Substance Use Disorder
Understand substance use disorder: symptoms, diagnosis, treatment options, and paths to recovery for this chronic condition.
Substance use disorder (SUD) is a chronic, treatable medical condition characterized by uncontrolled use of substances like alcohol, tobacco, or drugs despite harmful consequences. It impairs daily functioning and alters brain function, leading to intense cravings, tolerance, and withdrawal symptoms.
What Is Substance Use Disorder?
Substance use disorder, previously termed substance abuse or dependence, is defined in the DSM-5 as a problematic pattern of substance use causing significant impairment or distress. It ranges from mild to severe based on the number of criteria met, affecting millions of Americans and leading to health issues, disability, and social problems.
SUD impacts the brain’s reward system, producing euphoria initially but causing long-term changes that make quitting difficult. Both legal substances (alcohol, nicotine) and illegal ones (heroin, cocaine), as well as misused prescriptions, can trigger SUD.
Symptoms of Substance Use Disorder
Symptoms vary by substance but commonly include impaired control, social impairment, risky use, and pharmacological effects. Key signs are:
- Using larger amounts or longer than intended
- Persistent desire or failed efforts to cut down
- Spending excessive time obtaining, using, or recovering
- Cravings or strong urges
- Failure to fulfill major obligations at work, school, or home
- Continued use despite social or interpersonal problems
- Giving up important activities
- Recurrent use in hazardous situations
- Continued use despite physical or psychological problems
- Tolerance: needing more for the same effect
- Withdrawal symptoms upon cessation
Fewer than 2 symptoms indicate no disorder; 2-3 mild; 4-5 moderate; 6+ severe.
DSM-5 Criteria for Substance Use Disorders
The DSM-5 outlines 11 criteria for diagnosis across substances. A pattern must occur within 12 months, with severity graded by symptom count.
| Criterion | Description |
|---|---|
| Increasing tolerance | Higher doses needed for the same effect |
| Withdrawal symptoms | Physical/emotional distress upon stopping, e.g., nausea, anxiety |
| Larger amounts/longer use | Exceeds intentions |
| Desire to cut down | Unable to stop despite wanting to |
| Time spent | Much time getting/using/recovering |
| Craving | Intense urges |
| Obligation failure | Neglects responsibilities |
| Social problems | Strains relationships |
| Activity abandonment | Gives up hobbies/socializing |
| Risky use | In dangerous situations |
| Health worsening | Despite known problems |
Diagnosis requires clinical assessment; early intervention improves outcomes.
Types of Substance Use Disorders
SAMHSA and DSM-5 recognize nine distinct SUDs, including alcohol, cannabis, opioids, stimulants, hallucinogens, and others.
Alcohol Use Disorder
The most common SUD, involving heavy drinking leading to tolerance, withdrawal (tremors, seizures), and life interference. Affects health with liver disease risks.
Opioid Use Disorder
Opioids (heroin, fentanyl, prescriptions) cause euphoria but high addiction risk. Symptoms: strong cravings, tolerance, withdrawal (nausea, pain, insomnia). Chronic, with overdose potential.
Cannabis Use Disorder
Affects 4.2 million U.S. adults yearly. Symptoms: distorted perception, memory issues, tolerance, withdrawal (irritability, insomnia). Riskier for youth, linked to mental health issues.
Stimulant Use Disorder
Includes cocaine, methamphetamine. Causes intense energy then crash; symptoms: cravings, tolerance, withdrawal (fatigue, depression).
Hallucinogen Use Disorder
Rare (246,000 cases in 2014); involves LSD, PCP. Tolerance develops quickly; risky due to impaired judgment.
Risk Factors for Substance Use Disorder
Genetic, environmental, and developmental factors contribute:
- Family history of addiction
- Mental health disorders (e.g., depression, anxiety)
- Early substance exposure
- Trauma or stress
- Peer pressure or social environment
Brain changes from repeated use reinforce the cycle.
Diagnosis of Substance Use Disorder
Healthcare providers use DSM-5 criteria, patient history, and screening tools. No single test; involves physical exams, labs for substance detection, and ruling out other conditions.
Treatment for Substance Use Disorder
SUD is treatable with personalized plans combining medications, therapy, and support. First step: withdrawal management (detox).
Medications
Reduce cravings/withdrawal:
- Methadone/buprenorphine for opioids
- Naltrexone for alcohol/opioids
- Acamprosate for alcohol
- Nicotine replacement for tobacco
Behavioral Therapies
Cognitive-behavioral therapy (CBT), contingency management, motivational interviewing build coping skills.
Support Groups
AA, NA, self-help programs provide peer support.
Inpatient/Outpatient Programs
Tailored to severity; holistic care addresses medical, social needs.
Relapse is common but part of recovery; strong support aids long-term success.
Prevention of Substance Use Disorder
Healthy People 2030 emphasizes education, screening, and early intervention. Community programs reduce risks.
Living With Substance Use Disorder
Recovery is lifelong; involves lifestyle changes, ongoing therapy, avoiding triggers. Many achieve sustained remission.
Frequently Asked Questions
What is the difference between substance abuse and substance use disorder?
DSM-5 combines abuse/dependence into SUD, graded by severity.
Can substance use disorder be cured?
No cure, but treatable with high recovery rates via comprehensive care.
What are withdrawal symptoms?
Physical/psychological distress like anxiety, nausea upon stopping.
Is SUD only for illegal drugs?
No, includes alcohol, tobacco, prescriptions.
How effective is medication-assisted treatment?
Highly effective for opioids/alcohol, reducing cravings/relapse.
References
- Substance use disorders – Mental Health America — Mental Health America. 2023. https://mhanational.org/position-statements/substance-use-disorders/
- What Is a Substance Use Disorder? — American Psychiatric Association. 2023-10-01. https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder
- Substance use disorders: Get the facts and find support — MedlinePlus Magazine. 2023. https://magazine.medlineplus.gov/article/substance-use-disorders-get-the-facts-and-find-support
- Substance Use Disorder (SUD): Symptoms & Treatment — Cleveland Clinic. 2023-08-29. https://my.clevelandclinic.org/health/diseases/16652-drug-addiction-substance-use-disorder-sud
- Addiction – Healthy People 2030 — Office of Disease Prevention and Health Promotion. 2023. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/addiction
- Substance Use Disorder – Causes, Symptoms, Treatment & Help — SAMHSA. 2023. https://www.samhsa.gov/substance-use
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