A Clinical Approach Overview for Patients with Substance Use Disorder

Discover the key elements of substance use disorder in a clinical approach to better support those in need of treatment.

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

Imagine waking up every day with a craving that won’t go away, making even simple decisions like going to work or spending time with family feel like impossible battles. This is the reality for almost 48.4 million Americans aged 12 and older who had substance use disorder (SUD) in 2024, which is a shocking 16.8% of the population. SUD isn’t a sign of weakness or bad decisions; it’s a complicated brain disease that changes how we think, feel, and act, making us use drugs, alcohol, or even prescription drugs without thinking about how bad they are for us.

We no longer look at SUD through a lens of judgment. Today, experts from groups like the National Institute on Drug Abuse (NIDA) stress its biological roots: using drugs or alcohol over and over again changes the brain’s reward, stress, and self-control circuits, making it seem impossible to quit without help. Alcohol use disorder affects 27.9 million people (down slightly from previous years), and drug use disorders affect 28.2 million people (on the rise). The crisis affects everyone, from teens dealing with peer pressure to adults coping with chronic pain or mental health issues. More than half of people with SUD also have mental illnesses like depression or anxiety, which makes things worse and makes it hard to break the cycle alone.

But there is hope. Simple screenings, good management plans, and new ideas like integrative chiropractic care, which uses spinal adjustments and exercises to ease pain without using opioids, can all help turn things around. Nurse practitioners are also very important because they provide full care, ergonomic advice, and help coordinate treatments for both the body and the mind. We’ll talk about what SUD really is, the different types and signs of SUD, how to spot and address it, how it affects the body (including muscles and bones), and how holistic methods can support recovery in this guide. The first step toward healing is to learn about SUD, whether it’s for yourself or someone you care about.

What Is Substance Use Disorder?

People with SUD can’t stop using drugs or alcohol, even when it hurts them. Experts say that it is a long-term illness that can be treated and affects the brain and behavior. The Centers for Disease Control and Prevention (CDC) calls it a group of diseases that happen when people keep using drugs even though they are having problems with their health, work, or relationships (Centers for Disease Control and Prevention, 2024). The brain gets rewired to want the substance, which makes it hard to quit.

The National Institute of Mental Health (NIMH) says that SUD is a mental illness that makes people lose control over drugs or alcohol, whether they are legal or illegal. It can be mild or severe, with addiction being the worst kind (National Institute of Mental Health, n.d.). Addiction is when someone keeps using something even though it hurts them, and this is because their brain changes in areas that control reward, stress, and self-control.

What causes SUD to happen? It’s a mix of biology, the environment, and personal things. Some people are more likely to get sick because of their genes, and stress, trauma, or early exposure can make things worse. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 48.7 million Americans aged 12 and older had SUD in 2022. This shows how common it is (Substance Abuse and Mental Health Services Administration, 2023).

SUD is not a choice or a sign of weakness; it is a disease, just like diabetes or heart problems. The National Institute on Drug Abuse (NIDA) says that using kind words, like “person with SUD” instead of “addict,” can help people feel less ashamed and more likely to ask for help (National Institute on Drug Abuse, 2021). This change makes it easier for people to get help without being afraid.

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 handle co-occurring issues by developing plans with 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

Substance use disorder (SUD) is still a big problem for public health, but it can be treated and doesn’t have to be a part of anyone’s life. We can help people get their lives back on track by learning about the causes of the problem, identifying early signs through regular screenings, and using effective management techniques such as medications, therapy, and support groups. SUD has a big effect on the brain and body, making muscles and bones weaker, but integrative approaches give us hope. Chiropractic care, which includes adjusting the spine and doing exercises, helps bring the body back into alignment and ease pain without using drugs, which lowers the risks of SUD. Nurse practitioners offer important advice, from ergonomic tips to putting together comprehensive care plans that address both physical and mental needs.

Recent data shows how big the problem is: About 48.5 million Americans aged 12 and older had a substance use disorder (SUD) in 2023, which is about the same as in 2022. Alcohol use disorder affected 28.6 million people, and drug use disorder affected 27.8 million people (Substance Abuse and Mental Health Services Administration, 2024). But there is some good news: 73.1% of adults who know they have a substance problem say they are in recovery, which shows that change is possible.

Important Things to Remember for Recovery:

• Use tools like AUDIT or DAST-10 at every health visit to catch problems early and save lives.
• Holistic care works: Get better results by combining medical care with chiropractic and NP care.
• You’re not the only one. Millions of people get better every year with the right help.

If you or someone you care about is having trouble with SUD, don’t wait—call a hotline like SAMHSA’s at 1-800-662-HELP or a local provider right away. We can stop this epidemic and make the future healthier by being aware, caring, and taking action.

References

• American Association of Nurse Practitioners. (2024). Nurse practitioners guide patients on the road to recovery. https://www.aanp.org/news-feed/nurse-practitioners-guiding-patients-on-the-road-to-recovery
• American Medical Association. (2021). Substance use disorder how-to guide. https://www.ama-assn.org/system/files/bhi-sud-how-to-guide.pdf
• Centers for Disease Control and Prevention. (2024). Treatment of substance use disorders. https://www.cdc.gov/overdose-prevention/treatment/index.html
• Jimenez, A. (n.d.). Dr. Alexander Jimenez’s website. https://dralexjimenez.com/
• Jimenez, A. (n.d.). LinkedIn profile. https://www.linkedin.com/in/dralexjimenez/
• National Institute on Alcohol Abuse and Alcoholism. (2023). Screen and assess: Use quick, effective methods. https://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. https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-prevention
• National Institute on Drug Abuse. (2018). Understanding drug use and addiction: drug facts. https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction
• National Institute on Drug Abuse. (2021). Words matter: Preferred language for talking about addiction. https://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. https://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. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
• Novus Health. (2024). The effects of alcohol on the musculoskeletal system. https://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 muscle. https://pubmed.ncbi.nlm.nih.gov/6128217/
• PubMed Central. (2024). Understanding the effect of recreational drug use on bone health. https://pmc.ncbi.nlm.nih.gov/articles/PMC11402883/
• PubMed Central. (2023). Identifying and addressing patient substance use: A survey of chiropractors. https://pmc.ncbi.nlm.nih.gov/articles/PMC10316550/
• Physiology. (2019). Muscle toxicity of drugs: When drugs turn physiology into pathophysiology. https://journals.physiology.org/doi/full/10.1152/physrev.00002.2019
• Substance Abuse and Mental Health Services Administration. (2023). 2022 NSDUH annual national report. https://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. https://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. https://www.jospt.org/doi/10.2519/jospt.2017.7441
• WebMD. (2024). What to know about alcoholic myopathy. https://www.webmd.com/mental-health/addiction/what-to-know-alcoholic-myopathy