Understanding Substance Use Disorders

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David Fawcett PhD, LCSW

When most people hear the word addiction, they picture some form of substance use disorder – most likely alcoholism or illicit drug addiction. However, individuals can also become addicted to prescription medications, nicotine, and even caffeine. Any addiction that involves ingesting (swallowing, snorting, smoking, injecting, etc.) a mood-altering substance qualifies as a substance use disorder.

In its Diagnostic and Statistical Manual of Mental Disorders (the DSM-5), the American Psychiatric Association (APA) lists eleven possible criteria for substance use disorders, any two of which, occurring within a 12-month period, are sufficient for a diagnosis. The APA lists numerous categories of substance use disorder including alcohol use disorder, cannabis use disorder, hallucinogen related disorders, inhalant related disorders, opioid use disorder, sedative/hypnotic/anxiolytic related disorders, stimulant related disorders, tobacco related disorders, and other (or unknown) substance related disorders.

The eleven possible criteria listed in the DSM-5 are as follows:

  1. The substance is taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control use of the substance.
  3. A great deal of time is spent in activities necessary to obtain, use, or recover from use of the substance.
  4. Craving, or a strong desire or urge to use the substance.
  5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued substance use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
  7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  8. Recurrent substance use in situations in which it is physically hazardous.
  9. Substance use continues despite knowledge of a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:
    1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    2. A markedly diminished effect with continued use of the same amount of the substance.
  11. Withdrawal, as manifested by either of the following:
    1. The characteristic withdrawal symptoms for the substance.
    2. The substance or a closely related substance is taken to relieve or avoid withdrawal symptoms.

Once again, any two of these symptoms manifesting in a 12-month period are sufficient for a substance use disorder diagnosis.

Many addiction therapists simplify the APA’s criteria to a shorter and much more easily grasped list of three.

  1. Preoccupation to the point of obsession with the substance of choice.
  2. Loss of control over use of the substance, typically evidenced by failed attempts to quit or cut back.
  3. Directly related negative consequences – relationship trouble, issues at work or in school, declining physical health, depression, anxiety, diminished self-esteem, isolation, financial woes, loss of interest in previously enjoyable activities, legal trouble, etc.

Generally, substance use disorders, more commonly referred to as alcoholism or drug addiction or just simply addiction, are relatively easy for most people to understand and identify. If we do not have an addiction ourselves, we know someone who does, or, at the very least, we’ve seen relatively accurate portrayals of alcoholism and/or drug addiction on television and in the movies.

As a standalone issue, substance use disorders can be devastating both physically and emotionally to not only the addict, but his or her loved ones as well. When substance use disorders pair with a behavioral (process) addiction, as they often do, the consequence can be even more destructive.

If you or someone you care about is struggling with a substance addiction or a paired substance and behavioral addiction, plenty of help is available. To get started on the right path, please feel free to contact us via email or join one of our no-cost drop-in discussion groups, particularly my Wednesday evening (5 p.m. Pacific, 8 p.m. Eastern) Addiction and Recovery webinar.