Definition of Substance Use Disorder
Substance use disorder is, broadly speaking, defined as a pattern of specific symptoms stemming from the continued use of a substance, even though the continued use of the substance creates problems.
Substance use disorder develops as the continued use of a substances causes changes in the brain that lead to intense cravings for the “high”, or reward center stimulation, delivered by that substance. These emotional and physical cravings make it increasingly difficult to stop taking the substance. And over time, the brain develops a tolerance to the drug, meaning it requires more and more of the substance to satisfy the craving.
The most severe form of substance use disorder is more commonly known as addiction, when the use of the substance becomes compulsive. At a minimum, addiction interferes with the ability to lead a normal, productive life. If left treated, addiction can create serious, life-threatening medical problems.
The DSM 5 (The Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association) does not classify different types of substance use disorders. Instead, it recognizes 10 distinct classes of drugs which can result in a substance use disorder when used improperly. The classes are:
Caffeine
Tobacco
Alcohol
Cannabis (marijuana)
Inhalants
Stimulants
Hallucinogens
Opioids
Sedatives
Hypnotics or anxiolytics
The DSM 5 also recognizes the potential for an “other” or “unknown” category to include any other type of drug not included in one of the above classifications.
Diagnosing a Substance Use Disorder
The recreational, occasional, or even frequent use of a specific substance does not necessarily mean you have a substance use disorder. Most mental health experts recognize that not everyone is at the same risk of developing a substance use disorder. The DSM 5 outlines 11 criteria to help mental health experts evaluate whether an individual has developed substance use disorder and requires treatment. These criteria are:
1. Using the substance in larger amounts or for greater lengths of time than intended.
2. Not being able to stop using the substance even if you want to.
3. Devoting significant time to getting, using, or recovering from the substance.
4. Experiencing cravings to use the substance.
5. Use of the substance interferes with normal activities at work, school, or home.
6. Use of the substance even when it disrupts relationships.
7. Choosing to use the substance instead of participating in important social, professional, or recreational activities.
8. Continuing to use the substance even when you know that it could put you in a dangerous situation.
9. Continuing to use the substance even when you know it could cause or exacerbate a physical or psychological problem.
10. Requiring greater amounts of the substance to get “high” and satisfy the cravings.
11. Developing physical withdrawal symptoms that are only eliminated by taking more of the substance.
Two or three of these symptoms together indicates the potential for a mild substance use disorder. Four or five together indicates the potential for a moderate substance use disorder. Six or more indicates the potential for addiction. Yet despite the level of severity, all substance abuse disorders are potentially dangerous and should be treated immediately.
Treating Substance Use Disorder
The good news is that substance abuse disorder can be treated. Individuals who have suffered from a substance use disorder—no matter how severe—can live long, happy, and healthy lives after successful treatment.
The type of treatment will depend on the severity of the disorder. For instance, individuals with a mild substance use disorder may benefit from individual therapy or a self-help group (such as Alcoholics Anonymous). Individuals with a severe addiction may require hospitalization and/or residence in a controlled, drug-free environment in order to control withdrawal before other treatments can begin.
In nearly every case, however, treatment cannot begin without the individual’s recognition and acknowledgement that they have a substance use disorder.
For most individuals, a combination of different types of therapies, including both individual and group settings, will form the basis for long-term treatment. Therapy will help patients develop skills to cope with immediate cravings and make lifestyle choices that do not center on use of the substance. Therapy will also help patients understand why they began using the substance to begin with, build self-esteem and confidence issues, cope with stress, and address any other mental health concerns that may have led to the development of the disorder in the first place.
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