used and abused in the pursuit of relaxation or an urge to “turn off” or forget about stressful thoughts or feelings.

Barbiturates are sedatives. Phenobarbital and secobarbital are two examples (Seconal).

Benzodiazepines are a form of benzodiazepine. Sedatives like diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), and chlordiazepoxide are several examples (Librium).

Hypnotics are hypnotic substances. Prescription sleeping drugs like zolpidem (Ambien, Intermezzo, and others) and zaleplon are examples (Sonata).

Signs and symptoms of recent use can include:

• Drowsiness
• Slurred speech
• Lack of coordination
• Irritability or changes in mood
• Problems concentrating or thinking clearly
• Memory problems
• Involuntary eye movements
• Lack of inhibition
• Slowed breathing and reduced blood pressure
• Falls or accidents
• Dizziness

3. Meth, cocaine, and other stimulants

 Amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, among others) and amphetamine-dextroamphetamine are examples of stimulants (Adderall, Adderall XR, others). They are often used and abused in the pursuit of a “high,” or to raise energy, increase work or school results, lose weight, or regulate appetite.

Signs and symptoms of recent use can include:

• Feeling of exhilaration and excess confidence
• Increased alertness
• Increased energy and restlessness
• Behavior changes or aggression
• Rapid or rambling speech
• Dilated pupils
• Confusion, delusions, and hallucinations
• Irritability, anxiety, or paranoia
• Changes in heart rate, blood pressure and body temperature
• Nausea or vomiting with weight loss
• Impaired judgment
• Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
• Mouth sores, gum disease and tooth decay from smoking drugs (“meth mouth”)
• Insomnia
• Depression as the drug wears off

4. Club drugs

 Drugs widely used in bars, festivals, and parties are known as club drugs. Ecstasy or molly (MDMA), gamma-hydroxybutyric acid (GHB), flunitrazepam (Rohypnol, a brand used outside the US, also known as roofie), and ketamine are several examples. These drugs are not all in the same class, but they all have some of the same side effects and risks, including long-term damage.

Since GHB and flunitrazepam may cause sedation, muscle relaxation, confusion, and memory loss, they have the potential to cause sexual misconduct or sexual assault.

Signs and symptoms of use of club drugs can include:

• Hallucinations
• Paranoia
• Dilated pupils
• Chills and sweating
• Involuntary shaking (tremors)
• Behavior changes
• Muscle cramping and teeth clenching
• Muscle relaxation, poor coordination or problems moving
• Reduced inhibitions
• Heightened or altered sense of sight, sound, and taste
• Poor judgment
• Memory problems or loss of memory
• Reduced consciousness
• Increased or decreased heart rate and blood pressure

5. Hallucinogens

Depending on the drug, hallucinogens can cause a variety of signs and symptoms. The hallucinogens lysergic acid diethylamide (LSD) and phencyclidine (PCP) are used most.

LSD use may cause:

• Hallucinations
• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Impulsive behavior
• Rapid shifts in emotions
• Permanent mental changes in perception
• Rapid heart rate and high blood pressure
• Tremors
• Flashbacks, a re-experience of the hallucinations — even years later

PCP use may cause:

• A feeling of being separated from your body and surroundings
• Hallucinations
• Problems with coordination and movement
• Aggressive, possibly violent behavior
• Involuntary eye movements
• Lack of pain sensation
• Increase in blood pressure and heart rate
• Problems with thinking and memory
• Problems speaking
• Impaired judgment
• Intolerance to loud noise
• Sometimes seizures or coma

6. Inhalants

Inhalant use can cause a variety of signs and symptoms, depending on the drug. Glue, paint thinners, correction fluid, felt tip marker fluid, oil, cleaning fluids, and household aerosol products are some of the most frequently inhaled chemicals. Users can experience brain damage or death because of the toxic nature of these substances.

Signs and symptoms of use can include:

• Possessing an inhalant substance without a reasonable explanation
• Brief euphoria or intoxication
• Decreased inhibition
• Combativeness or belligerence
• Dizziness
• Nausea or vomiting
• Involuntary eye movements
• Appearing intoxicated with slurred speech, slow movements, and poor coordination
• Irregular heartbeats
• Tremors
• Lingering odor of inhalant material
• Rash around the nose and mouth

7. Opioid painkillers

Opioids are narcotic painkillers derived from morphine or synthesized from it. Heroin, morphine, codeine, methadone, and oxycodone are examples of this class of drugs.

Addiction to opioid prescription pain medications, also known as the “opioid crisis,” has reached unprecedented levels in the United States. Some patients who have been using opioids for a long time will require a temporary or long-term drug replacement prescribed by a doctor during treatment.

Signs and symptoms of narcotic use and dependence can include:

• Reduced sense of pain
• Agitation, drowsiness, or sedation
• Slurred speech
• Problems with attention and memory
• Constricted pupils
• Lack of awareness or inattention to surrounding people and things
• Problems with coordination
• Depression
• Confusion
• Constipation
• Runny nose or nose sores (if snorting drugs)
• Needle marks (if injecting drugs)

 Risk Factors

 Addiction can affect people of any age, gender, or socioeconomic status. Certain factors can influence the probability and pace at which an addiction develops:

• Family history of addiction. Drug abuse runs in some families and is most likely caused by a genetic predisposition. You are more likely to develop a drug addiction if you have a blood family with an alcohol or drug addiction, such as a parent or sibling.
• Mental health disorder. You are more likely to become addicted to drugs if you have a mental health disorder like depression, attention deficit hyperactivity disorder (ADHD), or post-traumatic stress disorder. Drug use can become a coping mechanism for painful emotions like anxiety, depression, and isolation, and it can exacerbate these issues.
• Peer pressure. Peer pressure is a strong factor in starting to use and misuse drugs, particularly for young people.
• Lack of family involvement. A lack of parental oversight, as well as difficult family circumstances or a lack of a relationship with your parents or siblings, may increase the risk of addiction.
• Early use. Early drug use can trigger changes in the developing brain and increase the chances of developing a drug addiction.
• Taking a highly addictive drug. Some medications, such as stimulants, cocaine, or prescription painkillers, may lead to addiction more quickly than others. Addiction can be exacerbated by smoking or injecting drugs. Taking drugs that are thought to be less addictive — so-called “light drugs” — can set you on the road to addiction.

Complications

 Short- and long-term consequences of drug use may be severe and harmful. Taking some drugs, especially in high doses or in combination with other drugs or alcohol, can be extremely dangerous. Here are a few illustrations.

• Methamphetamine, opiates, and cocaine are highly addictive and can lead to a variety of short- and long-term health problems, such as psychotic actions, seizures, and death from overdose.
• GHB and flunitrazepam may cause sedation, fatigue, and memory loss. These so-called “date rape drugs” are known to impair the ability to avoid unwanted touch as well as the ability to remember the incident. They can cause seizures, coma, and death in high doses. When these medications are combined with alcohol, the risk increases.
• Ecstasy or molly (MDMA) may cause dehydration, electrolyte deficiency, and risks such as seizures. MDMA has the potential to damage the brain over time.
• Club Drugs are often sold on the streets and the liquid, pill, or powder may often contain unknown substances that can be harmful, such as other illegally produced or prescription drugs.
• Inhalants are toxic by nature and users can experience varying degrees of brain injury.

 Other Life Altering Complications

 Sober house operators and staff should be aware that dependence on drugs can create dangerous and damaging complications, including:

• Communicable diseases. Addicts are more likely to contract an infectious disease, such as HIV, by unprotected sex or sharing needles.
• Other health problems. Drug addiction can result in a variety of mental and physical health issues, both short- and long-term. These are dependent on the medication being used.
• Addicts are more likely to drive or engage in other risky behaviors when under the influence of drugs.
• People who are addicted to drugs are more likely to commit suicide than those who are not.
• Family problems. Changes in behavior can lead to marital or family dispute, as well as custody issues.
• Work issues. Drug abuse can lead to poor work performance, absenteeism, and eventually job loss.
• Problems at school. Drug use may have a detrimental impact on academic performance and motivation to succeed.
• Legal issues. Buying or possessing illicit substances, cheating to fund the drug addiction, driving while under the influence of drugs or alcohol, or child custody disputes are all common legal issues for drug users.
• Financial problems. Spending money on drugs diverts funds from other uses, may result in debt, and may contribute to illegal or unethical actions.

 How is Substance Use Disorder Treated

 The first step is to recognize the problem. When an individual is unaware of their problematic drug use, the healing process may be slowed. Self-referrals are often welcome and encouraged, even though they are almost always prompted by concerned friends and family.

To determine whether a drug use disorder is present, a medical practitioner should perform a standardized examination of symptoms. Whether the condition is mild, moderate, or extreme, patients will benefit from treatment. Many individuals who meet the requirements for a drug use disorder and may benefit from treatment do not receive it.

 Medications are used to curb opioid cravings, alleviate withdrawal symptoms, and avoid relapse. Individuals with SUD will benefit from psychotherapy to better understand their actions and motives, build self-esteem, cope with stress, and resolve other psychological issues.

A person’s rehabilitation plan is tailored to their individual needs and can include interventions not used in traditional care. This may include the following:

• Hospitalization for medical withdrawal management (detoxification)
• Therapeutic communities (highly controlled, drug-free environments)
• Outpatient medication management and psychotherapy
• Intensive outpatient programs (IOP)
• Residential treatment (“rehab”)
• Many people find mutual-aid groups helpful (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery)
• Self-help groups that include family members (Al-Anon or Nar-Anon Family Groups)

 Sober living is not part of the treatment provided for SUD but can be instrumental as part of the continuing support for those in early recovery.

13 Principles of Effective Substance Use Disorder Treatment

Based on three decades of clinical study, these 13 principles of successful opioid addiction treatment were established. Treatment can help opioid addicts stop using drugs, prevent relapse, and reclaim their lives, according to research. Bring familiar with these 13 principles can help to understand residents in sober living and provide some insight into issues they may be facing.

1. Addiction is a disorder that affects brain function and actions. It is a complex, but treatable disease.
2. There is no one treatment that is right for everybody.
3. Treatment must be easily accessible.
4. Effective care addresses the individual’s various needs, not just his or her substance addiction.
5. It is important to stay in care for a sufficient time.
6. Person and/or group counseling, as well as other therapeutic approaches, are the most widely used types of opioid addiction care.
7. For many patients, medications are an important part of their care, especially when paired with therapy and other behavioral interventions.
8. A person’s care and service plan must be evaluated on a regular basis and adjusted as needed to meet his or her changing needs.
9. Many people who are addicted to drugs often suffer from other mental illnesses.
10. Detoxification with medical assistance is just the first step in addiction recovery, and it does nothing to improve long-term substance abuse.
11. Treatment does not have to be self-initiated to be successful.
12. Drug usage during recovery must be closely supervised as lapses do occur.
13. Patients should be tested for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and tailored risk-reduction therapy should be provided to help patients alter or improve habits that put them at risk of contracting or transmitting infectious diseases.

Recovery and Recovery Support

Recovery is a transformational process in which people strengthen their health and well-being, take control of their lives, and aspire to achieve their full potential. Recovery is assisted by four main dimensions:

• Health is described as the ability to overcome or manage one’s disease(s) or symptoms, as well as the ability to make educated, safe decisions that promote physical and emotional well-being.
• Getting a secure and healthy place to live is referred to as “home.”
• Purpose is described as engaging in meaningful daily activities while still having the freedom, income, and resources to participate in society.
• Having relationships and social networks that provide support, fellowship, affection, and hope is what community is all about.

The cornerstone of healing is hope, or the conviction that these difficulties and conditions can be resolved. Recovery is a highly personal process that can take many forms. Recovery is described as an ongoing process of growth and improvement in one’s health and well-being, which may include setbacks. Resilience becomes a crucial component of recovery since losses are a common part of life.

Relationships and social networks help to facilitate the healing process. Family members also take on the role of champions for their loved one’s recovery. Adversities can cause increased family stress, guilt, shame, frustration, fear, anxiety, loss, grief, and isolation in families of people in recovery. Family members who need deliberate supports to promote their wellbeing and well-being may benefit from the principle of resilience in recovery. Peer and friend support is also essential in engaging and helping people in recovery. Sober living can be an invaluable resource as part of an individual’s recovery support.

Flexible recovery resources and supports are needed. What works for adults will not work for children or the elderly. Adolescents, for example, have different social supports, peer counselors, and rehabilitation coaching than teenagers and older adults. To support rehabilitation, mental health and addiction programs should:

• Be responsive to and respectful of diverse people’s and groups’ health values, behaviors, and cultural and linguistic needs.
• Actively approach diversity in service delivery.
• Narrow health gaps in terms of access and results.

Sober living should be part of a recovery support system which encourages people in recovery from mental and substance use disorders, as well as their families. Staff and residents should help promote person, program, and system-level approaches that foster health and resilience (such as assisting people with behavioral health needs to be well, manage symptoms, and achieve and maintain a healthy lifestyle).

Preventing a Relapse

Once you have been addicted to a substance, you are at a high risk of relapsing into that trend. Even if you have had therapy and have not used the medication in a long time, if you start using it again, you are likely to lose control of it.

• Follow your recovery plan. Keep an eye on your appetite. It might appear that you have stabilized and that you do not need to take any more measures to remain drug-free. However, if you continue to see your psychiatrist or counselor, attend support group meetings, and take prescription medication, your chances of remaining drug-free will be much better.
• Avoid high-risk situations. Do not return to the drug-dealing area where you used to get your drugs. Also, stay away from your drug-addicted pals.
• If you use, seek help right away. If you start using the medication again, you can immediately contact your doctor, a mental health provider, or someone else who can assist you.

Sources

https://www.psychiatry.org/patients-families/addiction/what-is-addiction

https://www.samhsa.gov/find-help/recovery

https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112