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Australian Indigenous HealthBulletin
 

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What are substance use disorders?

There are two main types of ‘substance use disorders': substance misuse and substance dependence. A substance may be a legal drug, an illegal drug, a prescribed drug (medicine given out by a doctor), or a toxin (poison).

Substance misuse describes when a person experiences harmful or negative consequences when repeatedly taking a substance. These consequences can range from mild (e.g. headache) to severe (e.g. legal problems because of the substance). It is the severe consequences that can lead to someone having a substance misuse problem. It is important to note that the diagnostic guidelines use the term substance ‘abuse' when talking about people who have a substance misuse problem, but most health professionals now prefer the word ‘misuse'.

Substance dependence describes when a person continues to take a substance over a long period of time even though the behaviour is causing them serious problems. The person will experience a range of cognitive (mental processes), behavioural, and physiological (body) symptoms. They may also build up a tolerance for the substance (need to use more of the substance to get the same effects), and could also experience withdrawal symptoms when the substance is not taken regularly. Withdrawal symptoms are the unpleasant physical and mental effects that occur when the amount of substance in the body begins to drop. Most people who have a substance dependence problem also have a substance misuse problem.

There are many different substances and they can each affect the mind and body in different ways. The types of substances a person may misuse and/or become dependent on, include:

People can misuse and/or become dependent on more than one substance.

What are the signs and symptoms of substance use disorders?

Many people use substances without developing a substance use disorder, but there are a small number of people who will misuse and/or become dependent on a substance or substances. Some signs that a person may have a substance use disorder include:

A diagnosis of substance use disorder can only be made by a qualified and trained health professional, such as a psychiatrist. The diagnosis is based on the person meeting a strict set of criteria (meaning that the person using the substance(s) must experience a certain number of signs/symptoms for a certain length of time). It's important to remember that there will always be people who show some signs of a substance use disorder, but do not meet the diagnostic criteria; they should also be offered help and support.

What are the risk factors for substance use disorders?

There is no single reason why people misuse and/or become dependent on substances, but there are factors that can increase the likelihood of a person developing a substance misuse or dependence problem. These factors include:

What other conditions are associated with substance use disorders?

Substance use disorders can often occur with other mental illnesses, such as depression. The occurrence of two mental illnesses at the same time is called comorbidity. There are a number of reasons why comorbidity may occur:

Sometimes the effects a substance has on the mind and body are similar to the signs of mental illness. This can make it hard to recognise other mental illnesses in people with substance use disorders. Many types of substances have been linked with mental illnesses, such as:

How common are substance use disorders among Aboriginal and Torres Strait Islander people?

It is helpful to look at how common substance use is among Aboriginal and Torres Strait Islander people and non-Indigenous people before looking at how many people experience substance use disorders. Information from the 2008 National Aboriginal and Torres Strait Islander Social Survey showed that Aboriginal and Torres Strait Islander people are less likely to drink alcohol than are non-Indigenous people, but those Aboriginal and Torres Strait Islander people who do drink alcohol, are more likely than non-Indigenous people to do so at harmful levels.

The survey also reported that almost one-quarter of Aboriginal and Torres Strait Islander people aged 15 years or over had used an illicit substance in the previous 12 months. This was more than one-and-a-half times the amount reported by non-Indigenous people in a similar survey.

Alcohol and tobacco are the most commonly used substances among Aboriginal and Torres Strait Islander people followed by:

Information on how many Aboriginal and Torres Strait Islander people have been diagnosed with a substance use disorder is not available, but information from 2008-09 shows more Aboriginal and Torres Strait Islanders were hospitalised for substance use disorders than any other type of mental and behavioural disorder. Aboriginal and Torres Strait Islander people were nearly four times more likely to be hospitalised for substance use disorders than non-Indigenous people.

How do you treat substance use disorders?

Substance use disorders must be taken seriously and it is important that health workers don't react in a negative way to someone they think has a substance misuse and/or dependence problem. It is common for people with substance use disorders or other types of mental illness to not want to talk about the problem. To encourage people to get help, it is important to remind them that substance use disorders and other mental illnesses are health problems just like any other illness and that they have the right to seek treatment without blame.

Examples of how you can help someone with a substance misuse and/or dependence problem includes encouraging them to:

Dealing with substance use disorders requires a long-term approach. It begins with a solid practitioner-client relationship that is based on honesty, trust, and respect. It is important that the client's treatment preferences and readiness to change are taken into account when developing a treatment plan. For clients with substance use disorders and other mental illnesses, the treatment may focus on one or both of the illnesses and may include psychosocial interventions, medication, or a combination of both.

Please note the term ‘mental illness’ has been used in place of ‘mental disorder’ and ‘psychological disorder’ because it is a more common term.

References and further reading

American Psychiatric Association Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: text revision: DSM-IV (4 ed.). Washington, DC: American Psychiatric Association

Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. (ABS Catalogue no. 4715.0) Canberra: Australian Bureau of Statistics

Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. (AIHW Catalogue no IHW 53) Canberra: Australian Institute of Health and Welfare

Australian Institute of Health and Welfare (2011) 2010 National Drug Strategy Household Survey report. (Drug statistics series no. 25. Cat. no. PHE 145) Canberra: Australian Institute of Health and Welfare

Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. (AIHW Catalogue no AUS 122, Australia's health no. 12) Canberra: Australian Institute of Health and Welfare

Australian Institute of Health and Welfare (2009) Measuring the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples. (AIHW Catalogue no. IHW 24) Canberra: Australian Institute of Health and Welfare

Dingwall KM, Cairney S (2010) Detecting psychological symptoms related to substance use among Indigenous Australians. Drug and Alcohol Review; Early View (10.1111/j.1465-3362.2010.00194.x):1-7

Freeman D, Freeman B (2009) Aboriginal social and emotional wellbeing fact sheet series. Campbelltown, NSW: Campbelltown Community Mental Health Service (SSWAHS)

Gordon A (2009) Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician. (Monograph series no. 71) Canberra: National Drug Strategy

Hart LM, Bourchier SJ, Jorm AF, Kanowski LG, Kingston AH, Stanley D, Lubman DI (2010) Development of mental health first aid guidelines for Aboriginal and Torres Strait Islander people experiencing problems with substance use: a Delphi study. BMC Psychiatry;10. Retrieved 11 October 2010 from http://www.biomedcentral.com/1471-244X/9/47

Mills KL, Deady M, Proudfoot H, Sannibale C, Teesson M, Mattick R, Burns L (2009) Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: National Drug & Alcohol Research Centre

National Institute on Drug Abuse (2005) Research report series - inhalant abuse. Maryland: National Institute on Drug Abuse

Steering Committee for the Review of Government Service Provision (2011) Overcoming Indigenous disadvantage: key indicators 2011. Canberra: Productivity Commission, Australia

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