SUBSTANCE USE, ADDICTION AND PREVENTION

 

Psychoactive substances are substances that affect the functioning of the central nervous system and may alter an individual’s perception, mood, thoughts, behaviour or level of consciousness. Alcohol, nicotine, cannabis products, stimulants, opioids, sedative and sleep medications, and hallucinogenic substances may be included in this category.

The fact that a substance is legal, available by prescription or widely used in society does not mean that it is risk-free. Alcohol, tobacco products and certain prescription medications may also cause physical, psychological and social harm when used inappropriately.

The risks associated with substance use vary according to the type and amount of the substance, frequency and method of use, whether different substances are used together, the individual’s age and physical and mental health, and the circumstances in which use occurs.

 

Are Substance Use and Addiction the Same?

Not every instance of substance use indicates addiction. Nevertheless, no substance use should be considered entirely without risk. Patterns of use may develop differently from one person to another, and some individuals may gradually begin to use a substance more frequently, in larger quantities or in ways that are increasingly difficult to control.

Substance use may generally be considered under the following categories.

Experimental Use

Experimental use refers to using a substance once or several times because of curiosity, peer influence, the desire for a new experience or an attempt to fit into a particular social environment.

Experimental use does not necessarily mean that addiction has developed. However, it should not be considered safe because of risks such as unknown substance content, unexpected dosage, poisoning, accidents, loss of consciousness or repeated use.

Social or Occasional Use

This refers to using a substance in particular social environments or at certain intervals.

The fact that use occurs only occasionally or in certain settings does not mean that it is harmless. Occasional use may still result in accidents, poisoning, impulsive behaviour, academic difficulties or unsafe sexual behaviour.

Risky or Harmful Use

Risky or harmful use refers to substance use that damages an individual’s physical or mental health, threatens their safety or causes difficulties in their academic, social or professional life.

Examples may include:

•    Driving while under the influence of a substance;

•    Combining different substances;

•    Taking prescription medication without medical advice;

•    Attending a class or examination while under the influence;

•    Neglecting responsibilities because of substance use; and

•    Continuing to use a substance despite emerging health problems.

Substance Use Disorder

Substance use disorder is a condition in which an individual experiences difficulty controlling substance use and the use causes significant problems affecting health, relationships, education, employment or daily life.

Substance use disorder may be mild, moderate or severe. In everyday and clinical language, the term “addiction” is often used to refer to its more severe and persistent forms.

A diagnosis is not made solely on the basis of the amount of substance used. Loss of control, continued use despite harmful consequences, organising life around substance use and impaired functioning must also be considered.

 

What Is Addiction?

Addiction is a treatable health condition in which an individual experiences difficulty reducing or discontinuing substance use, loses control over their use and continues despite harmful consequences.

Addiction cannot be explained simply as a lack of willpower, weak character or a poor personal choice.

Biological vulnerability, the brain’s reward and learning systems, developmental characteristics, mental health, family and peer relationships, life experiences and the properties of the substance may interact to influence the risk of addiction.

People experiencing addiction should not be blamed, humiliated or labelled. Stigmatising language may cause individuals to conceal their difficulties and delay seeking help.

Person-first expressions such as “a person experiencing a substance use disorder” or “a person who needs support concerning substance use” should be preferred to expressions that define the individual entirely through the problem.

 

Why Might Substance Use Begin?

There is no single reason why substance use begins or continues. Every person’s circumstances and life history are different.

Factors that may contribute to substance use include:

•    Curiosity and the desire to have a new experience;

•    Attempting to fit into a peer group;

•    Peer pressure;

•    The need for acceptance and belonging;

•    Attempting to cope with intense stress;

•    Attempting to reduce anxiety, low mood, loneliness or anger;

•    Traumatic experiences;

•    Sleep problems;

•    Misconceptions that substances will improve academic performance;

•    The desire to feel more energetic or sociable;

•    Substance use among family members or close contacts;

•    Easy access to substances;

•    Underestimating potential harm;

•    A tendency to engage in risky behaviour;

•    Difficulties with impulse control; and

•    Attempting to manage a physical or mental health condition without professional support.

The presence of one of these factors does not mean that an individual will necessarily use substances or develop an addiction. Similarly, it should not be assumed that everyone who uses substances has the same background or risk factors.

 

Factors Affecting the Risk of Addiction

The development of addiction is associated with the interaction of biological, psychological and environmental factors.

Individual Factors

•    Beginning substance use at an early age;

•    Impulsivity and frequent risk-taking behaviour;

•    Limited stress-management skills;

•    Symptoms of anxiety, depression or trauma;

•    Difficulties with attention and behavioural regulation;

•    Feelings of loneliness or social exclusion; and

•    Underestimating the potential harm of substances.

Family and Social Factors

•    Intense conflict within the family;

•    Experiences of neglect or violence;

•    Substance use being common within the immediate social environment;

•    Peer pressure;

•    Limited supportive relationships;

•    Social environments that normalise substance use; and

•    Easy access to substances.

Environmental and Social Factors

•    Economic and social difficulties;

•    Exposure to violence or trauma;

•    Limited educational or social-support opportunities;

•    Messages that encourage substance use or minimise its risks; and

•    Difficulty accessing healthcare and counselling services.

Risk factors are not destiny. Supportive family and peer relationships, effective problem-solving skills, safe educational environments, a sense of belonging, healthy lifestyle habits and early access to support can reduce risk.

 

Possible Signs of Substance Use Disorder

Substance-related difficulties may appear differently from one person to another. The presence of a single sign is not sufficient to diagnose addiction.

The duration, severity and effect of the symptoms on daily functioning should be assessed by a qualified professional.

Reduced Control Over Use

•    Using a substance in larger amounts or for longer than intended;

•    Being unable to reduce or stop use despite wanting to do so;

•    Spending considerable time obtaining, using or recovering from the effects of the substance; and

•    Experiencing intense cravings.

Effects on Daily Life

•    Neglecting classes, examinations or assignments;

•    Difficulty fulfilling employment or family responsibilities;

•    Conflict in friendships or family relationships;

•    Withdrawing from previously valued activities;

•    Organising an increasing proportion of daily life around substance use; and

•    Experiencing financial problems.

Risky Use and Continued Use Despite Harm

•    Driving while under the influence;

•    Remaining in unsafe environments;

•    Continuing use despite physical or psychological problems;

•    Continuing use despite recognising its negative effects on relationships; and

•    Combining substances or medications that may be dangerous when used together.

Tolerance

Tolerance occurs when an amount that previously produced a particular effect becomes insufficient and the individual needs to use more of the substance to achieve the same effect.

Tolerance alone does not always indicate addiction. It may also develop when certain medications are used under medical supervision. It should therefore be considered within the individual’s overall pattern of use.

Withdrawal

Withdrawal refers to physical or psychological symptoms that develop after substance use is reduced or stopped. Symptoms vary depending on the substance and may include:

•    Restlessness;

•    Anxiety;

•    Sweating;

•    Trembling;

•    Sleep difficulties;

•    Nausea;

•    Pain;

•    Changes in mood; and

•    Intense cravings.

Suddenly stopping some substances—particularly after prolonged or heavy use of alcohol or certain sedative medications—may cause serious health complications. When regular or heavy use is present, discontinuation should not be attempted without medical assessment.

 

Warning Signs Among University Students

Substance-related difficulties among university students may be associated with:

•    Reduced class attendance;

•    A significant decline in academic performance;

•    Frequently failing to fulfil examination or assignment responsibilities;

•    Major changes in sleep patterns;

•    Increased need for money or unexplained expenditure;

•    Withdrawing from previous friendships;

•    Becoming involved in new and potentially risky social environments;

•    Sudden changes in mood or behaviour;

•    Increased secrecy;

•    Frequently lying or concealing the amount used;

•    Significant changes in physical appearance or self-care;

•    Attending classes or activities while under the influence;

•    Experiencing injuries, accidents or legal difficulties; and

•    Requiring extended periods to recover from the effects of substances.

These changes may also have other explanations. A calm, open and non-judgemental conversation is therefore more appropriate than immediately blaming or labelling the person.

 

Possible Consequences of Substance Use

The effects of substance use vary according to the type of substance and the pattern of use.

Physical Consequences

•    Poisoning and overdose;

•    Loss of consciousness;

•    Slowed or stopped breathing;

•    Cardiovascular problems;

•    Liver or kidney damage;

•    Disrupted sleep and eating patterns;

•    Increased risk of infection;

•    Injuries and accidents; and

•    Worsening of existing health conditions.

Psychological Consequences

•    Anxiety and panic symptoms;

•    Changes in mood;

•    Depressive symptoms;

•    Attention and memory difficulties;

•    Difficulty regulating anger and impulses;

•    Suspiciousness;

•    Impaired assessment of reality; and

•    Increasingly intense cravings.

Academic and Social Consequences

•    Reduced academic achievement;

•    Absenteeism;

•    Disengagement from education;

•    Deterioration in family and peer relationships;

•    Financial difficulties;

•    Loss of employment or internship opportunities;

•    Legal difficulties; and

•    Increased risk of violence and accidents.

Not every consequence occurs in every person who uses substances. However, more frequent use, larger quantities, combining substances and beginning use at a younger age may increase the risks.

 

Combining Different Substances

Using different substances together may produce unpredictable and more severe effects rather than simply combining their individual effects.

In particular, using alcohol together with opioids, sedative medications or sleeping medication may dangerously slow breathing and increase the risk of loss of consciousness.

Combining a stimulant with a depressant does not allow the substances to balance one another safely. An individual may feel more alert while toxic effects and the risk of overdose remain.

Prescription medications should not be combined with alcohol or other substances without consulting a physician or pharmacist.

 

Overdose and Emergency Warning Signs

The situation should be treated as a medical emergency when any of the following signs are present:

•    The person cannot be awakened;

•    The person is unconscious or severely confused;

•    Breathing is extremely slow, irregular or has stopped;

•    The lips or fingernails appear blue;

•    Severe chest pain occurs;

•    The person experiences a seizure;

•    Extreme agitation or aggression occurs;

•    The person’s connection with reality is seriously impaired;

•    High fever is accompanied by altered consciousness;

•    Repeated vomiting occurs;

•    The type or amount of substance used is unknown; or

•    There is a risk of harm to the individual or another person.

In these circumstances, call the 112 Emergency Call Centre immediately.

The individual should not be left alone, and others should not simply wait for them to “sleep it off.”

Do not attempt to make the person vomit, place them in a cold shower or give them coffee or another substance. Healthcare professionals should be informed, as accurately as possible, about which substance was used, when it was used and the approximate amount.

 

Addressing Addiction

Addressing addiction involves more than deciding to stop using a substance. The physical, psychological and social aspects of substance use should be assessed together.

Addiction is a treatable health condition. Treatment may help an individual stop or reduce substance use, improve their health and rebuild relationships and daily routines.

Recovery does not follow the same course for everyone and may require continued support over time.

Recognising the Problem

One of the first steps towards change is evaluating honestly how substance use is affecting one’s life.

An individual may ask:

•    Has my substance use increased recently?

•    Am I using more than I intended?

•    Have I tried unsuccessfully to reduce or stop?

•    Do I experience intense cravings or discomfort when I do not use?

•    Is my use affecting my education, employment or relationships?

•    Am I concealing my use from others?

•    Am I making excuses in order to use substances?

•    Do I continue despite experiencing health problems?

•    Do I engage in risky behaviour while under the influence?

•    Have I withdrawn from activities that were previously important to me?

Answering “yes” to some of these questions does not mean that an individual should diagnose themselves. It may, however, indicate that professional assessment would be beneficial.

Obtaining a Professional Assessment

The appropriate approach varies according to:

•    The substances used;

•    Frequency and amount of use;

•    The time of most recent use;

•    History of withdrawal or overdose;

•    Physical and mental health;

•    Medications currently being used;

•    Family and social support;

•    Academic or occupational functioning;

•    Risk of self-harm; and

•    Expectations concerning treatment.

Treatment plans should be tailored to the individual. No single approach is suitable for everyone.

Treatment Approaches

Treatment may include one or more of the following:

•    Medical assessment and monitoring;

•    Safe management of withdrawal symptoms;

•    Individual psychotherapy;

•    Cognitive behavioural interventions;

•    Motivational interviewing;

•    Group-based interventions;

•    Family counselling;

•    Social-work support;

•    Treatment of accompanying mental health conditions;

•    Physician-managed medication for certain substance use disorders; and

•    Relapse-prevention and long-term recovery support.

Medication may be effective for certain alcohol- and opioid-related disorders. All medication decisions must be made following a physician’s assessment.

Is It Safe to Stop Suddenly Without Medical Assistance?

Not always.

Suddenly stopping long-term or heavy use of alcohol, sedatives or sleeping medication may cause serious withdrawal symptoms, seizures or other medical complications.

When substance use is regular or heavy, a discontinuation plan should be developed with a physician. Medical assessment is particularly important when there is a previous history of severe withdrawal, seizures, unconsciousness or overdose.

 

Developing a Plan for Change

It may be helpful to develop a plan with professional support that includes:

•    A goal to reduce or stop substance use;

•    Treatment and counselling appointments;

•    Situations that trigger substance use;

•    Methods of reducing access to substances;

•    Trusted support persons;

•    People and institutions to contact during a crisis;

•    Healthy activities that can replace substance use;

•    Sleep, nutrition and daily routines; and

•    Steps to take if substance use occurs again.

Goals should be clear, realistic and appropriate to the individual’s readiness for change.

 

Recognising Triggers

A trigger is an internal or external circumstance that increases the desire to use a substance.

External Triggers

•    Environments in which substances are used;

•    People with whom substances were previously used;

•    Particular locations or music;

•    Easy access to substances;

•    Celebrations or entertainment settings; and

•    Days on which money becomes available.

Internal Triggers

•    Anxiety;

•    Anger;

•    Loneliness;

•    Boredom;

•    Shame;

•    Sleep deprivation;

•    Feelings of failure;

•    Thoughts about substance use; and

•    Physical pain.

Identifying triggers does not mean that every trigger must be avoided permanently. However, limiting exposure to high-risk settings and developing alternative coping methods may be particularly helpful during the early stages of recovery.

 

Coping with Cravings

Cravings may be intense but generally do not remain at the same level indefinitely.

When a craving occurs, an individual may:

•    Delay making a decision and wait for a defined period;

•    Leave the high-risk environment;

•    Call a trusted person;

•    Contact their treatment team;

•    Temporarily redirect attention towards another activity;

•    Recall the short- and long-term consequences of using the substance;

•    Observe the physical and mental effects of the craving without judgement; and

•    Make access to the substance more difficult.

These methods do not replace professional treatment but may be used as part of an established treatment plan.

 

Returning to Substance Use During Recovery

Some individuals may return to substance use during recovery. This does not mean that treatment has completely failed or that recovery is impossible.

However, it is an important warning sign that requires the treatment plan to be reassessed.

Following renewed use:

•    Support should be sought as early as possible rather than continuing to use;

•    The treatment team should be informed honestly;

•    The circumstances that triggered the renewed use should be reviewed;

•    The risk of overdose should be considered; and

•    The individual should not be blamed or humiliated.

Tolerance may decrease after a person has not used a substance for some time. Returning to a previously used amount may therefore increase the risk of overdose.

 

How Should Family Members and Friends Respond?

Supporting someone experiencing substance-related difficulties can be challenging. Family members and friends must balance supporting the individual with protecting their own boundaries.

Helpful Approaches

•    Choose a calm time when the individual is not under the influence;

•    Use non-accusatory language;

•    Refer to specific behaviours that have been observed;

•    Express concerns clearly;

•    Listen;

•    Research professional support options;

•    Assist with arranging appointments or reaching a treatment centre;

•    Avoid taking complete responsibility for the person’s treatment; and

•    Seek counselling as a family when necessary.

For example:

“Over the past few weeks, I have noticed that you have missed classes and, on several occasions, had difficulty speaking clearly. I am concerned about your health. I believe it is important for us to seek professional support.”

Approaches to Avoid

•    Humiliating or threatening the individual;

•    Saying, “You could stop immediately if you really wanted to”;

•    Explaining the entire problem as a lack of willpower;

•    Constantly monitoring every behaviour;

•    Concealing the consequences of substance use;

•    Repeatedly paying debts in ways that facilitate continued use;

•    Arguing while the individual is under the influence;

•    Attempting to force the individual to stop without professional support; and

•    Using violence.

Even when the individual is not yet ready to seek help, family members may obtain counselling for themselves from services specialising in addiction.

 

Preventing Substance Use

Prevention is not limited to describing the harms of substances or attempting to frighten people.

Effective prevention addresses personal skills, family relationships, educational environments and broader social conditions together.

Obtain Accurate and Reliable Information

Information obtained from social media, peers or individual user experiences may be incomplete or misleading.

Statements such as the following should not be considered reliable:

•    “It is natural, so it is harmless.”

•    “Nothing will happen if you use it once.”

•    “Everyone uses it.”

•    “I can stop whenever I want.”

•    “It is safe because it is available by prescription.”

•    “Two substances will balance each other’s effects.”

•    “It will definitely make studying easier.”

Reliable information should be obtained from healthcare institutions, university health services and evidence-based public-health resources.

Develop Refusal Skills

You are not required to provide a lengthy explanation when a substance is offered. A clear and brief response may be sufficient:

•    “No, I do not use it.”

•    “I do not want it.”

•    “That is not for me.”

•    “I am not taking any.”

•    “Do not pressure me about this.”

When pressure continues, the person may leave the setting, approach a trusted friend or make transportation arrangements in advance.

Repeated pressure, ridicule or threats of exclusion are not signs of a healthy friendship.

Recognise Peer Pressure

Peer pressure is not always expressed through direct force. It may appear through jokes, ridicule, threats of social exclusion or statements such as “everyone is doing it.”

A person should not have to engage in unwanted behaviour in order to belong to a group. Relationships that respect personal boundaries are an important protective factor.

Develop Healthy Coping Skills

Using substances to manage anxiety, loneliness, sadness or intense stress may produce temporary relief but can reduce the individual’s ability to manage emotions over time.

More constructive options include:

•    Speaking with a trusted person;

•    Participating in physical activity;

•    Dividing problems into smaller steps;

•    Supporting a regular sleep routine;

•    Using relaxation and attention-regulation techniques;

•    Applying to the University’s psychological counselling services; and

•    Obtaining psychiatric or psychotherapeutic support when necessary.

Use Prescription Medication Safely

Prescription medication is not safe under every circumstance simply because it has been prescribed.

Medication should be used:

•    Only by the person for whom it was prescribed;

•    At the recommended dose;

•    For the recommended period; and

•    In accordance with the physician’s instructions.

Medication should not be shared. Medication prescribed for another person should not be used, and the dosage should not be changed to increase its effects.

A physician or pharmacist should be consulted before combining medication with alcohol or other substances.

Review Your Social Environment

Regularly remaining in environments where substances are offered, use is normalised or abstaining is ridiculed may increase risk.

Leaving such environments does not necessarily mean abandoning all friendships or withdrawing completely from social life.

It is important to develop relationships that respect personal boundaries, support healthy activities and accept the decision not to use substances.

Establish a Structured and Meaningful Daily Life

Structured leisure time, social belonging and participation in meaningful activities may have a protective role.

Students may strengthen supportive social relationships by participating in:

•    Sports and artistic activities;

•    Student clubs;

•    Volunteering activities;

•    Academic study groups;

•    Professional-development programmes; and

•    Healthy social activities.

These activities cannot guarantee that addiction will be prevented. However, they may strengthen social connection, belonging and healthy coping resources.

Seek Early Support for Mental Health Difficulties

Some individuals experiencing anxiety, depression, trauma, intense loneliness or sleep difficulties may use substances as a form of self-medication.

Although substance use may appear to reduce symptoms temporarily, it may worsen mental health difficulties over time.

When psychological difficulties affect daily life, psychological or medical support should be obtained before turning to substance use.

Mental health conditions and substance use disorders may occur together, and both areas may require assessment.

 

When Should Professional Support Be Sought?

Professional support should be considered when:

•    Substance use has increased;

•    Attempts to reduce or stop have been unsuccessful;

•    Intense cravings are experienced;

•    Substance use affects academic performance or attendance;

•    Relationships or responsibilities are being neglected;

•    Withdrawal symptoms occur;

•    Risky behaviour takes place while under the influence;

•    The substance is used to cope with emotional difficulties;

•    Use is concealed from others;

•    Different substances or medications are combined;

•    Physical or mental health problems are worsening; or

•    There is a risk of overdose, self-harm or harm to others.

Seeking support at an early stage may prevent the problem from becoming more severe.

 

Conclusion

Substance use and addiction are complex health issues influenced by biological, psychological and social factors.

Addiction should not be understood as a character weakness or a simple failure of willpower. It is a treatable condition, and recovery is possible with appropriate medical, psychological and social support.

Accurate information, healthy coping skills, supportive relationships, respect for personal boundaries and early help-seeking are important elements of prevention.

The aim is not to blame or stigmatise individuals experiencing substance-related difficulties, but to support them in accessing appropriate care and rebuilding a safer and healthier life.