Updated January 2013
Substance abuse and addiction cause serious health-related problems for many people, including those living with HIV (HIV+). The US National Institute on Drug Abuse reported that in 2010, around seven percent of Americans – almost 18 million people – were abusing or addicted to alcohol. Among American girls and women, more than five out of every 100 had a problem with some type of substance abuse or addiction in 2011.
The World Health Organization (WHO) reports that the harmful use of alcohol results in two and a half million deaths each year around the world and that over 15 million people have problems with drug use. There are about 16 million injection drug users (IDUs) worldwide – one in five of them may be living with HIV.
It is important to understand what substance abuse and addiction are, if they affect you, and what you can do to get help if you need it.
It can be helpful to know what people mean when they talk about substance use, substance abuse, dependence, and addiction.
Substance: When used with the words use or abuse, ‘substance’ generally refers to things like prescription drugs, over-the-counter drugs, street drugs, alcohol, and tobacco. What these substances have in common is that they change how we feel – physically and/or emotionally – when we take them.
Substance use: To use a substance simply means to put that substance in your body in some way (e.g., to swallow, eat, drink, smoke, snort, inject the substance). Some common examples of substance use include: drinking a glass of wine, snorting a line of cocaine, taking a prescription anti-anxiety pill, smoking a cigarette, or injecting (shooting) some heroin.
Substance abuse: This term is used to describe a pattern of substance use that involves serious problems or negative consequences in the user’s life. These problems include, but are not limited to: not going to work or school, legal troubles, struggles in relationships with family or friends, and substance use in dangerous situations (e.g., while driving a car).
Dependence: This word is used most often to describe what happens when the body gets used to a particular substance. Sometimes the body ‘learns’ to tolerate a substance, so that more of the substance is needed to get the same effect. This is called physical dependence and also means that suddenly stopping the use of the substance will likely cause withdrawal symptoms. If a substance is used to get relief from emotional discomfort, emotional dependence may also develop. Often, substances that cause physical dependence are referred to as addicting.
Addiction: This word is used to refer to substance abuse that involves loss of control (compulsive use), continued use despite harmful consequences, and denial (refusal to acknowledge the problem). Addiction is now understood as a chronic (long-lasting) disease of the brain’s reward and motivation system. Continued use of substances that alter how we feel can change our brain’s chemistry and electrical wiring. In other words, addiction does NOT occur only because someone does not have enough willpower.
As with any disease, vulnerability to the disease of addiction differs from person to person. There are several factors that can put you at risk for abusing or becoming addicted to alcohol and drugs:
- Substance abuse or addiction in the family
- Early age of first use of drugs or alcohol
- Trauma, abuse, violence, or neglect in childhood
- Emotional problems like anxiety and depression
So how is the use of things like alcohol, street drugs, and prescription medications related to HIV? First, substance use increases the spread of HIV infection in the following ways. For many people, drinking and using drugs go together with sex. When people are under the influence of drugs or alcohol, they are more likely to make bad decisions and have unsafe sex. Drug users are also more likely to exchange sex, including unprotected sex, for drugs or money to buy drugs. In the US in 2010, injection drug use (IDU) was responsible for about one out of eight new HIV infections among African-American and Hispanic women. Among white women, IDU was responsible for one in four new HIV infections.
Substance use also causes problems for people living with HIV. When you are under the influence of drugs or alcohol, you are more likely to miss doses of your HIV drugs. This reduces your adherence to the medications that are needed to keep your immune system healthy and to prevent drug resistance.
One of the functions of your liver is the breaking down of drugs and toxins that enter the body. If you take HIV drugs – especially protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) – while also using street drugs or alcohol, your HIV drugs are ‘competing’ for your liver’s attention with the other substance. As a result, both your HIV drugs and whatever substance you have taken may take longer to break down. This means that you may have higher than expected levels of either or both of them in your bloodstream. Having too much HIV drug in your system can cause serious, even life-threatening side effects. In the same way, an overdose of recreational drugs, prescription drugs, or alcohol can be fatal.
Lastly, substance abuse plays a major role in domestic violence. Because violence is linked to poor decision-making and more risk taking, women who experience violence are more likely to suffer bad health consequences. These consequences include a higher risk for getting HIV as well as poor adherence to HIV drugs.
Millions of people use substances in a controlled and safe manner. However, many people have a hard time knowing when their substance use becomes problematic or harmful. Here are some questions to help you figure out if you are abusing substances:
- Have you ever felt you needed to cut down on your drinking or substance use?
- Have you lost control over when, how long, or how much you drink or use?
- Do you drink or use more to get the same effect as before?
- Do you use or drink more often to cope or ‘escape?’
- Do you need to drink or use regularly to feel socially capable, self-confident, or less shy?
- Do you hide your drinking or substance use, or behave secretively around it?
- Have others annoyed you by questioning or criticizing your substance use?
- Do you spend increasing amounts of money on your substance?
- Does your substance use cause problems with life activities (e.g., dropping grades in school, missing work or poor job performance, trouble in relationships with friends or family)?
Substance abuse and addiction are less about how much or how often a substance is used and more about whether substance use causes problems in your life. If drinking or using drugs is causing problems for you, it is important for you to get help.
For many people struggling with substance abuse or addiction, recognizing you have a problem is the first step toward health and recovery. It is a step that can take enormous courage and strength. So can the next step: deciding to make a change. The good news is that with support and treatment, change is possible.
There are many treatment options for drug and alcohol addiction, and no one option is best for all people. For some, self-directed treatment and self-help groups are best. For others, therapy or rehab may be necessary. Medications such as bupenorphine (Suboxone, Subutex) and methadone, which can help ease withdrawal symptoms and block cravings, are an important part of treatment for many people as well.
Which treatment is right for you depends on several factors and needs to match your special needs and circumstances. It is also important to seek help for any other emotional or physical issues when you get treatment for your addiction.
Regardless of the treatment option you choose, it is very important that you get support. Recovery can be a long and difficult road with many setbacks and challenges. You will be more likely to succeed if you have others to lean on, encourage you, guide you, and remind you of the commitment you are making to change your life for the better. Support can come from friends and family, people in your spiritual community, health care providers, other recovering substance abusers/addicts, and therapists or counselors.
For help finding support and treatment in the US you can contact:
- SAMSHA (Substance Abuse and Mental Health Services Administration): 1-800-662-HELP [1-800-662-9832 (Español)] to reach a free hotline or go to their facility locator website
- Narcotics Anonymous website for those who use drugs
- Alcoholics Anonymous website for those who abuse alcohol