Substance Abuse and Addiction

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Substance abuse and addiction cause serious health-related problems for many people, including those living with HIV. The World Health Organization (WHO) reports that the harmful use of alcohol resulted in three million deaths around the world in 2016. The United Nations Office on Drugs and Crime estimates that, of the 275 million users of street drugs worldwide, some 31 million had problems with drug use in 2016. In the past decade, the negative health impact of street drug use has increased more rapidly among women than men across the globe. According to WHO, about 13 million people worldwide inject drugs. About two thirds of them are living with hepatitis C and about 10% of HIV transmissions globally are due to injection drug use.

The US National Institute on Drug Abuse reported that in 2017, around six percent of people over the age of 18 – about 14 million people – were abusing or addicted to alcohol in the US. It estimates that in 2015-2016, 15 percent of women over age 18 used drugs prohibited by US federal law or misused prescription drugs.

Unfortunately, use of opioids (a highly addictive class of drugs that includes the illegal drug heroin, as well as legal prescription drugs such as morphine) among pregnant women has increased substantially over the past several years. Babies born to women who use opioids can experience a drug withdrawal syndrome called neonatal abstinence syndrome (NAS). Babies with NAS often have digestive problems, tremors, seizures, trouble sleeping, and difficulty with temperature control. According to the US Centers for Disease Control and Prevention (CDC), in 2014, almost 100 babies a day were born with NAS.

It is important to understand what substance abuse and addiction are, whether they affect you, and what you can do to get help if you need it.

What Do These Terms Mean?

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 (not including those that are treatments for chronic illnesses such as diabetes or high blood pressure, which do not have the potential for abuse), over-the-counter drugs, street drugs, alcohol, and tobacco. All these substances change how people feel – physically and/or emotionally – when they 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 alcohol, 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/or street drugs:

  • Substance abuse or addiction in the family
  • First use of drugs or alcohol when young
  • Trauma, abuse, violence, or neglect in childhood
  • Emotional problems, such as anxiety and depression

Substance Use and HIV

So how is the use of things like alcohol, street drugs, and mind-altering prescription medications related to HIV? First, substance use can increase the likelihood of HIV transmission 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 potentially harmful decisions, including having unsafe sex. People who use drugs are also more likely to exchange sex, including sex without condoms or other barriers, for drugs or money to buy drugs.

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 and less likely to take your HIV drugs as they are prescribed (this is called adherence). As a result, your body may not receive the medications it needs to keep your immune system healthy and to prevent drug resistance.

Your liver's job is to break down 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" with other substance for your liver's attention. As a result, both your HIV drugs and whatever substance you have taken may take longer to break down. This means you may have higher than expected levels of either or both of them in your bloodstream. In the same way, an overdose of recreational drugs, prescription drugs, or alcohol can be fatal. That said, it is not recommended that you stop or skip your HIV medicine if you drink or use drugs.

Lastly, substance abuse plays a major role in intimate partner violence. Because experiencing violence is linked to poor decision-making and more risk taking, women who experience violence are more likely to suffer negative health effects. These effects include a higher risk for getting HIV as well as poor adherence to HIV drugs.

How to Know if You Have a Problem with Substance Use

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 alcohol, street drugs, or prescription drugs:

  • 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)?
  • Do you have medical problems related to your alcohol or drug use, such as liver fibrosis, cirrhosis or endocarditis?

Answering yes to just one of these questions could mean that you have a substance use problem. 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.

What You Can Do

For many people struggling with substance abuse or addiction, recognizing you have a problem is the first step toward health and recovery. This step 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. For many people, medications such as buprenorphine (Suboxone, Subutex) and methadone, which can help ease withdrawal symptoms and block cravings, are an important part of treatment.

Which treatment is right for you depends on several factors and needs to match your particular needs and situation. 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 you can contact:

  • Narcotics Anonymous website for those who use drugs; they provide services worldwide, including websites, helplines, and in-person meeting locations
  • Alcoholics Anonymous (A.A.) website for those who struggle with alcohol; click here to find A.A. resources near you worldwide
  • 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 for help in the US

The Well Project is a non-profit organization whose mission is to change the course of the HIV/AIDS pandemic through a unique and comprehensive focus on women and girls. We are a recognized leader in the fight against HIV, revolutionizing the availability and accessibility of meaningful and relevant information designed specifically for women and girls living with HIV. The Well Project does not control, promote, distribute, endorse or market prescribed substances associated with the treatment of HIV/AIDS or related diseases and should in no way take precedence over the qualified assessment and diagnosis of a medical professional or certified physician/doctor. The information contained on this website is for educational purposes only.

Additional Resources

Select the links below for additional materials related to substance abuse and addiction.
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