A Clinical Approach for Patients with Substance Use Disorder

Learn about the clinical approach for substance use disorder and its importance in developing effective treatment strategies.

Understanding Substance Use Disorder: Causes, Identification, Management, and Health Impacts

Imagine waking up every day with a need that won’t go away, making even seemingly straightforward decisions like going to work or spending time with family seem like insurmountable obstacles. In 2024, about 48.4 million Americans aged 12 and older—a startling 16.8% of the population—struggled with drug use disorder (SUD). SUD is a complicated, curable brain condition that rewires our thoughts, feelings, and behaviors, causing us to use substances like alcohol, narcotics, or even prescription medications uncontrollably despite the damage they cause. It is not a sign of weakness or bad decisions.

The days of considering SUD from a judgmental perspective are long gone. Experts from groups like the National Institute on Drug Abuse (NIDA) now highlight its scientific origins: recurrent drug use modifies reward, stress, and self-control pathways in the brain, making quitting seem unachievable without assistance. With drug use disorders affecting 28.2 million people (on the increase) and alcohol use disorders affecting 27.9 million people (down somewhat from previous years), the problem affects every segment of society, from individuals suffering with mental health issues or chronic pain to teenagers struggling with peer pressure. The fact that more than half of people with SUD also struggle with co-occurring mental diseases like anxiety or depression is concerning since it creates a vicious cycle that is difficult to escape on one’s own.

However, there is hope. The tide may be turned by early identification via simple screenings, efficient management techniques, and cutting-edge methods like integrated chiropractic therapy, which combines spine adjustments and exercises to reduce pain without the need for narcotics. Additionally, nurse practitioners are essential because they provide holistic care, ergonomic guidance, and treatment coordination for both physical and mental health issues. The true nature of SUD, its classifications and symptoms, how to recognize and treat it, its effects on the body (including the muscles and bones), and how holistic approaches might aid in recovery will all be covered in this book. Understanding SUD is the first step in recovery, whether you’re looking for information for yourself or a loved one.

What Is Substance Use Disorder?

SUD occurs when a person is unable to regulate their use of drugs or alcohol, even when doing so is harmful. According to experts, it is a long-term, curable condition that affects the brain and behavior. According to the Centers for Disease Control and Prevention (CDC), it is a category of illnesses characterized by continued use despite issues with relationships, employment, or health (Centers for Disease Control and Prevention, 2024). It’s difficult to quit since the brain seems to be rewired to want the chemical.

SUD is defined by the National Institute of Mental Health (NIMH) as a mental illness in which individuals lose control over drugs, whether they are legal or illicit. Addiction is the most serious kind, and it may vary from moderate to severe (National Institute of Mental Health, n.d.). Compulsive usage despite negative consequences is known as addiction, and alterations in reward, stress, and self-control regions of the brain cause it.

Why does SUD arise? It is a combination of environmental, biological, and individual variables. Some individuals are more susceptible due to their genes, and risks are increased by stress, trauma, or early exposure. The prevalence of SUD is shown by the fact that 48.7 million Americans aged 12 and older had it in 2022, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) (Substance Abuse and Mental Health Services Administration, 2023).

Like diabetes or heart issues, SUD is a sickness, not a decision or a sign of weakness. The National Institute on Drug Abuse (NIDA) emphasizes the use of compassionate terminology, such as “person with SUD” rather than “addict,” to lessen stigma and promote assistance (National Institute of Drug Abuse, 2021). People may now get therapy without fear thanks to this change.

Key Facts About SUD

• Affects brain circuits for pleasure and stress.
• Often linked to mental health issues like anxiety or depression.
• It can lead to relapse even after long abstinence.
• Treatable with meds, therapy, and support.

Different Categories of Identifying SUD

SUD is identified by patterns of use and types of substances. The American Psychiatric Association lists 10 categories of substances that can lead to SUD: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants (like amphetamines or cocaine), tobacco, and others.

Each category has unique effects, but all activate the brain’s reward system, causing pleasure that leads to repeated use. From the 2022 national survey, alcohol use disorder affected 29.5 million people, while drug use disorder hit 27.2 million (Substance Abuse and Mental Health Services Administration, 2023). Opioids, including prescription painkillers and heroin, caused 6.1 million cases.

Identification relies on symptoms like using more than planned, failing to cut back, spending time on the substance, cravings, neglecting duties, relationship problems, risky use, tolerance, and withdrawal (National Institute on Drug Abuse, 2018). Severity is mild (2-3 symptoms), moderate (4-5), or severe (6+).

Common Substance Categories and Signs

• Alcohol: Frequent binge drinking, blackouts, legal issues. Affects 10.5% of Americans.
• Opioids: Drowsiness, slowed breathing, needle marks. High overdose risk; 2.2% prevalence.
• Stimulants: Increased energy, paranoia, and weight loss. Includes cocaine (0.5%) and meth (0.6%).
• Cannabis: Memory issues, lack of motivation. Disorder in 6.7%.
• Tobacco: Coughing, nicotine dependence. Often co-occurs with other SUDs.

These categories help doctors classify and treat SUD. Dr. Alexander Jimenez, a chiropractor and nurse practitioner, notes in his practice that pain from SUD often leads to musculoskeletal issues, pushing for drug-free management (Jimenez, n.d.).

The Process of Identifying Patients with SUD

Identifying SUD starts with routine screening in all health settings, from doctors’ offices to emergencies. NIDA recommends asking everyone about substance use to catch it early (National Institute on Drug Abuse, n.d.). Tools like AUDIT for alcohol or DAST-10 for drugs make it objective.

Brief pre-screens are quick, like AUDIT-C (3 questions on drinking) or SASQ (one question on heavy drinking days) (National Institute on Alcohol Abuse and Alcoholism, 2023). Positive results lead to full screens like ASSIST for multiple substances or CUDIT-R for cannabis.

If positive, evaluate with a full history. The AMA guide suggests team-based care: talk non-judgmentally, use motivational interviewing to build readiness (American Medical Association, 2021). Check for co-occurring issues like mental health—half of SUD cases have them (National Institute of Mental Health, n.d.).

Steps in Identification:

• Pre-screen everyone: “How many times in the past year have you used a recreational drug?”
• Full screen if positive: Use tools like TAPS for adults or SUBS for general use.
• Assess risk: Low (reinforce healthy choices), moderate (brief talk), high (refer to specialist).
• Document and follow up: Track behaviors like tolerance or withdrawal.

Dr. Jimenez observes that screening for pain-related SUD in chiropractic settings helps spot risks early (Jimenez, n.d.).

Managing Patients with SUD

Management focuses on detox, meds, therapy, and support for long-term recovery. SAMHSA emphasizes integrated care for SUD and mental health (Substance Abuse and Mental Health Services Administration, 2023). Start with detox under medical watch to handle withdrawal safely.

For alcohol, use meds like naltrexone to reduce cravings. Opioids need MAT like buprenorphine to prevent relapse (National Institute on Drug Abuse, 2020). Tobacco: Nicotine patches plus counseling.

Therapy includes CBT to change thinking, motivational interviewing to build will, and groups like AA. Only 14.9% with SUD get treatment, so access is key (Substance Abuse and Mental Health Services Administration, 2023).

Management Steps

• Detox: Meds for symptoms, monitoring in hospital if severe.
• Meds: Tailor to substance, e.g., disulfiram for alcohol aversion.
• Therapy: Individual or group to address triggers.
• Support: Family involvement and peer groups for ongoing support.
• Follow-up: Regular checks to prevent relapse.

Nurse practitioners (NPs) play a big role, prescribing MAT, giving ergonomic advice for pain, and coordinating care (American Association of Nurse Practitioners, 2024). They provide full management, from screening to referrals.

How SUD Affects the Body, Including the Musculoskeletal System

SUD harms nearly every body system. Brain changes lead to addiction, while physical effects include liver damage from alcohol or lung issues from smoking. The NIMH notes SUD alters behavior and control (National Institute of Mental Health, n.d.).

Musculoskeletal effects are common. Alcohol causes myopathy—muscle weakness and wasting—by interfering with repair (WebMD, 2024). Opioids lead to tendon rupture and fibrosis (PubMed, 1982). Stimulants like cocaine cause muscle pain and cramping (Physiology, 2019). Cannabis and others disrupt bone health, raising fracture risk (PMC, 2024).

Dr. Jimenez sees SUD worsening pain, leading to misalignment that is treatable without drugs (Jimenez, n.d.). Teens with pain show higher SUD rates (JOSPT, 2017).

Body Effects

• Heart: Irregular beats from stimulants.
• Liver: Cirrhosis from alcohol.
• Muscles: Weakness, pain, toxicity.
• Bones: Lower density, easy breaks.
• Nerves: Neuropathy from long-term use.

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Understanding Long Lasting Injuries- Video

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Integrative Chiropractic Care and Nurse Practitioner Role in SUD

Integrative chiropractic care uses spinal adjustments and exercises to fix alignment, easing pain that might fuel SUD. It reduces risk by managing pain naturally, avoiding opioids (Isaiah House, n.d.). Adjustments help with withdrawal aches and improve mood.

Dr. Jimenez combines chiropractic with functional medicine for drug-free recovery, noting better outcomes (Jimenez, n.d.). Surveys show chiropractors often see SUD patients and need training (PMC, 2023).

NPs provide full care: screening, prescribing, advising on ergonomics to prevent pain, and coordinating with therapists (NP Journal, 2024). They address co-occurring issues by developing plans that include various treatments.

Chiropractic Benefits

• Adjustments reduce stress and aid detox.
• Exercises build strength and prevent relapse.
• Holistic: Lowers SUD risks by addressing the root causes of pain.

NP Contributions

• Comprehensive assessments.
• Ergonomic tips for daily life.
• Coordinate meds, therapy, and support.

Conclusion

Although it is a curable illness that does not define a person’s life, substance use disorder (SUD) continues to be a significant public health concern. We can assist individuals in regaining control by understanding their roots, identifying early symptoms through regular testing, and using effective treatment approaches such as medication, counseling, and support groups. Keep in mind that SUD has significant effects on the body and brain, including weakening of the bones and muscles, yet integrative methods provide hope. Through spine adjustments and exercises, chiropractic therapy lowers the risks associated with SUD by restoring alignment and reducing pain without the need for drugs. From ergonomic advice to comprehensive treatment plans that account for both mental and physical needs, nurse practitioners provide crucial guidance.

The magnitude of the problem is shown by recent data: Similar to 2022 statistics, about 48.5 million Americans aged 12 and older had a past-year SUD in 2023, with alcohol use disorder affecting 28.6 million and drug use disorder affecting 27.8 million (Substance Abuse and Mental Health Services Administration, 2024). Positively, however, 73.1% of individuals who acknowledge they have a drug issue report being in recovery, demonstrating that change is achievable.

Important Recovery Takeaways:

• Utilize technologies such as AUDIT or DAST-10 during routine medical visits to ensure early diagnosis, which may save lives.
• Combining medical therapies with chiropractic and NP assistance may improve the results of holistic treatment.
• With the correct assistance, millions of people recover every year, so you’re not alone.

Do not hesitate to contact local providers or hotlines such as SAMHSA’s at 1-800-662-HELP if you or a loved one is experiencing SUD. We can stop this pandemic and create healthy futures with understanding, empathy, and action.

References

• American Association of Nurse Practitioners. (2024). Nurse practitioners guide patients on the road to recovery. www.aanp.org/news-feed/nurse-practitioners-guiding-patients-on-the-road-to-recovery
• American Medical Association. (2021). Substance use disorder how-to guide. www.ama-assn.org/system/files/bhi-sud-how-to-guide.pdf
• Centers for Disease Control and Prevention. (2024). Treatment of substance use disorders. www.cdc.gov/overdose-prevention/treatment/index.html
• Jimenez, A. (n.d.). Dr. Alexander Jimenez’s website. dralexjimenez.com/
• Jimenez, A. (n.d.). LinkedIn profile. www.linkedin.com/in/dralexjimenez/
• National Institute on Alcohol Abuse and Alcoholism. (2023). Screen and assess: Use quick, effective methods. www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/screen-and-assess-use-quick-effective-methods
• National Institute on Drug Abuse. (n.d.). Screening tools and prevention. nida.nih.gov/nidamed-medical-health-professionals/screening-tools-prevention
• National Institute on Drug Abuse. (2018). Understanding drug use and addiction: drug facts. nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction
• National Institute on Drug Abuse. (2021). Words matter: Preferred language for talking about addiction. nida.nih.gov/research-topics/addiction-science/words-matter-preferred-language-talking-about-addiction
• National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders: research report. nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders
• National Institute of Mental Health. (n.d.). Substance use and co-occurring mental disorders. www.nimh.nih.gov/health/topics/substance-use-and-mental-health
• Novus Health. (2024). The effects of alcohol on the musculoskeletal system. novushealth.co.uk/2024/07/the-effects-of-alcohol-on-the-musculoskeletal-system-what-you-need-to-know/
• PubMed. (1982). Adverse effects of drugs on the muscle. pubmed.ncbi.nlm.nih.gov/6128217/
• PubMed Central. (2024). Understanding the effect of recreational drug use on bone health. pmc.ncbi.nlm.nih.gov/articles/PMC11402883/
• PubMed Central. (2023). Identifying and addressing patient substance use: A survey of chiropractors. pmc.ncbi.nlm.nih.gov/articles/PMC10316550/
• Physiology. (2019). Muscle toxicity of drugs: When drugs turn physiology into pathophysiology. journals.physiology.org/doi/full/10.1152/physrev.00002.2019
• Substance Abuse and Mental Health Services Administration. (2023). 2022 NSDUH annual national report. www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf
• Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national-report.pdf
• The Journal of Orthopaedic and Sports Physical Therapy. (2017). Increased substance use and poorer mental health in adolescents with musculoskeletal pain. www.jospt.org/doi/10.2519/jospt.2017.7441
• WebMD. (2024). What to know about alcoholic myopathy. www.webmd.com/mental-health/addiction/what-to-know-alcoholic-myopathy