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Table of Contents
- What Do These Terms Mean?
- Substance Use and HIV
- How to Know if You Have a Problem with Substance Use
- What You Can Do
There are many reasons why people may use substances, including alcohol and drugs. People may use substances to feel better, self-medicate for mental health challenges, meet social expectations, and more. Individuals' approaches to using substances can range from occasional social or recreational use to ongoing problematic use or dependency (substance abuse, addiction).
Substance abuse and addiction cause serious health problems for many people, including those living with HIV. The World Health Organization (WHO) reports that the harmful use of alcohol results in three million deaths per year around the world. According to the US Centers for Disease Control and Prevention (CDC), one in six adults binge drinks in the US.
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.
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 11 million people worldwide inject drugs. About 40 percent of them are living with hepatitis C and about 1.4 million of them are living with HIV
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.
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.
Sometimes the body "learns" to tolerate a substance, so that more of the substance is needed to get the same effect.
Substance: When used with the words use or abuse, "substance" generally refers to things like prescription drugs (not including those that are treatments for illnesses such as diabetes or high blood pressure, which do not have the potential for abuse) that were not prescribed for you; 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, but are not limited to:
- drinking alcohol
- snorting a line of cocaine
- ingesting a hallucinogenic substance ("magic" mushrooms, LSD)
- taking an anti-anxiety pill
- smoking a tobacco or marijuana cigarette
- injecting (shooting) some heroin or methamphetamine (meth, crystal)
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
- 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 is a physical health condition and does NOT occur only because someone does not have enough willpower.
Recovery: This term refers to a process through which people who are dealing with problematic substance use or other behavioral health challenges make a range of positive changes in their lives, including improving wellness and living in a self-directed way. Recovery is deeply personal, can happen through a variety of pathways, and involves support from other individuals and communities.
Harm reduction: This term describes various strategies intended to reduce negative consequences associated with drug use. It is also an approach rooted in believing in and respecting the rights of people who use drugs.
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? The ways substance use intersects with HIV are not the same in every case – or with every drug.
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
- Sharing needles and other equipment to inject drugs can also transmit HIV, as well as hepatitis C. Injection drug use was responsible for 16 percent of new HIV cases among women in 2019.
- Factors having to do with environment, such as living in an area where it is difficult or impossible to access healthcare or harm reduction services such as needle exchanges or safe injection sites, increase vulnerability to HIV
Substance use can also cause 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 (adherence).As a result, your body may not get 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 substances 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 the substances in your bloodstream. In the same way, an overdose of recreational drugs, prescription drugs, or alcohol can be fatal (cause death). That said, it is not recommended that you stop or skip your HIV medicine if you drink or use drugs.
As with HIV, intersecting conditions of oppression (racism, gender bias and transphobia, poverty, etc.) create environments that heighten negative effects of substance use in different ways. HIV and substance use are syndemic, meaning they are overlapping health conditions occurring at the same time, at higher rates in the same communities – and interacting with each other, resulting in worse health outcomes than either epidemic by itself.
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 acquiring HIV as well as poor adherence to HIV drugs.
Important: if you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the US at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)]. You can also search for a safe space online at Domestic Shelters. If you live outside the US, go to the Hot Peach Pages to find help near you.
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
There are many treatment options for drug and alcohol addiction, and no one approach is best for all people.
For many people struggling with problematic substance use, 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.
Responses to substance use cover a wide range. Each has value, from stopping using substances completely (cessation, abstinence) to harm reduction (reducing negative impact of substance use) and safer use. Responses can include different methods of treatment or recovery and different forms of support from professionals.
There are many treatment options for drug and alcohol addiction, and no one approach 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), naltrexone (Vivitrol, Revla), or others are an important part of treatment. Substance dependency is considered a physical health condition as well as a behavioral health matter, and is difficult to treat without addressing other aspects of health.
Which treatment is right for you depends on several factors and should 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, healthcare 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. Find A.A. resources near you worldwide
- SAMSHA (Substance Abuse and Mental Health Services Administration): 1-800-662-HELP (1-800-662-4357) in English and Español to reach a free hotline or go to their facility locator website for help in the US
- Al-Anon for family members or close friends of people who struggle with substance abuse
Special thanks to The Well Project community advisory board emerita member, Vickie Lynn, PhD, MPH, MSW (University of South Florida), for crucial additions to the 2024 update of this fact sheet.