One result of the abuse of an addictive substance can be a Substance Use Disorder, or SUD. SUDs are primarily psychological ailments, though they may have physical effects if the user’s brain has suffered damage from the substance abused. A SUD can prove harder to recover from than a physical injury, and though they usually can’t be seen, the scars they leave are real and often permanent.
In the Part I of this blog, I covered the definition of SUDs, based on the general description in the APA‘s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5). Because my site, Johnny’s Ambassadors, focuses on the dangers of today’s high-potency marijuana, I also detailed the specific damage caused by Cannabis Use Disorder (CUD).
Since the disorder’s formal definition in 2013, CUD’s frequency has grown along with the legalization and decriminalization of the recreational use of marijuana. It occurs most frequency in people under 25, a large percentage of whom are adolescents who cannot obtain marijuana legally.
SUD Recovery Methods
The brain is a delicate and complex organ, and a severe SUD can damage it in ways that nothing can repair. Medical personnel and users can effectively treat SUDs, depending upon the user’s support system and determination to change. We had the best medical treatment available for Johnny, but he refused to participate. Because he was 18 after his first suicide attempt, he checked himself out after the first day of intensive outpatient treatment. He said he only agreed to do it to get out of the hospital, and there was nothing we could do. We tried to admit him to 12-step program, but he refused to participate. After being admitted again for psychosis, he saw a therapist twice and then refused additional treatment, only agreeing to go to his psychiatrist monthly for med refills. Then he took himself off his antipsychotics without telling anyone. So, clearly the cooperation of the patient is critical for success. It’s near impossible to achieve that positive change by yourself, and the user must want to change. At some point, you can’t control another human being. Looking back, I wish we would have sent him to a long-term, residential dual diagnosis program before he turned 18.
Most treatment programs, including 12-step programs like Alcoholics Anonymous and Narcotics Anonymous, focus on abstinence from the drug and social support from other members who have been through similar experiences. Support is crucial, whether it comes from friends, family, or 12-step comrades. As the Surgeon General’s Office points out, abstinence isn’t enough to define recovery. “Recovery goes beyond the remission of symptoms to include a positive change in the whole person.”
While emphasizing that remission from an SUD can take years and multiple rounds of treatment to fully take hold, the Surgeon General’s site goes on to note that SUD recovery is more common than most people realize. At least 50% of all SUD sufferers in the US have been in remission for more than a year or longer. This applies to all users, both adolescent and adult.
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from addiction as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA provides guidelines for living a life in recovery, including four basic dimensions for supporting such a life:
- Maintaining one’s health
- A stable home environment
- Maintaining purpose through meaningful daily activity (work, school, volunteering, caring for others, creative endeavors) and the means and resources to participate in society
- Community relationships and social networks to provide support
Most recovery paths focus on total abstinence from the abused substance. One study that focused specifically on 119 participants attributed their success to focusing on reasons to change, commitment to change, and conquering denial and self-deception. Some took advantage of some level of formal treatment, while others focused purely on natural recovery based on their willpower. More than three-quarters of participants of both types recommended treatment and use of self-help materials to sharpen their focus, but more than half also saw value in natural recovery.
Detox and Initial Recovery
The reason most recovery paths for SUDs emphasize abstinence is to purge all remaining traces of the substance from the user’s system, a process that can take days to weeks to six to 12 months or longer. Dealing with the withdrawal symptoms during and following abstinence requires significant support and strength to push through.
Again, SUDs are not purely psychological, because they often cause physical brain damage. Brain scan studies have revealed that some substance abusers, especially those with severe alcohol and cocaine and opioid SUDs, have suffered significant damage to both the gray and white matter in the brain, especially in areas associated with the “reward system” that releases dopamine. Dopamine is the brain chemical that makes you feel good when you accomplish something.
Addictive substances release 2-10 times the normal amount of dopamine, and they do it more often and more effectively than feel-good tasks. This short-circuits the reward system, one reason they’re so addictive. In time, the damaged areas of the brain require more and more of the substance to work and for the user to function “normally.”
Altered dopamine flow was first observed in PET brain scans of addicted individuals in a 2009 study, before SUDs were formally defined, with the neurochemical especially low in areas associated with risk-taking and decision making. Various brain areas, however, are associated with different addictive substances and activities, a factor that makes SUDs and addiction so hard treat. There is no single method or medication that works for everything and everyone.
Fortunately, human brains are flexible in their response to damage and injury, so given enough time and abstinence from the substance(s) abused, they can recover most functions lost to or dulled by SUD and addiction. This ability to self-repair is called neuroplasticity. It’s most easily seen in adolescents and young adults, whose brains are still making new connections that haven’t yet been pruned away or set into stone by physical maturity.
However, older adult brains also display neuroplasticity, so any brain can heal at least somewhat over time. Some alcohol-related damage can heal in weeks; damage from opioids and cocaine takes more than a year for the brain to recover. Sometimes the brain accomplishes this through the creation of new brain cells; sometimes it just reroutes functions around damaged areas. In addition to neuroplasticity, a 2013 study indicates mindfulness training and meditation can help retrain the engrained brain pathways that normally tempt a user to relapse. Physical activity may also help.
The Final Diagnosis
The milder the SUD, the easier it is to recover from. Unfortunately, the potential for relapse always remains, and it’s not always possible for the brain of someone with a severe SUD to fully recover. Sadly, once triggered, some mental illnesses are permanent at our present level of medical knowledge. However, users can sometimes manage them with careful and consistent use of medication.
The road is hard, and the lingering effects can be a bitter pill to swallow; however, in the final analysis, cannabis use disorder is treatable. As medical science advances and our understanding of the human brain advances with it, our options for healing from SUDs can only grow. So, if your child has been diagnosed with an SUD, don’t despair, and don’t give up. Get help and stay on the lookout for new treatments and medications that can help bring them back to normalcy.