An Introduction to Substance Use Disorders for Dental Professionals
Stages of Substance Abuse

• Experimentation
• Regular to Risky Use
• Dependence
• Addiction

Experimentation, regular to risky use, dependence and addiction are the stages of substance abuse. These behaviors can be addressed and treated at any stage, despite popular myths that people must hit bottom before they can benefit from help. One role of a dental professional is to recognize symptoms and behaviors that could indicate a substance abuse pattern.

Experimentation

Substance use starts with a voluntary use of alcohol or other drugs. The user may be trying to erase an emotional problem but often there are other causes. An older person may self-medicate through alcohol consumption to cope with depression after losing a spouse. A teenager, angry about a parental divorce, may start smoking marijuana or huffing inhalants. Experimentation may also include a husband taking his wife’s prescription painkiller to cope with recurring back pain.

Regular to Risky Use

The transition from regular to risky use and why it happens differs for every individual. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates nearly one-third of Americans engage in risky drinking patterns. As a result, what constitutes “risky behavior” can be difficult to define. If a person’s behavior worries those close to them, the behavior and suspicions should be addressed. There are groups and interventions that may reduce, stop or derail the progression to dependence. Partnership to End Addiction and Family Intervention Now provide information for interventions.

Dependence

Medical dictionaries define chemical dependence as a syndrome featuring persistent usage of a drug, difficulty in stopping and withdrawal symptoms. Chemically dependent people will go to great lengths to maintain access to the drug, often resorting to crime. Drug dependence is not limited to dependence on illegal drugs.^1,20 Alcohol or drug dependence follows risky behavior. At this stage, alcohol or other drug use may not be compulsive or out of control. Many dependent people are able to work, maintain family relationships and friendships, and limit the use of alcohol or other drugs to certain time periods, such as weekends or evenings. However, it is also difficult for the impaired individual (and for others) to recognize the affects their substance use may be having on themselves, friends, coworkers and family members. Characteristics of dependence include:

• Repeated use of alcohol or other drugs leading to failure to fulfill major responsibilities related to work, family, school or other roles.
• Repeatedly drinking or using drugs in situations that are physically hazardous, such as driving or operating heavy machinery when intoxicated.
• Repeated legal, familial and relationship problems surrounding the substance.

Psychological dependence is a behavioral pattern characterized by drug craving, out of control drug usage, overwhelming desire to obtain a drug supply, drug use causing personal and legal problems, denial about the personal drug use, and continuing to use the drug despite personal and legal difficulties.

Physical dependence is an adaptive state, occurring after prolonged use of a drug, in which discontinuation of the drug causes physical symptoms that are relieved by re-administering the same drug or a pharmacologically related drug.

Both types of dependence can lead to compulsive patterns of drug use where the user’s lifestyle is focused on taking the drug.¹⁹

Addiction

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.¹

Addiction is a medical condition involving serious psychological and physical changes from repeated heavy use of a substance. The symptoms of addiction are uncontrollable drug cravings, drug seeking, and drug use that persists even in the face of negative consequences. Addiction is a progressive illness that worsens over time if left untreated. Using drugs repeatedly over time changes brain structure and function in long lasting ways that can persist after drug use is stopped. The amount of a drug necessary to cause this change is different for everyone. It is postulated, however, that after a certain amount of the drug is consumed, the brain essentially switches from a normal state to an addicted state as if a switch in the brain was flipped.³⁸

The American Society of Addiction Medicine (ASAM) defines the ABCDE of addiction.¹

1. Inability to consistently Abstain
2. Impairment in Behavioral control
3. Craving or increased ‘hunger’ for drugs or rewarding experiences
4. Diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and
5. A dysfunctional Emotional response