By Angela Li

If you plan to have a margarita after a stressful day, is that substance abuse? How about four? And if every day is just as stressful, how easy will it be to stop?

Rates of substance abuse in America rose during the COVID-19 pandemic. Experts at The University of Toledo Medical Center say that increased stress from health concerns, the hazards of socialization and financial pressure from inflation and job insecurity have led to more people using drugs and alcohol than before.

As a result, it’s more important than ever to intervene in substance abuse cases before they turn into addiction.

“We are still dealing with the pandemic elevation,” says Dr. Tanvir Singh, a psychiatrist at UTMC. His focus is on addiction prevention, which is “a key part of trying to reduce substance use complications.”

Singh, who is board certified in adult psychiatry, child psychiatry and addiction medicine, said it’s important to understand the difference between substance abuse and addiction.

Substance abuse is a high-risk behavior in which individuals may use drugs, alcohol or prescription medication beyond their intended purpose or to an excessive degree. They may do so for reasons that include to experience euphoric feelings or to distract themselves from trauma, anxiety and depression. When stress is high, people are more vulnerable to participating in — and becoming reliant on — high-risk behaviors. Over time, substance abuse becomes a habit, altering the brain’s chemistry and leading to a loss of control.

“Addiction happens much later,” Singh says. “And once you are in addiction, the structures change in the brain. The intent [to use] is not the issue anymore. The behavior has gained so much strength that it assumes a compulsive and impulsive pattern. Then you’re going to be using it even if you do not want to use it.”

Approximately 85% of substance users have not yet reached the point of addiction. This means there is a window in which medical interventions can start before addiction sets in, leading to better outcomes and a shorter recovery.

Signs that substance abuse is progressing to addiction include increased preoccupation with the drug and distraction from other activities — even important ones. Individuals begin to make compromises in other areas of their lives such as failing to show up for work or pulling away from family and friends. They may develop a pattern of such behavior and create excuses for it to deny or justify a growing dependence on the drug.

Eventually, persistent use leads to a “free fall” after which the behaviors around substance abuse are no longer about an individual’s intended behavior. Rather, behaviors are controlled by drug-seeking compulsions regardless of a person’s intent — and can be difficult to stop even if the person intends to quit.

“That’s where prevention in substance use disorder is key,” Singh says, “because once you reach a point of addiction, then it’s a very long, long road to recovery.”

UTMC operates Toledo’s only hospital-based adult inpatient medical detox program. Singh said treatment from a hospital-based program is especially beneficial because many who struggle with substance abuse and addiction also deal with other health issues arising from complications of the substance abuse, such as from contracting hepatitis, HIV, and even heart conditions like endocarditis from needles.

Care in a hospital setting ensures patients get the medical attention they need for health issues in addition to treatment for addiction. UTMC performs medication-assisted treatment in conjunction with counseling to provide substance abuse and addiction patients with a comprehensive recovery plan.

Whether one seeks treatment for substance abuse or addiction, Singh says he understands self-doubt can arise. The most common question he hears from patients in treatment: Can I pull this off?

“The answer is always ‘yes,’” he says. “We tell [our patients] that, ‘OK, so you’re trying to do something difficult.’ The word ‘difficult’ means there is always the chance there will be setbacks and persistence is the key. It’s like if you’re trying to solve a very difficult puzzle. It’s likely going to take you a bit longer, and sometimes it will feel that you can never figure this puzzle out. With anything that is difficult, persistence is the key.”

Individuals struggling with substance abuse or addiction who are interested in treatment and recovery services can reach out to the recovery services team at the UTMC Department of Psychiatry at 419-383-3441. 

First Published May 12, 2023, 4:00 a.m.