Substance use disorders continue to represent a significant problem in the United States. In 2018, there were 67,367 overdose deaths in the country, and it was the first time overdose death rates dropped in over a decade. The steady increase in overdose and addiction problems is mainly due to prescription and illicit opioids. However, drugs like cocaine, methamphetamine, and alcohol represent a public health problem in many areas of the country. In Maryland, the opioid crisis has taken a toll, and the vast majority of overdose deaths involve opioids.
Substance use disorders can also contribute to other issues that affect the health of the state, including crime rates, homelessness, and the spread of certain diseases. However, access to addiction treatment can help address public health problems related to addiction.
Learn more about drug and alcohol treatment and how addiction has affected Maryland.
Addiction is a disease that affects the brain and changes the way you respond to drugs or alcohol. Addictive behavior can be caused by more than just psychoactive substances, but drug and alcohol addiction may be the most pronounced form of addiction. Addiction involves compulsive and repeated drug use, despite harmful consequences that it may cause. Drug compulsions may also get out of hand, whether you’re aware of your substance use problem or not. Addiction can also get worse over time when it’s ignored, affecting multiple areas of your life, including your health, relationships, and financial stability.
Substance use problems can specifically affect the reward center of the brain. Your reward system works by releasing feel-good chemicals like serotonin, endorphin, dopamine, and oxytocin in response to certain activities like eating your favorite meal or a warm hug from a loved one. Your learning center responds to the activities that trigger these chemical releases and encourages you to repeat them when you’re feeling sad, uncomfortable, or stressed.
However, drugs and alcohol directly influence the chemicals in your brain and body. Some do this by introducing a chemical that is very similar to a natural brain chemical, like opioids that mimic endorphins. Others do this by blocking the process in which chemicals are removed from your system, like cocaine blocks the reuptake of dopamine. In any case, this creates powerful, rewarding effects when you take a drug, which is what produces a euphoric high.
Your brain isn’t able to tell the difference between normal healthy activities and drug use. When you’re feeling negative physical or emotional issues, your brain will encourage you to return to something with a powerful, rewarding effect. Addiction occurs when your brain starts to create compulsions to use drugs or alcohol. Over time, you may subconsciously start to prioritize maintaining your addiction over other responsibilities, hobbies, and needs.
Addiction to a psychoactive substance like drugs or alcohol is officially diagnosed as a substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). In the fifth edition of the DSM, substance use disorders have been split into three categories based on severity: mild, moderate, and severe. The DSM also has a list of eleven criteria that are used to identify substance use disorders. These factors include things like using more than you intended to, trying and failing to cut back, drug or alcohol cravings, continuing to use despite problems, and others.
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The number of these factors that apply to you can tell a doctor or clinician how severe your substance use problem is. Two or three factors point to a mild disorder, four or five represent a moderate disorder, and six or more factors point to a severe substance use disorder. Since addiction is a chronic disease, you will still have a substance use diagnosis after treatment. But if you go through treatment and achieve sobriety, your diagnosis may change to a substance use disorder in early remission, or sustained remission if your sobriety lasts a long time.
Substance use disorders are chronic and complex diseases, but they can also be effectively treated with the right therapy options and levels of care.
Though drug and alcohol addiction are chronic diseases that are difficult to overcome, they can be effectively treated through a complex, multileveled treatment process. Addiction treatment involves multidisciplinary care over four main levels of treatment. The first is medically managed inpatient care. Also called medical detox, this level of care involves active care from medical professionals that can diagnose and treat issues related to withdrawal or issues that might be complicated by withdrawal. Detox usually lasts around a week as your body adjusts to life without the drug you were dependent on.
After detox, you may move on to the next level of care that’s appropriate for your needs. Medically monitored or clinically managed inpatient treatment is the next level of care in addiction treatment. It involves medical supervision and clinical treatment for people with high-level needs. At inpatient treatment, you’ll receive care 24 hours per day.
Next is intensive outpatient treatment, which involves nine or more hours of treatment services each week. It may also involve a partial hospitalization program, which can include 20 or more hours per week. In this level of care, you will attend treatment during the day and live independently at night. As you progress, you may move on to outpatient treatment with fewer than nine hours of treatment services each week.
The levels of care you go through will depend on your specific needs. When you enter an addiction treatment program, you’ll undergo an intake process that’s likely to involve a biopsychosocial assessment. This assessment looks at biological, psychological, and social problems that may contribute to or complicate your substance use disorder. In your assessment, you’ll also create a unique treatment plan with the help of your therapist. Each week, that plan will be reassessed to check its effectiveness.
Your treatment plan may involve several therapies, depending on your needs. You’ll likely go through individual and group therapy sessions, guided by your therapist. Some people also go through family therapy. Behavioral therapies are also common in addiction treatment. They involve approaches that deal with thoughts and emotions and how they influence your behavior. Cognitive-behavioral therapy is especially useful, and it’s used in creating relapse prevention strategies.
The east coast, especially the northeast, has been severely impacted by the opioid epidemic. As much as 90 percent of Maryland’s overdose deaths involve opioids. The misuse of alcohol and other drugs may only exasperate the opioid problem. Alcohol and other depressants can increase your risk for a fatal overdose when combined with an opioid. Similar effects can cause the substances to potentiate one another, quickly leading to a loss of consciousness and respiratory depression.
Opioids were involved in 2,087 deaths in Maryland in 2018. Heroin and prescription opioids were involved in 356 and 576 deaths, respectively. These rates have been in decline since 2016. However, rates of synthetic opioid deaths have been in a sharp increase since 2015. Synthetic opioids like fentanyl were involved in 1,825 overdose deaths in Maryland in 2018.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
ASAM. (n.d.). What is the ASAM Criteria? Retrieved from https://www.asam.org/resources/the-asam-criteria/about
Verywellmind. (2020, March 21). The Symptoms Used to Diagnose Substance Use Disorders. Elizabeth Hartney, B. Retrieved from https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926
National Institute on Drug Abuse. (2020, May 01). Maryland: Opioid-Involved Deaths and Related Harms. Retrieved from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/maryland-opioid-involved-deaths-related-harms
National Institute on Drug Abuse. (2020, August 25). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates