Substance Use Disorders and Harm Reduction

About Substance Use Disorder

• Substance use disorder (SUD) is a medical condition that affects a person’s brain and behavior and can lead to an inability to control the use of certain substances. These may include illegal drugs, such as heroin and cocaine, or the misuse of legal substances: both those that are approved and regulated by the U.S. Food and Drug Administration (FDA), like alcohol and tobacco, and those that are not approved or regulated by the FDA, like kratom, tianeptine, and cychlorphine. These emerging opioid-like substances are linked to dependence, overdoses, death (especially with the occurrence of polysubstance use), and other serious health risks.
• Substance use disorders can impact many aspects of a person’s life, including mental and physical health, relationships, and their ability to balance responsibilities at work, school, and home. While substance use disorders can be serious, and in some cases life-threatening, they are treatable health conditions, and recovery is possible with the right support and care. Clinicians should be informed about all substance use, including legal supplements and herbal products, to ensure awareness of kratom use and any other concurrent substance use.

Causes of Substance Use Disorder

• There are many factors that may contribute to an individual’s substance use disorder, including:
  • Genetics
  • Psychiatric conditions
  • Social pressures
  • Cultural norms
  • History of SUD
    • Substance use disorder is a lifelong process and relapse is common.

Accessibility of Substances

A growing number of newer opioid-like substances — such as kratom, tianeptine, and cychlorphine — are widely available in gas stations, local shops, and online retailers, making them easy to access and easy to overlook as potentially dangerous. Several factors contribute to the false sense of safety surrounding these products:

• Marketed as “natural,” “herbal,” or “supplements.” Some substances are viewed as “healthy alternatives to opioids” because they are derived from natural sources, like kratom. However, substances marketed as natural may still carry significant risks, including dependence and adverse effects.
• Promoted as “brain enhancers.” These products are sometimes sold with wellness-oriented branding, positioning them as cognitive or mood boosters rather than substances with misuse potential.
• People often assume that legal or widely available products are safe, but many unregulated products have wide variability in dosing and preparation, making the risk of overdose unpredictable.

Signs of Substance Use Disorder

• Substance use signs vary among individuals, but symptoms include:
  • Ongoing drug or alcohol use that interferes with daily responsibilities
  • Spending a lot of time getting, using, and/or recovering from drug or alcohol use
  • A strong desire to use drugs or alcohol
  • Continuous use of drugs or alcohol despite it causing physical, psychological, and/or social problems
  • Stopping or reducing daily activities due to drug or alcohol use

Substance Use Disorder Treatment

• Treatment options for substance use disorder include therapy, supportive housing, peer support, medication, and more. People experiencing signs of substance use disorder should talk to a healthcare professional about the treatment that’s best for them. Treatment for substance use disorder is based on several factors, including the type of substance a person is using, the extent of their symptoms and dependence, and their age and overall health. 

Prevention of Substance Use

Programs developed to reduce substance use and its associated harms are called evidence-based prevention programs or interventions. These programs are often tailored to address the needs of individuals at different points in life, such as during pregnancy, early childhood, adolescence, or adulthood. They are also delivered in a variety of settings, including homes, healthcare settings, and community environments.

The goals of prevention programs often include:

• Lowering risk factors—conditions or experiences that increase the likelihood of developing a substance use disorder, such as adverse childhood experiences, social isolation, or early exposure to substances—while strengthening protective factors—individual, family, and community characteristics that reduce risk and promote resilience, such as strong social support, positive coping skills, and stable family relationships.
• Preventing or delaying the initiation of substance use.
• Reducing escalation to higher-risk use or the development of a substance use disorder.

Examples in practice:

• School-based programs that teach healthy decision-making.
• Family-focused interventions that improve parent-child communication and monitoring.
• Community coalitions that reduce youth access to alcohol, tobacco, and other substances.
• Programs that teach stress management, emotional regulation, and resilience to adolescents and young adults.

About Harm Reduction

• Harm reduction refers to interventions that lower the risk of harm that comes with using drugs. At their core, harm reduction programs work to destigmatize substance use disorders and support individuals on their road to recovery. 
• Examples of harm reduction tools include: 
  • Naloxone kits (used to reverse an opioid overdose)
    • Used to reverse an opioid and opioid-like substance overdose.
    • Naloxone kits should be used, including when the substance involved is unknown, and it may take multiple administrations to reverse the effects of an overdose.
  • Free syringes and sterile injection equipment (prevents use of contaminated syringes)
  • Fentanyl test strips (used to detect and ultimately address the presence of fentanyl in a person’s system)
    • New synthetic opioids, like cychlorphine, may not be detected by fentanyl test strips.
  • Counseling is the primary harm reduction treatment for some disorders, like kratom use disorder.
• Harm reduction interventions can often be found in a community’s central locations, including health clinics, places of worship, public transportation hubs, and food banks.

The Impact of Harm Reduction Programs

Harm reduction programs have proven effective at helping individuals avoid many of the dangers caused by substance use disorders. 

• Harm reduction prevents death. By reversing the most serious effects of drug use and detecting when a drug may have been laced with a lethal substance (like fentanyl), harm reduction programs reduce the risk of death among people with substance use disorders. 
• Harm reduction reduces the spread of diseases. When people have access to sterile equipment (such as sterile syringes and smoking equipment), they are less likely to use contaminated equipment and spread diseases such as HIV, hepatitis B, and hepatitis C. 
• Harm reduction is often a first step to treatment for substance use disorders. Harm reduction programs that are visible and accessible within a community often reach people who otherwise could not or would not seek treatment for their substance use disorder. 
  • Some harm reduction programs, such as syringe services programs, provide sterile injection equipment and connect people to healthcare and treatment services and are associated with reduced substance use. People who use these programs are nearly three times more likely to reduce or stop drug use and five times more likely to enter treatment than those who do not use them. 

Sources

• Cleveland Clinic. (2025, April 7). Relapse (return to substance use). https://my.clevelandclinic.org/health/articles/relapse-return-to-substance-use
• Cleveland Clinic. (2024, September 9). Substance use disorder (SUD). https://my.clevelandclinic.org/health/diseases/16652-drug-addiction-substance-use-disorder-sud
• Coulson, M., & Hartman, M. (2022). What is harm reduction? Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2022/what-is-harm-reduction
• Johns Hopkins Medicine. (n.d.). Substance use disorder. https://www.hopkinsmedicine.org/health/conditions-and-diseases/substance-abuse-chemical-dependency
• New York State Office of Addiction Services and Supports. (n.d.). Naloxone. https://oasas.ny.gov/keywords/naloxone
• Overbeek, D. L., Abraham, J., & Munzer, B. W. (2019). Kratom (mitragynine) ingestion requiring naloxone reversal. Clinical Practice and Cases in Emergency Medicine, 3(1), 24–26. https://pmc.ncbi.nlm.nih.gov/articles/PMC6366391/
• Strang, J., Manning, V., Mayet, S., Best, D., Titherington, E., Santana, L., Offor, E., & Semmler, C. (2008). Overdose training and take-home naloxone for opiate users: Prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction, 103(10), 1648–1657. https://pmc.ncbi.nlm.nih.gov/articles/PMC2528824/
• Talbot County Health Department. (2026, March 3). New & emerging substances. https://talbothealth.org/new-emerging-substances/