SUD can range in severity from mild to severe, which is frequently called addiction. The symptoms can differ across people, even when they are using the same substance, like alcohol. The symptoms that clinicians pay attention to are:

• Taking the substance in larger amounts or for longer time period than intended
• Wanting to cut down or stop using but not able to do so
• Spending a lot of time getting, using or recovering from the use of the substance
• Having cravings and urges to use
• Not being able to perform major roles at work, home or school due to substance use
• Continuing to use even when it causes problems in social relations
• Giving up important social, occupational or recreational activities due to substance use
• Using substances even when it is dangerous to do so
• Continuing to use even when it causes or worsens a physical or psychological problem
• Needing more of the substance to get the desired effect
• Development of withdrawal symptoms

People with mild SUD have two or three of these symptoms. People with moderate SUD have four or five symptoms and people with six or more symptoms have severe SUD. Someone who takes pain relievers and has withdrawal symptoms or just one symptom, does not have SUD.

According to the federal government, first responders are at a higher risk of SUD. From this report, firefighters drink and binge drink twice as much as the general population, and police officers are twice as likely to abuse drugs or alcohol as the general population. This higher risk is most likely due to the high pressure and stress of the job without adequate attention to healthy coping. Too often first responders may cope with alcohol and/or drugs, especially if heavy drinking is part of the work culture (“Work hard, play hard”) and over-use of pain relievers following on-the-job injury (blog by Silverman).

There are many effective treatment options for SUD with options dependent on the severity of SUD and the substance(s) used. For people with opioid use disorder, there are three very effective medications (i.e., methadone, buprenorphine from doctor’s offices or clinics, and naltrexone). There are also medications for alcohol use disorder but they are not as effective as those for opioid use disorder. Scientists are researching medications to treat other SUDS but we don’t have them yet.

The most effective strategy is a stepped down approach if severity of SUD requires intensive interventions as one intervention will not solve the problem. Like other psychological problems, family support and learning to cope with stresses are needed. Some common non-medication forms of treatment from least to most intensive are listed below:

• Brief intervention with education
• Self-help groups for the individual and for the family
• Outpatient psychotherapy
• Intensive outpatient treatment
• Residential
• Medical withdrawal management, especially for alcohol and benzodiazepine as withdrawal can be deadly for these substances

• Attempt to learn as much as you can about alcohol and drug misuse and addiction.
• Speak up when you see changes or have concerns: talk to your loved one about your concerns and help in finding help and support.
• Don’t wait until your loved one “bottoms out”. Communicate your worry and concerns as soon as you see it.
• Understand it will be hard to stop use of any kind without help. Treatment, support, and new coping skills are needed to overcome addiction to alcohol and drugs.
• As it is with all chronic diseases like diabetes and hypertension, treatment and recovery is a continuing process.

Alcohol

The 2019 National Survey on Drug Use and Health reports that 139.7 million Americans age 12 or older were alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month.

Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions

Tobacco

In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH).
Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States.

Opioids

Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH).
In 2019, there were 10.1 million people age 12 or older who misused opioids in the past year. The vast majority of people misused prescription pain relievers (2019 NSDUH).

Marijuana

The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH).
Approximately 4.8 million people aged 12 or older in 2019 had a marijuana use disorder in the past year (2019 NSDUH).

For more information on how to access a provider for assessment and treatment of possible substance use disorder: https://fst5.org/treatment/

https://www.samhsa.gov/find-help/atod

https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder

https://nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders

https://www.firerescue1.com/fire-chief/articles/firefighters-and-alcohol-what-the-data-says-EEmQCV9ztxdv60BH/

https://www.psychologytoday.com/us/blog/sure-recovery/201803/police-and-addiction

https://www.yourcrisiscoach.com/blog/why-first-responders-are-at-a-higher-risk-for-suds/

https://www.samhsa.gov/dtac/disaster-responders