Substance Abuse Substance use disorder (SUD) is a complex condition in which there is the uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems. The most severe SUDs are sometimes called addictions.
People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain’s structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavioral control.
Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate effect of the substance wears off, or in other words, after the period of intoxication. Intoxication is the intense pleasure, euphoria, calm, increased perception and sense, and other feelings that are caused by the substance. Intoxication symptoms are different for each substance.
When someone has a substance use disorder, they usually build up a tolerance to the substance, meaning they need larger amounts to feel the effects.
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:
• Feel good — feeling of pleasure, “high” or “intoxication”
• Feel better — relieve stress, forget problems, or feel numb
• Do better — improve performance or thinking
• Curiosity and peer pressure or experimenting
In addition to substances, people can also develop addiction to behaviors, such as gambling. People with substance use and behavioral addictions may be aware of their problem but not be able to stop even if they want and try to.
Addiction may cause physical and psychological problems as well as interpersonal problems such as with family members and friends or at work. Alcohol and drug use are one of the leading causes of preventable illnesses and premature death nationwide.
Symptoms of substance use disorder are grouped into four categories:
• Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
• Social problems: substance use causes failure to complete major tasks at work, school, or home; social, work or leisure activities are given up or cut back because of substance use
• Risky use: substance is used in risky settings; continued use despite known problems
• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)
Many people experience substance use disorder along with another psychiatric disorder. Oftentimes another psychiatric disorder precedes substance use disorder, or the use of a substance may trigger or worsen another psychiatric disorder.
Criteria for Substance ABUSE Disorders:
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, often called the DSM-V or DSM 5, is the latest version of the American Psychiatric Association’s gold-standard text on the names, symptoms, and diagnostic features of every recognized mental illness—including addictions.
The DSM 5 criteria for substance use disorders are based on decades of research and clinical knowledge. This edition was published in May 2013, nearly 20 years after the original publication of the previous edition, the DSM-IV, in 1994.
Did you know?
There are 10 substance-Induced Disorders:
The toxic effects of substances can mimic mental illness in ways that can be difficult to distinguish from mental illness. This chapter of diagnosis focuses on symptoms of mental illness that are the result of substance abuse—a condition referred to as “substance-induced mental disorders.”
The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs:
• Alcohol
• Caffeine
• Cannabis (Marijuana)
• Hallucinogens (phencyclidine or similarly acting Aryl cyclohexylamines, and other hallucinogens, such as LSD)
• Inhalants
• Opioids
• Sedatives
• Hypnotics or anxiolytics
• Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
• Tobacco and other or unknown substances.
Therefore, while some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.
The activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.
The pharmacological mechanisms for each class of drug are different. But the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”
The DSM 5 recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders. Some people have lower levels of self-control that predispose them to develop problems if they are exposed to drugs.
There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders.
• Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result.
• Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorders.
Criteria for Substance USE Disorders
Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
1. Taking the substance in larger amounts or for longer than you are meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances repeatedly, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.
SEVERITY of Substance Use Disorders:
The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a mild substance use disorder; four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder.
Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy” for certain substances, and “in a controlled environment.” These further describe the current state of the substance use disorder.
Did you know there is a Substance Abuse diagnosis called Medication-Induced Mental Disorder?
Substance/medication-induced mental disorders are mental problems that develop in people who did not have mental health problems before using substances.
They include:
• Substance-induced psychotic disorder
• Substance-induced bipolar and related disorders
• Substance-induced depressive disorders
• Substance-induced anxiety disorders
• Substance-induced obsessive-compulsive and related disorders
• Substance-induced sleep disorders
• Substance-induced sexual dysfunctions
• Substance-induced delirium
• Substance-induced neurocognitive disorders
Substance Intoxication:
Substance intoxication, a group of substance-induced disorders, details the symptoms that people experience when they are “high” from drugs. Disorders of substance intoxication include:
• Marijuana intoxication
• Cocaine intoxication
• Methamphetamine intoxication (stimulants)
• Heroin intoxication (opioids)
• Acid intoxication (other hallucinogen intoxication or “acid trip”)
• Substance intoxication delirium
In closing: Untreated substance use disorders can be harmful to your health, relationships, and life. They can even be fatal, so get help as early as possible. Your physician can refer you to a specialist or an addiction program to ensure that you receive the correct course of treatment.
If you or a loved one are struggling with substance, use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
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