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Substance use disorders (SUD) occur when someone's use of a substance (drug or alcohol) causes health problems or problems at work, school, or home. A common sign of a SUD is when someone is unable to stop using a substance despite adverse consequences. Commonly associated terms include substance abuse, drug abuse, drug use disorder, and drug addiction.
Substance use disorders are progressive, chronic, relapsing, and treatable diseases. They alter the way your brain functions, resulting in changed behaviors, priorities, and the ability to work, go to school, and maintain healthy relationships.
It is common for people with mental health disorders to develop substance use disorders, and vice versa. If someone is diagnosed with a substance use disorder and mental disorder at the same time, they have a co-occurring disorder or dual diagnosis.
The DSM 5 states that for someone to be diagnosed with a substance use disorder, they must meet at least two of the following criteria:
SUDs get categorized in terms of their severity. If a patient exhibits two or three of the criteria, they have a "mild" substance use disorder. Four or five means they have a "moderate" substance use disorder, while six or more makes it a "severe" diagnosis.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, referred to as the DSM-V or DSM 5, is the American Psychiatric Association’s current manual for assessing and diagnosing mental disorders. It is the gold-standard text of the diagnostic criteria for all mental health issues in the United States.
The causes of SUDs and addiction are only partially understood by researchers. Typically, users progress from occasional to heavy substance use and then proceed to develop a substance use disorder. This progression is very complex and depends on the interaction between the person, setting, and drug.
Different people have different risk factors for developing a SUD. Both genetics and environment play a role in the likelihood of someone misusing or abusing drugs.
People whose families have a history of addiction or mental health disorders are more likely to develop one themselves. People who live in high-risk environments, such as lower-income families, the LGBTQ+ community, and people without access to healthcare are also more at risk.
Anyone can develop a substance use disorder, regardless of their background. However, certain types of people are more susceptible, such as:
A person's environment can play a huge role in drug use. Family, peers, and even doctors can contribute to someone's substance use.
Certain environments are more conducive to drug abuse. For example, someone who grows up watching a family member struggle with addiction, or whose entire friend group starts doing drugs, has a higher chance of developing a SUD.
Drugs are categorized by how likely they are to cause use disorders or addiction. This is also known as assessment of abuse, potential of drugs, abuse liability, or addiction liability. This liability depends on:
People tend to use drugs that are legal, or easier to obtain, such as tobacco, alcohol, and marijuana, first. These can cause addiction, or make people feel comfortable with drug use, leading them to try stronger or illegal drugs.
Symptoms of drug abuse and addiction include, among others:
The signs of drug use will vary by the type of drug, but some of the most common signs that someone is intoxicated include:
Some of the most common signs of unhealthy substance use include:
It’s important to note that not everyone showing these symptoms has a substance use disorder. Many mental health disorders, such as depression and anxiety disorders, will cause people to act these ways as well. It’s also possible that someone is going through a rough patch, or has just had a negative reaction to something, and will recover on their own.
A person’s SUD diagnosis depends on the type of substance that they misuse. If someone misuses multiple types of substances, this is known as “polysubstance use disorder.
The most common types of substance use disorders include:
Alcohol is one of the most commonly consumed substances in the world. It’s legal almost everywhere and very easy to obtain. The three main categories of alcohol problems are binge drinking, alcohol abuse, and alcohol dependence (alcoholism).
Nearly 500,000 deaths each year make cigarette smoking the number one cause of preventable death in the United States. Over 30 million people are current smokers.
Marijuana is the third most used substance in the United States, after alcohol and tobacco. According to the National Institute on Drug Abuse (NIDA), Marijuana use disorder is similar to other substance use disorders. However, the long-term effects may be less severe.
Opioids are pain relievers that are generally safe when taken as prescribed by a doctor for a short period. However, they also produce a euphoric high, which makes people misuse and abuse them frequently. Opioid misuse can lead to dependency, addiction, overdose, and even death. Common opioids include hydrocodone (Vicodin), oxycodone (OxyContin and Percocet), oxymorphone (Opana), morphine (Kadian, Avinza), codeine, and fentanyl.
Stimulants are a class of drugs that increase alertness and energy, as well as blood pressure, heart rate, and breathing. They include illicit drugs such as cocaine and methamphetamine, as well as prescription drugs like Adderall and Ritalin. Prolonged use of stimulants can have significant negative effects, including heart damage, memory loss, and psychotic behavior.
Sedatives are central nervous system (CNS) depressants that slow brain activity. They are used to treat anxiety and sleep disorders. However, they are also abused frequently. Tolerance and dependence can develop quickly when someone misuses or abuses sedatives. Examples of common sedatives include alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), and zolpidem (Ambien)
Hallucinogens are either synthetically produced, like LSD, or occur naturally, like shrooms and peyote. They produce visual and auditory hallucinations, feelings of detachment from one's self and environment, and a distorted perception in time and space. Most hallucinogens do not cause physical addiction. However, users may develop a psychological dependence. They may also develop hallucinogen persisting perception disorder (HPPD), which is spontaneous, recurring flashbacks.
What's best for one person may not be best for someone else. Several factors will determine what type of treatment program is best for each individual, including:
What’s best for one person may not be best for someone else. There are several factors that will determine what type of treatment program is best for each individual including:
If you or someone you know is displaying symptoms of a substance use disorder, the best thing to do is to start doing research and talk to a healthcare professional.
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McLellan, A Thomas. “Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?.” Transactions of the American Clinical and Climatological Association vol. 128 (2017): 112-130.
NIDA. "Common Comorbidities with Substance Use Disorders." National Institute on Drug Abuse, 1 Apr. 2020, https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders.
SAMHSA. "Mental Health and Substance Use Disorders." Substance Abuse and Mental Health Services Administration, 13 Apr. 2019, www.samhsa.gov/find-help/disorders.
Agrawal, Arpana, et al. "DSM-IV to DSM-5: the impact of proposed revisions on diagnosis of alcohol use disorders." Addiction, vol. 106, no. 11, 2011, pp. 1935-1943.
"NIMH » Substance Use and Mental Health." National Institute of Mental Health, May 2016, www.nimh.nih.gov/health/topics/substance-use-and-mental-health/index.shtml.