When a Substance Stops Being a Choice

Understanding the Basics

Understanding Substance Use Disorder

What it is — and how it develops

A substance use disorder is diagnosed when a person's pattern of using alcohol or drugs causes significant impairment or distress — affecting health, relationships, work, and daily functioning — and the pattern continues despite those consequences. The DSM-5 replaced the older terms "abuse" and "dependence" with a single spectrum diagnosis ranging from mild to severe.

Addiction — the severe end of the spectrum — involves changes in brain circuitry that affect reward, memory, and impulse control. The brain of someone with a severe substance use disorder responds to drugs or alcohol differently, and the pull toward the substance is neurological as well as psychological. Effective support addresses both dimensions.

Substance use disorders develop through a combination of genetic vulnerability, early exposure, trauma, mental health, and environment. They frequently co-occur with other mental health conditions — anxiety, depression, PTSD — in ways that can make both harder to treat. Effective treatment addresses the whole person, not just the substance.

Substance Use Disorders

Alcohol Use Disorder

The most prevalent substance use disorder

Alcohol use disorder is the most common substance use disorder in the United States — and one of the most normalized, which makes it one of the hardest to recognize and address. Because alcohol is legal, widely available, and socially encouraged in many settings, the line between heavy social drinking and a diagnosable disorder can be genuinely difficult to see from the inside.

People with alcohol use disorder often describe a relationship with alcohol that feels different from other people's — drinking more than planned, thinking about alcohol when not drinking, feeling anxious or irritable without it. Many function at a high level for years before the consequences become impossible to ignore. This "high-functioning" pattern can delay recognition and treatment significantly.

Alcohol withdrawal can be medically dangerous — even life-threatening in severe cases — and should always be managed with medical supervision. This is one of the few substances where attempting to stop abruptly without medical support can carry serious risk. Effective treatments include medication, therapy, and peer support programs.

Substance Use Disorders

Opioid Use Disorder

Includes: prescription painkillers, heroin, fentanyl

Opioid use disorder has become one of the most significant public health challenges of our time. What makes opioids particularly difficult to stop is how rapidly and powerfully they can rewire the brain's reward system — and how intensely uncomfortable withdrawal can be, making it extraordinarily difficult to stop without medical support.

Many people with opioid use disorder began with a legitimate prescription for pain. The transition from therapeutic use to dependence can happen gradually and without the person fully realizing it. Others began using recreationally and found themselves unable to stop. Opioid use disorder is a medical condition that responds to medical treatment — compassionate, evidence-based care produces real results.

Evidence-based medication treatment is the gold standard for opioid use disorder and dramatically reduces overdose risk and improves outcomes. Therapy and peer support are important complements. Overdose reversal medication saves lives and should be accessible to anyone at risk.

Substance Use Disorders

Stimulant Use Disorder

Includes: cocaine, methamphetamine, prescription stimulants

Stimulant use disorder involves a problematic pattern of use of cocaine, methamphetamine, or prescription stimulants — such as those prescribed for ADHD — that causes significant impairment or distress. Stimulants produce intense euphoria and energy by flooding the brain with dopamine, and the crash that follows can be severe enough to drive continued use just to feel normal.

Methamphetamine in particular has a significant neurological profile — long-term use can affect dopamine-producing neurons, leaving people with diminished capacity to experience pleasure from ordinary activities. The psychological pull of stimulants can be as powerful as the physical pull of opioids, and evidence-based treatment produces meaningful recovery.

Substance Use Disorders

Cannabis Use Disorder

More common than many realize

Cannabis use disorder is the most frequently diagnosed illicit substance use disorder, and one of the most contested — partly because cannabis is increasingly legal and normalized, and partly because its harms are often minimized compared to other substances. For a significant minority of people who use cannabis regularly, dependence develops — and stopping becomes genuinely difficult.

Cannabis use disorder is characterized by continued use despite negative consequences, unsuccessful attempts to cut back, and in heavy users, withdrawal symptoms when stopping — including irritability, sleep disturbance, appetite changes, and anxiety. Research shows that approximately 9% of people who use cannabis develop a use disorder, and that number rises significantly with daily use or early onset use.

Substance Use Disorders

Other Substance Use Disorders

Sedatives, hallucinogens, inhalants, and more

The DSM-5 recognizes substance use disorders across a wide range of substances beyond those covered above. Sedative, hypnotic, and anxiolytic use disorder — involving benzodiazepines, sleep medications, and similar drugs — is increasingly common, particularly given how frequently these medications are prescribed. Like alcohol, benzodiazepine withdrawal can be medically dangerous and requires supervised tapering.

Hallucinogen use disorder, inhalant use disorder, and tobacco use disorder are also recognized categories. Tobacco use disorder is one of the most common and most treatable substance use disorders — effective interventions including medication and behavioral support produce strong outcomes. Treatment is available and recovery is possible across all of these conditions.

Clinical Expertise

Why Dr. Fitzgerald González's expertise matters

51,000 hours of clinical and research experience including substance use across complex populations

Dr. Fitzgerald González has assessed and treated substance use disorders across clinical settings where co-occurring presentations are the rule rather than the exception — correctional and forensic environments where substance use disorders co-occur with serious mental illness, personality pathology, trauma, and neurodevelopmental conditions simultaneously. Substance use disorders in isolation are rare. The clinical skill required is the ability to hold the full picture — to understand how the substance use interacts with everything else, and to build treatment accordingly.

Substance use disorders are also among the most diagnostically significant findings in mental health — because they can both produce and mask virtually every other psychiatric condition on the diagnostic spectrum. Stimulant use can look like mania. Cannabis use can precipitate psychosis. Alcohol dependence can be indistinguishable from depression. Getting the diagnosis right requires a clinical psychologist who understands both substance use and the full range of psychiatric conditions it intersects with.

Integrated treatment — addressing substance use and co-occurring mental health conditions together — consistently produces better outcomes than treating either in isolation. That integration is the foundation of every substance-related evaluation at Saludos.

Clinical Relevance

Why it matters for you

The right diagnosis changes everything that follows

If you or someone you love has been finding it difficult to stop using a substance — or if treatment has been tried before without lasting results — accurate assessment of the full clinical picture is the foundation of treatment that actually works. Substance use disorders rarely exist in isolation. What drives the use, what the use is managing, and what other clinical conditions are present all determine what treatment needs to address.

Recovery is not a matter of willpower. It is a matter of accurate diagnosis, targeted treatment, and clinical support that meets the complexity of what is actually there.

An accurate diagnosis and evidence-based treatment changes everything.