Substance Use Disorder (SUD): Understanding the Cycle of Dependence
Substance Use Disorder (SUD) is a complex condition in which the use of one or more substances leads to clinically significant impairment or distress. This can involve problems with physical and mental health, interpersonal relationships, and ability to function at work, school, or home. SUD is a chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences. It’s important to understand that SUD is a treatable condition, and recovery is possible. This page provides a comprehensive overview of SUD, including its symptoms, types of substances involved, potential causes, risk factors, and diagnostic criteria, based on established medical and psychological research.
Defining Key Terms in Substance Use Disorder
To understand SUD, it’s important to define some key terms:
- Substance: Any psychoactive compound, whether legal or illegal, that can alter mood, perception, cognition, or behavior. Common substances include alcohol, tobacco, cannabis, opioids, stimulants, and sedatives.
- Use: The act of ingesting a substance.
- Misuse: The use of a substance in a way that is not intended or prescribed.
- Abuse: The continued use of a substance despite negative consequences.
- Dependence: A state in which the body has adapted to the presence of a substance and experiences withdrawal symptoms when the substance is discontinued.
- Addiction: A chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences. Addiction is the most severe form of SUD.
- Tolerance: Needing to use more of a substance to achieve the same effect that was once reached at lower doses.
- Withdrawal: Symptoms that occur when the use of a substance is stopped or reduced.
Symptoms of Substance Use Disorder
SUD is characterized by a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. The DSM-5 outlines 11 criteria for diagnosing SUD. The severity of the SUD is determined by the number of criteria met:
- Impaired Control:
- Taking the substance in larger amounts or for longer than intended.
- Wanting to cut down or stop using the substance but not managing to.
- Spending a lot of time getting, using, or recovering from use of the substance.
- Craving: A strong desire or urge to use the substance.
- Social Impairment:
- Failure to fulfill major role obligations at work, school, or home.
- Continuing to use the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
- Giving up or reducing important social, occupational, or recreational activities because of substance use.
- Risky Use:
- Recurrent substance use in situations in which it is physically hazardous.
- Continuing to use the substance despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Pharmacological Criteria (Tolerance and Withdrawal):
- Tolerance: Needing markedly increased amounts of the substance to achieve intoxication or desired effect.
- Withdrawal: Experiencing withdrawal symptoms when the substance is stopped or reduced.
Citation: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).(Purchase Link: https://www.appi.org/Products/DSM)
Types of Substance Use Disorders (By Substance)
SUD can involve a wide range of substances. The DSM-5 specifies separate diagnostic codes for each class of substance:
- Alcohol Use Disorder
- Cannabis Use Disorder
- Stimulant Use Disorder (e.g., cocaine, methamphetamine)
- Opioid Use Disorder (e.g., heroin, prescription pain relievers)
- Sedative, Hypnotic, or Anxiolytic Use Disorder (e.g., benzodiazepines)
- Tobacco Use Disorder
- Hallucinogen Use Disorder (e.g., LSD, psilocybin)
- Inhalant Use Disorder
- Other (or Unknown) Substance Use Disorder: This is indicated if there is a SUD that doesn’t qualify under one of the other categories.
Citation: National Institute on Drug Abuse (NIDA). (n.d.). Drugs of Abuse.
Potential Causes and Risk Factors for Substance Use Disorder
The exact cause of SUD is complex and multifaceted, involving a combination of genetic, biological, environmental, and social factors:
- Genetics: A family history of SUD increases the risk of developing the condition.
- Brain Chemistry: Substance use alters brain chemistry, particularly in areas related to reward, motivation, and impulse control.
- Environmental Factors: Exposure to substance use in the home or community, peer pressure, and stressful life events can increase the risk of SUD.
- Early Childhood Trauma: Adverse childhood experiences (ACEs) can significantly increase the risk of developing SUD later in life.
- Mental Health Conditions: Individuals with mental health conditions, such as anxiety, depression, or PTSD, are more likely to develop SUD (self-medication hypothesis).
Diagnosing Substance Use Disorder: A Comprehensive Evaluation
Diagnosing SUD involves a thorough evaluation by a qualified healthcare professional or mental health professional. The evaluation may include:
- Clinical Interview: Gathering detailed information about the individual’s substance use history, medical history, family history, and current life circumstances.
- Physical Examination: Assessing the individual’s physical health and looking for signs of substance use.
- Urine or Blood Drug Screening: Testing for the presence of substances in the body.
- Standardized Questionnaires: Using standardized questionnaires and assessment tools to measure the severity of substance use problems.
The diagnostic criteria for SUD are outlined in the DSM-5. A diagnosis is typically made when the individual’s symptoms meet the specific criteria for a particular substance use disorder and cause significant distress or impairment in their daily functioning.
Citation: American Society of Addiction Medicine (ASAM). (n.d.). Definition of Addiction.
Important Disclaimer:
This page is for informational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- National Institute on Drug Abuse (NIDA). (n.d.). Drugs of Abuse.
- Kendler, K. S., Schmitt, E., Aggen, S. H., Prescott, C. A., & Neale, M. C. (2008). Genetic and environmental influences on alcohol, caffeine, cigarette, and illicit drug use reported prospectively from early adolescence to adulthood. Archives of General Psychiatry, 65(6), 674-682.
- Volkow, N. D., Fowler, J. S., Wang, G. J., & Swanson, J. M. (2004). Dopamine in drug abuse and addiction: results from imaging studies and treatment implications. Molecular Psychiatry, 9(6), 557-569.
- American Society of Addiction Medicine (ASAM). (n.d.). Definition of Addiction.