Substance Use Disorders (SUD)

Substance use disorder (SUD) is a medical condition characterized by the compulsive use of substances despite harmful consequences. It affects brain function and behaviour, leading to an inability to control the intake of alcohol, drugs, or prescription medications. SUD is a major health concern, contributing to mental health disorders, physical health deterioration, and social complications.  

Substance use disorder (SUD) profoundly affects an individual’s daily life, influencing decision-making, priorities, and overall well-being. It can create a cycle where the compulsive needs to use substances takes precedence over personal responsibilities, relationships, and self-care. Over time, individuals may experience a diminished sense of control, where substance use becomes central to their thoughts and actions, often at the expense of personal and professional aspirations. This loss of autonomy can lead to a growing disconnect from previously valued activities, social interactions, and long-term goals.  

The condition also impacts cognitive function and emotional regulation, making it challenging for individuals to manage stress, cope with emotions, or respond to external pressures in a healthy manner.  

Furthermore, the disorder can foster a sense of isolation, as individuals may withdraw from loved ones due to fear of judgment, misunderstandings, or strained relationships. This social detachment can further reinforce reliance on substances, creating a cycle that becomes increasingly difficult to break.  

Why Cuba 

In Cuba, rehabilitation is primarily structured around a highly individualized program that integrates clinical, psychological, and physical assessments to develop a comprehensive recovery plan. This approach takes into account not only medical and behavioural health factors but also the individual’s social and cultural background, specific family dynamics, and broader life circumstances. The treatment process is managed by a multidisciplinary team, including addiction medicine specialists, psychiatrists, psychologists, licensed therapists, social workers, and rehabilitation nurses, ensuring a holistic and supportive environment for recovery. The program is designed with two fundamental objectives: achieving abstinence and fostering a transformative change in lifestyle. By addressing both the physiological and behavioural aspects of addiction, Cuban rehabilitation centers aim to equip individuals with the necessary tools to sustain long-term recovery and reintegrate into society successfully. 

Causes of Substance Use Disorder 

SUD does not have a single cause; instead, it results from a combination of genetic, environmental, psychological, and social factors. These include: 

Genetic Factors:  

• Family history of addiction increases the likelihood of developing SUD. 
• Genetic predisposition affects how the body processes drugs and alcohol. 

Environmental Influences 

• Exposure to drug use during childhood or adolescence. 
• Peer pressure and social acceptance of substance use. 
• Availability of substances in the environment. 

Psychological Factors 

• Mental health conditions such as depression, anxiety, or post-traumatic stress disorder (PTSD) often co-occur with SUD. 
• Trauma and unresolved emotional distress can contribute to substance use as a coping mechanism. 

Neurobiological Factors 

• Changes in the brain’s reward system due to prolonged substance use can lead to dependency. 
• Dopamine surges create a cycle of addiction by reinforcing drug-seeking behaviours.

Classification of Substance Use Disorders 

 SUD can be categorized based on the severity and pattern of use:  

Mild SUD 

• Early signs of substance abuse. 
• Some difficulty controlling use but no severe life disruptions. 

Moderate SUD 

• Increased frequency of use with noticeable effects on relationships, work, or health. 
• Withdrawal symptoms may start appearing. 

Severe SUD (Addiction) 

• Loss of control over substance use. 
• Significant physical and mental deterioration. 
• High risk of overdose and life-threatening complications.  

Types of Substance Use Disorders  

SUDs are further classified based on the type of substance being abused.  

• Alcohol Use Disorder (AUD): Chronic consumption of alcohol leading to dependency. 
• Opioid Use Disorder: Abuse of prescription painkillers, heroin, or synthetic opioids. 
• Stimulant Use Disorder: Addiction to substances like cocaine, methamphetamine, or prescription stimulants. 
• Cannabis Use Disorder: Excessive consumption of marijuana leading to dependency. 
• Sedative, Hypnotic, or Anxiolytic Use Disorder: Abuse of benzodiazepines or barbiturates. 
• Hallucinogen Use Disorder: Use of LSD, psilocybin, or PCP with persistent psychological effects. 
• Inhalant Use Disorder: Addiction to volatile substances like paint thinners or glue. 
• Polysubstance Use Disorder (Co-occurring Substance Use Disorder): Dependency on multiple substances simultaneously. 

Symptoms of Substance Use Disorder 

Symptoms vary depending on the substance but generally include: 

Behavioural Symptoms 

• Loss of control. 
• Spending excessive time obtaining, using, or recovering from the substance. 
• Neglecting responsibilities at work, school, or home. 
• Engaging in risky behaviours under the influence. 

Physical Symptoms 

• Tolerance (needing higher doses for the same effect). 
• Withdrawal symptoms such as sweating, shaking, nausea, and irritability. 
• Changes in sleep patterns and appetite. 
• Weight fluctuations. 

Psychological Symptoms 

• Mood swings, depression, or anxiety. 
• Paranoia and hallucinations (in some substances). 
• Memory problems and cognitive decline. 

Diagnosis of Substance Use Disorder 

The SUD is a crucial step in formulating an effective and personalized rehabilitation program. A comprehensive evaluation is essential to determine the extent of substance use, assess its impact on an individual’s physical and mental health, and identify any underlying factors contributing to continued use. The diagnosis process includes: 

Medical History and Interview 

A thorough medical history and interview provide essential insights into an individual’s substance use patterns to understand the severity, underlying causes, and impact on daily life. 

Physical Examination 

A physical examination helps identify visible signs of substance dependence, withdrawal symptoms, and any associated health complications. 

Laboratory Tests 

Laboratory tests are conducted to confirm substance use, detect levels of substances in the body, and assess potential organ damage. 

Mental Health Evaluation 

A mental health evaluation helps identify co-occurring psychiatric disorders that may contribute to or result from substance use. 

Treatment of Substance Use Disorder 

Beyond medical treatment, emphasis is placed on equipping individuals with essential life skills, coping mechanisms, and strategies to reintegrate successfully into society. Through a combination of individualized care and community support, rehabilitation programs aim to empower individuals to regain control of their lives, sustain long-term recovery, and build a future free from substance dependence. 

INDIVIDUAL THERAPY 

Individual therapy plays a critical role in the recovery process, providing one-on-one counseling tailored to each person’s unique challenges and needs. Addiction is not solely a physical dependence—while detoxification is a significant step, addressing the underlying psychological, emotional, and social factors is essential for long-term recovery. A variety of evidence-based therapeutic approaches are integrated into the rehabilitation program, ensuring a comprehensive and personalized treatment experience: 

• Cognitive Behavioural Therapy (CBT)
  CBT is based on the concept that thoughts shape emotions and behaviours. This therapeutic approach enables individuals to identify and restructure negative thought patterns that drive substance use, fostering healthier coping mechanisms and decision-making.  

• • Key benefit of CBT: 

• • • Identifies negative thought patterns  
    • Develops healthy coping strategies 
    • Improves emotional regulation 
    • Strengthens problem-solving skills  
    • Reduces risk of relapse 
    • Enhances self-awareness  
    • Promotes long-term behavioural change 
    • Boosts confidence and self-efficacy 

• Didactic Therapy:
  Focuses on teaching individuals how to live in the present, manage stress effectively, regulate emotions, and enhance interpersonal relationships. 

• • Key benefit of didactic therapy:

• • • Enhances understanding of addiction 
    • Develops coping skills   
    • Encourages mindfulness and present awareness 
    • Improves emotional regulation 
    • Strengthens decision-making abilities  
    • Promotes personal growth and self-awareness  
    • Enhances communication and relationship skills  

• Rational Emotive Therapy:
  Aims to reshape negative thought patterns, improve emotional well-being, and enhance overall quality of life. 

• • Key benefit of rational emotive therapy:   

• • • Identifies and restructures irrational beliefs  
    • Reduces emotional distress  
    • Enhances self-control and decision-making 
    • Strengthens coping mechanisms  
    • Promotes a positive mindset  
    • Decreases self-blame and guilt 
    • Improves problem-solving skills  
    • Supports long-term recovery 

• Humanistic Therapy: 
  Humanistic therapy is a client-centered approach that emphasizes self-exploration, personal growth, and the realization of an individual’s full potential by fostering self-awareness, autonomy, and emotional well-being.  

• • Key benefit of humanistic therapy:  

• • • Encourages self-exploration 
    • Promotes personal growth  
    • Enhances emotional resilience 
    • Fosters self-empowerment 
    • Strengthens self-worth and confidence   
    • Develops healthy coping strategies  
    • Encourages authenticity and self-expression 
    • Supports holistic well-being 

• Systemic Therapy
  Systemic therapy for SUD is a holistic approach that examines an individual’s substance use within the context of their relationships, family dynamics, and social environment, aiming to improve communication, support systems, and behavioural patterns to foster lasting recovery. 

• • Key benefit of systemic therapy:  

• • • Improves family communication  
    • Identifies unhealthy relationship patterns 
    • Strengthens social support networks 
    • Promotes shared responsibility  
    • Addresses relational stressors 
    • Encourages long-term recovery 

• Occupational Therapy
  Occupational therapy focuses on helping individuals rebuild daily routines, develop essential life skills, and restore their roles in work, family, and social life to support long-term recovery and overall well-being. 

• • Key benefit of occupational therapy: 

• • • Restores daily functioning  
    • Enhances life skills 
    • Improves work readiness 
    • Strengthens social and communication skills 
    • Builds healthy coping mechanisms 
    • Promotes self-identity and purpose 
    • Encourages physical and mental well-being 
    • Reduces risk of relapse 
    • Supports emotional resilience 
    • Facilitates community reintegration 

GROUP THERAPY    

Group therapy provides a structured and supportive environment where individuals can share experiences, learn from others, and develop problem-solving skills under professional guidance. The group setting encourages open dialogue while allowing participants to build confidence, foster self-worth, and develop a sense of belonging.  

• • Key benefit of group therapy: 

• • • Provides peer support 
    • Promotes shared learning  
    • Enhances accountability  
    • Develops healthy social skills 
    • Encourages emotional expression 
    • Reduces stigma and shame 
    • Improves problem-solving abilities 
    • Increases motivation for recovery 
    • Builds self-esteem and confidence 
    • Provides relapse prevention strategies 

OTHER THERAPEUTIC APPROACHES 

• Acupuncture and Relaxation Sessions 
• Physical Rehabilitation and Physiotherapy 
• Oral Vitamin Therapy 
• Community activities outside the unit  
• Recreational activities sessions   
• Medication for the control of addiction disorders (only in cases of severe withdrawal and only for limited time)