Addiction & Substance Use Disorders

A substance use disorder is present when use continues despite clear harm and control over it has gone: more is taken than intended, attempts to cut down fail, and a growing part of the day is spent obtaining, using or recovering. Over time the same amount does less, so the amount rises, and stopping brings physical withdrawal.

Repeated use changes the brain circuits that govern reward, motivation and self-control, and those changes outlast the last drink or dose by months. This is a medical condition and not a failure of character, and treating it as one is what makes recovery possible.

It covers alcohol, tobacco, cannabis, opioids including prescribed painkillers, sedative and sleeping tablets, and stimulants. Prescribed medicines are involved more often than people expect. Depression, anxiety, chronic pain and sleep problems very commonly sit underneath, and treating them is part of treating the substance use.

One fact changes how this is handled: withdrawal from alcohol and from sedative tablets can be medically dangerous and occasionally fatal. Stopping those two suddenly and alone is unsafe.

Assessment turns on an honest account, and the consultation is built to make that possible. Your doctor will ask what is used, how much, how often, when the first one of the day is taken, how long this pattern has run, what happens on a day without it, and what has been tried before.

They are looking for the features that define the disorder: rising amounts for the same effect, failed attempts to cut down, use continuing after it has cost you money, work, a licence or a relationship, and withdrawal.

They will ask specifically about withdrawal fits, blackouts, previous detox attempts and any morning shaking or sweating, because those determine whether stopping needs medical supervision and where it should happen. They will examine you, with attention to the liver, nutrition, blood pressure and injection sites where relevant, and check liver function, blood counts and blood-borne infection where indicated. They will also assess mood, since depression and anxiety frequently underlie the use. What you disclose is confidential.

Recovery runs in phases and the whole of it is longer than most people expect.

Withdrawal, where it is needed, is managed over roughly five to ten days with medicine that is tapered down. For alcohol and sedatives this is done under medical supervision, at home only with daily review or as an Inpatient where there is a history of fits or heavy dependence. Sleep and mood stay unsettled for several weeks afterwards, and that stretch is when most early relapses happen.

Structured treatment then continues for several months, usually with regular counselling, and in some cases with medicine that reduces craving or blocks the effect. Follow-up is monthly or more often through the first year.

Time off work is typically one to three weeks around the withdrawal phase. Longer residential programmes run four to twelve weeks. Relapse is common and is treated as part of the course and not as the end of it; what matters is coming back quickly. The first year asks for the most attention, and support from family, employment and a stable routine do a large part of the work.