National Substance Use Prevention Month
Globally, drug and alcohol use and misuse lead to enormous societal and economic burdens. The economic impact of substance misuse is estimated at over $440 billion dollars in the US alone. Last year in the US there were a record number of drug overdose deaths, including over 3,000 overdose deaths in NC during 2020. While many people try drugs and alcohol (86% of adults report having tried alcohol at some point), a subset of individuals develop substance use disorder (SUD), characterized by continued use despite negative consequences, and sometimes a physical dependence and withdrawal (where discontinued use of the drug results in unpleasant and sometimes life-threatening physical symptoms). Scientists are trying to untangle and understand how alcohol and drugs change the brain (neurochemically and physiologically) and how these changes manifest in drug and alcohol addiction.
Many individuals report drinking or drug use to cope with stress and anxiety. Studies have shown that experiencing stressful life events can serve as a trigger for addiction and relapse. As such, one can imagine the detrimental impact of COVID-19-related stressors (isolation, uncertainty, job loss, and death of loved ones) on alcohol and substance use. In fact, emerging data indicates that the number of U.S. deaths attributed to alcohol increased by over 25% from 2019 – 2020. Centers for Disease Control (CDC) data indicate that the rate of alcohol-attributable deaths in North Carolina has nearly doubled since 2010, including a sharp increase from 2019-2020. While the brain and body can effectively adapt to stress, studies in humans and animals show that prolonged stress or severe stress exposure can have adverse effects. Stress can promote a shift in the balance of the brain circuitry that regulates mood, decision making, and cognitive states. Therefore, this negative impact may make an individual more susceptible to seeking out drugs or alcohol. The effects of stress can also vary by many factors, such as the individual’s perception of the stress, sex, age, and the environment. Better understanding the consequences of stress and how it relates to drug and alcohol use is important to help develop new treatments and interventions. The use of preclinical research can help determine paths for treatment, combining both pharmacological and psychological techniques to improve long-term outcomes.
Despite the availability of effective behavioral and pharmacological treatments for SUD, these treatments remain largely under-utilized (often due to social stigma, see below). Pharmacological treatments for opioid use disorder – such as methadone and buprenorphine – are among the most effective treatments for addiction. Approved pharmacological treatment options for alcohol use disorder include disulfiram, acamprosate, and naltrexone, an opioid receptor antagonist. Importantly, if someone has a physical dependence on alcohol, and they are looking to discontinue use, they should consult a physician before discontinuing alcohol use. Because of the way alcohol modifies brain circuits and neurotransmission, quitting “cold turkey” can result in seizures and even death. Physicians can prescribe other medications to reduce this risk and assist their patient in recovery. Behavioral treatments for SUD, such as cognitive behavioral therapy, motivational enhancement therapy, and contingency management, are also effective options for the treatment of SUD. Mutual support groups, including traditional 12-step programs and SMART Recovery, are easily accessible and remain the most utilized treatments for SUD. Ongoing research at UNC and other institutions is exploring novel treatment options for alcohol use disorder and SUD.
Given the prevalence and chronicity of SUD, experts agree that SUD treatment should be viewed as similar to treating other common medical conditions (e.g., diabetes). However, addiction-related stigma continues to pose a significant barrier to treatment availability and access: many with SUD do not seek help due to perceived stigma, and many clinicians remain hesitant to treat SUD, even if qualified to do so. Ongoing efforts to reduce stigma have included modifying our terminology to avoid terms such as “addict” or “alcoholic” and instead using terms like “a person with substance use disorder” or “a person with alcohol use disorder” (see here for additional information). This month is recognized to bring awareness to the impact of substance use on the individual, our families and relationships, and our communities, which is an important part of efforts to reduce the stigma of SUD.
UNC Substance Treatment and Recovery (STAR): https://www.uncmedicalcenter.org/uncmc/care-treatment/substance-treatment-and-recovery-star/
NC Department of Health and Human Services Mental Health and Substance Abuse resources: https://www.ncdhhs.gov/assistance/mental-health-and-substance-abuse
US Department of Health and Human Services Substance Use and Mental Health Administration (SAMHSA) resources: https://www.samhsa.gov/
Joyce Besheer, Ph.D.
Christian Hendershot, Ph.D.
Zoe McElligott, Ph.D.
Todd K. O’Buckley