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Addictions and Substance Use Disorder

What is a Substance Use Disorder?

Every day, millions of people use substances such as drugs, alcohol, tobacco, and caffeine. The reasons for doing so are usually numerous and complex in nature. They vary with each individual. While habitual substance use is commonly referred to as addiction, “Substance Use Disorder” is a more neutral term used by mental health professionals to characterize chronic and compulsive substance-related behavior.

Substance use is a very serious condition and often leads to devastating and sometimes fatal circumstances, for users and their loved ones.

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the criteria for substance-related disorders. The distinction between substance “abuse” and “dependence” has been removed. Instead, substance-related disorders have been divided into two categories: “Substance Use Disorders” and “Substance-Induced Disorders.”

Substance use disorders combine the criteria previously set for abuse and dependence in one category. Severity of the substance use is based on how many symptoms individuals present with at the time of assessment. They range from mild to severe.

What are Substance-Induced Disorders?

Substance-Induced Disorders refer to those disorders that are caused specifically by using substances. These can include the states of intoxication and withdrawal. They also include substance-induced mental disorders such as schizophrenia and other psychotic disorders, bipolar disorders, depressive disorders, and anxiety disorders.

Classification of Substance Use Disorders

There are 10 separate classes of drugs that encompass clinical substance-related disorders. They include:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens (with separate categories for phencyclidine (PCP) and similar substances)
  • Inhalants
  • Opioids
  • Sedatives, Hypnotics, and Anxiolytics
  • Stimulants (amphetamine-type substances, cocaine, and others)
  • Tobacco
  • Other (unknown) substances

What are the Symptoms of Substance Use Disorder?

The problematic use of any of the above substances has to lead to significant distress or impairment in daily functioning, as represented by at least two of the following symptoms:

  • The substance (alcohol, cannabis, heroin, etc.) is taken in larger amounts or over an extended period of time than was originally intended
  • Consistent effort or unsuccessful efforts to decrease, control, or stop substance use
  • Significant amount of time is spent trying to obtain, use, or recover from substance and its effects
  • Cravings or urges for substance
  • Recurrent substance use that lead to an inability to fulfill major life obligations across different contexts (work, school, home)
  • Continuation of substance use despite recurrent interpersonal issues that are caused by substance effects
  • Failure to engage in important social, occupational, or recreational activities because of substance use
  • Continued substance use in physically harmful situations
  • Recurrent substance use despite knowings its effects have caused or exacerbated continued physical or psychological problems
  • Tolerance to substance
  • Withdrawal from substance

Severity of disorder is based on number of present symptoms.

  1. Mild: 2-3 symptoms
  2. Moderate: 4-5 symptoms
  3. Severe: 6 or more symptoms

What is Tolerance?

Tolerance is defined by either of the two following criteria:

  1. Needing increased amounts of a particular substance to become intoxicated or reach a desired effect
  2. Continued use of the same amount of substance results in a significantly diminished effect

What is Withdrawal?

Withdrawal is marked by the reduction or cessation of substance use that has been substantial and prolonged (usually on a daily basis). It is also accompanied by physiological symptoms that vary in severity and differ depending on the type of substance used. Some of these symptoms include:

  • Sweating
  • Pulse rate greater than 100 bpm (beats per minute)
  • Increased hand tremor
  • Nausea
  • Vomiting
  • Insomnia
  • Anxiety
  • Seizures
  • Temporary hallucinations or illusions
  • Headache
  • Fatigue/Drowsiness
  • Depressed mood
  • Irritability
  • Difficulty concentrating
  • Flu-like symptoms
  • Decreased appetite
  • Muscle aches and pains

Treatment for Substance Use Disorders

Individuals with substance use disorders are a diverse population. A therapeutic approach that comprises a number of treatment modalities is ideal to effectively address all clinically significant features.

Psychiatric Management

Proper psychiatric assessment is crucial to substance use treatment. Proper care can address co-morbid psychiatric disorders such as depression and anxiety.

Pharmacological Treatment

Psychopharmaceuticals have proven to be effective in the treatment of substance use. Medication-Assisted Treatment (MAT) refers to the pharmacologic component of treating substance use disorders. The Food and Drug Administration (FDA) has approved several medications (naltrexone, buprenorphine, methadone) that have been effective in treating dependence on substances such as alcohol and opioids.

Psychotherapy

Therapy is a significant component in the comprehensive treatment of substance use disorders. Motivating individuals to change harmful behaviors, creating a safe environment that facilitates trust and rapport, and addressing psychological and emotional issues are all key areas of the therapeutic process. Therapy is offered for individuals, couples, families, and in a group setting. Evidence-based treatments include cognitive-behavioral therapies (CBT, social skills training, relapse prevention, psychoeducation).

Treatment Settings

The appropriate setting for substance use disorder varies with each individual and the severity of symptoms. Treatment settings include hospitalization for those who are at a higher safety risk, residential treatment programs, and outpatient services.

If you or someone you know is struggling with a substance use disorder, please reach out to your primary care physician or a local mental health practitioner.

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