SUD Literature Review: Signs, Symptoms, and Treatment

This report presents a comprehensive literature review on substance use disorder (SUD), focusing on its prevalence and impact among young adults, particularly college students. It delves into the signs and symptoms of SUD, including compulsive drug use and its adverse effects on physical, psychological, and social well-being. The report classifies various drugs, such as depressants, stimulants, and cannabis, and discusses the DSM-5 criteria used for diagnosis. It explores different treatment approaches, including college recovery communities and positive psychology interventions. Additionally, it examines the interplay between SUD and factors like depression, anxiety, and sociological strain. The review highlights the importance of prevention and education programs within colleges and universities to mitigate the risks associated with substance abuse. The report also touches upon the role of age and perceived risk in influencing substance use behaviors.

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CHAPTER TWO: LITERATURE REVIEW
The second chapter contains a comprehensive literature review on the topic and is
divided into several sections. Section 1 provides a comprehensive overview about substance use
disorder. The second section provides a general overview about the signs and symptoms of
substance abuse disorder amid college students who are young adults. The following sections
encompass classification of drugs, the DSM-5 criteria that are predominantly used for diagnosing
substance use disorder, the different types of treatment, college recovery community, positive
psychology, and comparative mythology, in relation to substance use disorder.
Overview of Substance Use Disorder
Substance use disorder (SUD) at the time of young adulthood has been identified as a
matter of major concern in the United States (Lee et al., 2018). The condition generally refers to
the uses of a drug by a person, in the absence of a legitimate medical requirement for using it. It
has been noted by researchers that all people who consume drugs on a regular basis typically
exhibit poor choices in relation to the substance used (Murphy & Dennhardt, 2016). Addiction
has also been characterized as a behavioral and psychological syndrome marked by several
symptoms of harmful behavior and an extreme tendency for recurrence of the symptoms even
after withdrawal (Sussman et al., 2017). According to Arria et al. (2017) drug usage amongst
college students is allied with poor health outcomes and poor academic performance, and also
threaten the health and safety of the consumers. Findings from their longitudinal study suggested
that marijuana is the most commonly used substance, with maximum annual prevalence rate in
year 3. Despite the low prevalence of ecstasy drugs and cocaine, non-medical consumption of
prescription drug was comparatively high in the later years of college.

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Substance use generally makes the affected person ruminate about the drug, and extend
efforts to satisfy the drug craving by any means. In addition, this compulsiveness towards
substance use also results in the onset of potential physical, psychological, and social risks
(Birtel, Wood & Kempa, 2017). These people are commonly subjected to interpersonal, financial
and other difficulties due to the abuse (Bonnaire et al., 2017). An addiction to drugs is also
associated with incapacitating legal, occupational, financial, and medical problems, along with
the individual generally trying to rationalize or deny the existence of substance use. The
prevalence of SUD amid young adults was also investigated by Walters et al. (2018) who found
that depressive symptoms are commonly reported among college students who engage in
consumption of tobacco, cannabis, cocaine, amphetamine, hallucinogens, and sedatives. Though
there does not exist any significant correlation between anxiety and SUD in college students, the
findings support the need for prevention and education at colleges and universities. According to
Hanauer et al. (2019) engagement of young adults in cigarette smoking, binge drinking and
marijuana consumption are found to be less likely under circumstances when the anticipated risk
amid them is high. Age plays an important role on the link between self-reported consumption of
marijuana and perceived risk with the younger adults demonstrating increased correlation
between substance abuse and its negative impacts.
Symptoms of substance use disorder
Substance abuse is generally considered to be the underlying factor for substance
dependence, addiction, or both, based on the substance that is consumed. Hence, the primary
symptom of substance use disorder is characterized by the presence of compulsive involvement
in consumption of drugs and alcohol, with the aim of attaining a rewarding stimulus,
notwithstanding the adverse impacts that are created on both physical and psychological health

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(Joe et al., 2019). Clinically, physiological dependence upon a particular drug necessitates the
onset and progress of tolerance in the addicted individual, thereby leading to the manifestation of
a plethora of withdrawal symptoms. According to Ali et al. (2017) when particular drugs are
repeatedly consumed over time, the individual fails to adequately respond to the drug in a
manner that was initially observed. In other words, substance use disorder is characterized by the
consumption of a higher drug or alcohol dosage, with the sole intent to attain comparable level of
response. Both drug dependence and abuse are separate from addiction, which typically
encompasses the compulsion to continue consuming the substance, in spite of the negative
concerns, and might often consist of chemical dependency. Walker (2019) elaborated on the fact
that depression acts in the form of a mediator between substance abuse and sociological strain.
On assessing the drug usage pattern, demographic variables and depression symptoms amid
college students, it was found that though most students were subjected to strain, no many of
them experienced depression signs and symptoms. The findings suggested that depression and
stress create significant influence on usage of prescription opiates.
It has often been found that substance dependence frequently hints at abuse, nonetheless
abuse often happens without dependence, predominantly when the person initially starts to abuse
a particular substance (Jordan & Andersen, 2017). According to Delker, Brown and Hasin (2015)
substance dependence commonly consist of a physiological mechanism, while the concept of
substance abuse reflects a multifaceted interaction between the substance, the person, and the
wider society. The words substance abuse and drug abuse are used interchangeably, however
refer to the consumption of substances in a way that is not considered appropriate as per the
social convention. Some of the most common signs and symptoms of substance use disorder
comprise of the inability to sleep, which in turn is concomitant with awakening at rare times and

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lethargy (Mossie, Kindu & Negash, 2016). The addicted person also gradually develops a change
in their feeding habit and also report a loss of appetite. Moreover, researchers have elaborated on
the presence of red and watery eyes in the addicts, with size of pupils being smaller or larger
than usual (Jackson, Yule & Wilens, 2017). Cole and Hussong (2020) also mentioned that high
misuse of stimulants are substantially correlated with an increase in impulsivity and SUD
consequences amongst college students. However, the college going stimulant misusers manifest
similarity with those who consume opioids and cocaine, in relation to the overall risks.
Furthermore, the findings also suggested that college students who regularly consume stimulants
demonstrate greater impulsivity.
Time and again it has been found that substance use disorder manifests in the form of
tremor or shakes of the feet and hands, and also lead to vomiting, nausea and excess sweating
(Kerfoot & Burhan, 2019). People who consume substances for a prolonged duration also
develop irregular heartbeat, hacking cough, extreme hyperactivity, and unusual smells on body
and breath. It has also been found that there occurs a gradual deterioration of their physical
health and hygiene with an increase in time. According to Dariotis and Johnson (2015) signs and
symptoms of substance use disorder are not merely restricted to the physical domain, but also
encompass behaviour. There occurs a gradual but significant change in the overall personality
and attitude of the addicted individual, with altered interest in hobbies or activities, which were
once considered pleasurable. Other behavioural signs include a drop in performance at the
workplace or at school. Lipari and Jean-Francois (2016) presented facts about substance use
amid college students belonging to the age group 18-22 years and found that on an average day,
all college students most frequently engaged in consumption of marijuana and alcohol. Of 9
million college students in the USA, there were around 703,759 who consumed marijuana and

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1.2 million consumed alcohol. Moreover, it was also found that methamphetamine and heroin
were the least commonly consumed substances in college.
The addicts eventually develop dishonesty and manifest indignant behaviour, temper
tantrums and sudden oversensitivity. Research evidences have also elucidated the presence of
moodiness, nervousness, paranoia, and general lack of self-esteem and motivation amid addicted
individuals (Darrell-Berry, Berry & Bucci, 2016). In addition, they also demonstrate suspicious
or secretive behaviour, to prevent disclosing information about their substance abuse habits. It
has often been found that with time, the addicted persons gain possession of drug paraphernalia
that refers to any product, accessory or equipment, required for using, making or hiding drugs,
generally for recreational purpose (Cavanaugh, 2016). Moreover, Gomez (2019) also mentioned
that college students typically engage in substance abuse at house parties or dormitories where
the drugs are easily accessible. Most college students engage in SUD by consuming illegal drugs
through inhalation, injection, and consumption, absorption through patches located on the skin,
or dissolution under the tongue. These drugs bring about a temporary physiological alteration in
the body of the young adults, thus providing a good sensation till the impacts last.
Classification of drugs
Depressants
Also referred to as central depressants, these drugs typically lower the level of
neurotransmitters, in order to reduce or modify stimulation arousal in different areas of the brain
(Darracq, Thornton & Ly, 2017). Depressants are also referred to as downers owing to the fact
that they bring about a reduction in the level of arousal at the time of consumption. The
mechanism of action of this category of drugs is antagonistic to that of stimulants, which
increase physical or mental function (Myrseth et al., 2018). Depressants are used all across the

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world as both prescription medicines and illicit substances. They typically comprise of
alcohol, cannabis, barbiturates, and benzodiazepines, and exert their impact via a plethora of
pharmacological mechanism, the most significant of which encompasses facilitation of GABA
activities, followed by inhibition of monoaminergic or glutamatergic activities (Liu et al.,
2015).
Stimulants
Often referred to as psychostimulants, this overarching term refers to several drugs that
increase the activity of the body and the central nervous system. These drugs are invigorating
and pleasurable, and also create sympathomimetic impacts (Behere, Das & Behere, 2019).
According to Seth et al. (2018) sympathomimetic drugs comprise of stimulant compounds that
imitate the effects of endogenous agonist directly on the sympathetic nervous system. Although
they are used for the treatment of low blood pressure and cardiac arrest, they are also consumed
by addicts, in order to attain a state of euphoria. Apart from their use in the form of prescription
medicine, they are also consumed illicitly as recreational or performance enhancing drugs
(Reardon & Factor, 2016). Some commonly consumed stimulants are amphetamine,
lisdexamfetamine, and methylphenidate (Schulz et al., 2018). It has often been found that
addiction to amphetamine results in a decrease in appetite and increased energy of the affected
individual. Moreover, people who abuse stimulants also manifest rapid breathing rate, irregular
heartbeat, and an increase in mental alertness, delusions, and hallucinations (Nakamura & Koo,
2016). Researchers have claimed that frequent consumption of the stimulant generally leads to
overdose, followed by episodes of anxiety and obsession, in addition to panic attack psychosis
and severe depression (Kariisa et al., 2019).

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Cannabis marijuana
This psychoactive drug is extracted from the Cannabis plant and used for recreational
purpose, with tetrahydrocannabinol being the major psychoactive component of the drug (Chang
et al., 2018). The drug is generally taken by vaporizing, smoking, in the form of an extract, or
within food, and creates strong physical and mental effects (Nielsen et al., 2017). The drug has
been found to modify feelings, bringing about an alteration in perception, heightened mood, and
an increase in appetite (Roberts et al., 2019). It has been identified as one of the most commonly
consumed illegal drugs in the United States and across the world, and approximately 51% of
individuals in the United States reported they have consumed cannabis in their lifetime (Salvanto
et al., 2016). Furthermore, it was also found that 12% of US citizens used cannabis in 2015
(Geiger, 2019). The immediate physiological and psychoactive impacts of cannabis comprise of
a sense of euphoria and relaxation, followed by an increase in awareness related to sensation,
increased libido, and distortions about perception of space and time (Payne et al., 2019).
When consumed at a higher dosage by the addicted individuals, the drug also results in
pseudo-hallucination, visual illusions, and ataxia that can be accredited to selective impairment
in relation to polysynaptic reflex (Hill, 2017). However, the addict also often suffers from severe
short-term and long-term side effects of the drugs. Short-term effects of cannabis drug abuse
comprise of dry mouth, impairment in motor skills, reduced short term memory, feelings of
anxiety, paranoia, and red eyes (Lin et al., 2016). Long-term impacts of the drug decrease the
mental capability of people who started using it since their teenage years, leads to the
development of behavioral problems, and increases the risk of psychosis (El Marroun et al.,
2019).

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Cocaine
Also referred to as coke, cocaine has been identified as the most frequently used
stimulant in the form of recreational drug, and is generally injected in the vein or
dissolved. Some of the common mental effects associated with the use of this drug comprise of a
loss of direct contact with reality, agitated mood, and feelings of intense happiness or pleasure
(Foltin et al., 2015). Long-term impacts of this substance include sweating, dilation of pupils,
increases in heart rate, increases in body temperature, and hypertension (Kandel & Kandel,
2015). The addictive nature of cocaine is due its stimulation of the reward pathway located in the
brain (Calipari et al., 2017). This reward pathway is responsible for the regulation of nucleus
accumbens, and also plays an important role in controlling reinforcement learning, fear,
motivation, and other cognitive processes (Kononoff et al., 2018). The impact of the substance
on the nervous system can be accredited to the fact that cocaine inhibits the reuptake of
neurotransmitters such as dopamine, epinephrine, and serotonin, which leads to an increase in the
concentration of these neurotransmitters in the brain (Dos Santos et al., 2018). Cocaine has also
been identified as the second most commonly consumed illegal drug on a global basis, next to
cannabis, and its consumption is the highest in North America, followed by South America and
Europe (Fukumi, 2016).
Heroin
Also referred to as diamorphine, heroin refers to an opioid that is generally consumed in
the form of a recreational drug, owing to the euphoric impacts that are exerted. Though used
medically for opioid replacement therapy or pain relief, heroin rapidly leads to the development
of tolerance. This drug is typically snorted, smoked, inhaled or injected into the vein and
generally results in side effects such as, dry mouth, respiratory depression, impairment in mental

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functioning, and drowsiness. According to Guindon (2017) heroin consumption for a short time
is characterized by symptoms that are similar to morphine tolerance. Moreover, young adults are
more addicted to heroin, when compared to different opioids such as, pethidine, oxycodone,
fentanyl, and hydromorphone, thus confirming the role it plays in the development of substance
use disorder. Moreover, heroin has also been found to result in overexpression of ΔFosB, the
gene transcription factor that is situated in the nucleus accumbens (Engeln et al., 2016). This in
turn results in an amplification of obsessive drug-seeking behavior (Xia et al., 2017).
Furthermore, overuse of heroin also affects the neurotransmission of dopamine in the nucleus
accumbens, which in turn is medicated by the disinhibition of dopaminergic pathways (Corre,
2018). Hence, according to Steidl, Myal and Wise (2015) heroin addiction negatively governs
the dopamine neurotransmitters and inhibit the projections to ventral tegmental area (VTA) from
the rostromedial tegmental nucleus (RMTg).
LSD
Lysergic acid diethylamide (LSD) is a common hallucinogenic drug that brings about an
alteration of feelings, awareness and thoughts in an individual (De Gregorio et al., 2018).
Although LSD does not seem to be addictive, it results in tolerance with an increase in the
consumed dosages. Most young adults consuming LSD generally hear or visualize things or
events that do not exist in real. Moreover, the drug also results in an increase in body
temperature, blood pressure, and pupil dilation, with effects lasting as long as 12 hours (Schmid
et al., 2015). Primarily used for spiritual reasons and recreational purpose, LSD leads to a
decrease in appetite, while inducing a state of wakefulness. Moreover, consumption of this drug
has been associated with negative experiences that are generally known as ‘bad trips,’ owing to
the generation of paranoia, intense negative feelings, anxiety, irrational fear, intrusive thoughts,

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suicidal ideation, harmful behaviour, and rapid mood swings (Lyvers, 2016). It has also been
reported that LSD leads to the onset of sensory effects, most commonly visualizations of radiant
colours, eidetic imagery, crawling geometric figures, morphing items, and overlaying walls
(Sessa, 2015).
Of all the drugs that had been classified by David Nutt, LSD was identified to be 1/10th as
damaging as alcohol, with the most noteworthy adverse consequence being diminished mental
functioning while high (Carhart-Harris et al., 2016). Harmful impacts of the drug also encompass
panic attacks and the onset of symptoms related to acute psychosis. Moreover, the consumers
also report a psychological phenomenon, referred to as ‘flashbacks’ where they experience an
incident of subjective effects, which mostly continues years or months after consumption of this
hallucinogenic drug (Hwang & Saadabadi, 2018).
Positive psychology theory
This research is based on the theoretical framework of positive psychology that focuses
on understanding contentment and cheerfulness in commonplace life. In the foundational
textbook titled ‘Motivation and Personality’, Maslow identified the presence of difference
between domain of clinical psychology that placed an emphasis on mental illness and the
practical approach to assisting persons construct healthy lives (Cherry, 2017). Despite the fact
that the term positive psychology had been coined by Maslow, the history of this theoretical
framework dates back to the year 1908. While addressing the American Psychological
Association, William Jaames dared his peers to enquire why some individuals live completely
engaged lives, however others fail to do so (Waters, 2017). Even during ancient times,
philosophers like Aristotle and Socrates also contemplated the actual meaning of living a
virtuous life, and accomplishing fulfilment. Modern psychology was no longer associated with

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thought experiment and started incorporating scientific during the late 19th century, followed by
the firm establishment of a link between particular behavior and motor skills with the local areas
of the brain. It was not until the year 1998 that the domain of positive psychology was
recognized as a significant scientific field of study. The presidential address made by Martin
Seligman to the APA undoubtedly drew a demarcation between the disease model that was used
by early psychologists and the model of positive psychology.
Positive psychology emerged as a new arena of psychology during 1998 and places an
emphasis on both societal and individual wellbeing. According to Hansen and Schramm (2017)
three types of happy life had been proposed by Seligman that are namely, pleasant life, good life,
and meaningful life. Applying this theory helps in governing how the individuals optimally feel,
estimate and savor the positive sentiments and emotional state that are a core component of
healthy and normal living such as, interest, hobbies and relationships. Moreover, application of
this theory also helps in establishing association between the individual’s strength and current
task, thus making the person feel confident about accomplishing their life goals. The inventor
Seligman also associated the phenomenon of positive psychology with the psychological
disorder of depression and stated that several individuals affected with depression generally
report feelings of hopelessness and bleakness. Application of this theory hence proved effective
in treatment of depression since it resulted in an enhancement in positive emotions, built
resilience, improved coping skills, and fostered social support (Clarry & Carson, 2020).
Moreover, positive psychology must not be confused with experimental self-help,
footless confirmation, or materialistic religion, regardless of the impact they create on the mind.
The theoretical framework of positive psychology holds significance for substance use disorder
amid young adults because the theory identified that happiness and contentment is rooted at

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present, in contrast to meaningfulness that focuses more on the past experiences, and the future.
It has often been found that positive psychology proves effective in exerting an optimistic and
constructive influence on the life of an affected person and also helps in improving the
experiences of the client, in relation to positive emotions (Fredrickson & Joiner, 2018). Not only
does positive psychology provide assistance during identification and development of talents and
unique strengths, but also instils a sense of hope in the perspective of the client.
The Six-factor Model of Psychological Well-being had been formulated by Carol Ryff
and facilitates determination of six different factors that significantly contribute to the
psychological wellbeing of a person. According to Lee and Taniguchi (2015) this theory helps in
creating a propensity to over-exaggerated self-evaluations and idealistic optimism that brings
about a positive psychological wellbeing. These positive illusions result in optimism and help the
individual to adapt to the surrounding circumstances, where there are subjected to intimidating
negative feedback. Thus, the optimistic illusions facilitate adaptation in these conditions to
safeguard self-confidence and psychological wellbeing.
The theoretical framework of positive psychology emphasised on shifting the attention to
“what works” rather than “what’s broken”. Seligman along with Christopher Peterson,
hypothesised that satisfaction with the past, contentment in the present, and hopefulness for the
future are significant components of positive psychology (Park et al., 2016). At the moment,
positive psychology is generally implemented by professionals in a plethora of fields. The
concept of positive psychology is also used by different organisations with the aim of studying
worker engagement, retaining important talent, enhancing job satisfaction, and matching persons
to their most operative roles within their corporations. According to research evidences,