Substance abuse disorder—which is referred to as substance use disorder in the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5)—is a chronic and complex disorder involving the continued use of drugs or alcohol (substances) despite significant substance-related problems.
Quitting is not a matter of willpower, nor is it a simple choice. This is because addiction involves physical and mental changes in the brain that make it difficult to stop using.
No matter a persons addiction there are many commonalities when it comes to signs and symptoms, regardless of the specific type of substance being used.
Symptoms
Regardless of the specific type of substance a person is using, there will be similar signs and symptoms. This includes substance use disorder involving:
- Alcohol
- Illicit drugs—such as cocaine or meth
- Prescription drugs
Each type of drug (or alcohol) use falls under the general category of substance use disorder.
Signs and symptoms of substance use disorder may include:
- Using substances that cause physically dangerous situations
- Getting into physical altercations
- Having accidents
- Having legal problems
- Experiencing a decline in attendance or performance at school, work, or home
- Exhibiting suspicious behavior
- Experiencing a change in appetite or sleep cycle
- Having personality or attitude changes
- Experiencing mood swings
- Exhibiting anger, irritability, hyperactivity, agitation, or emotional outbursts
- Having a lack of motivation
- Feeling paranoia or fearfulness
- Having a sudden weight gain or weight loss
- Exhibiting a decline in physical appearance and/or personal hygiene
- Having abnormal pupil size or bloodshot eyes
- Having foul-smelling breath, body, or clothing
- Appearing physically disheveled
- Having tremors
- Experiencing impaired physical coordination
- Having a decreased interest in hobbies
- Changing social interests
- Having money or financial problems
- Having relationship problems linked with substance use
Diagnosis
The diagnostic criteria for substance use disorder includes a wide range of signs and symptoms resulting from substance use. The DSM-5 spells out specific criteria for a diagnosis of substance use disorder, including:
- Amount: Ingesting larger amounts of alcohol or drugs than intended
- Control: An unsuccessful desire to quit using or reduce the amount of use
- Time: Spending a lot of time obtaining the substance and/or planning to use or thinking about using
- Cravings: A strong desire and cravings to use the substance
- Obligations: A pattern of being unable to meet major responsibilities at work, at school, or at home
- Social: Recurring or ongoing social problems linked with substance use, but regardless of the problems, the substance use continues
- Activities: Losing interest in hobbies, foregoing important social engagements, and/or missing leisure activities because of substance use
- Hazard: Continued risky behavior (such as drinking and driving) regardless of hazardous consequences
- Harm: Using substances continually, regardless of knowing about recurrent physical or psychological problems caused by the substance use
- Tolerance: An adaptation of the body over time, characterized by the brain attempting to adjust to the abnormally high level of drugs or alcohol in the body. This results in the need to increase the amount of alcohol (or drug) ingested to get the desired effect. It may also result in experiencing a diminished effect when using the same amount of the substance. Overall, tolerance causes the need for more and more of a substance, over time, to get the same level of intoxication.
- Withdrawal: Experiencing negative symptoms, called withdrawal symptoms, when stopping the use of the substance, or using the substance to avoid having withdrawal symptoms. Withdrawal symptoms can include shakiness, sweating, increase in pulse, nausea and vomiting, insomnia, hallucinations, and seizures. Withdrawal symptoms differ depending on the type of substance a person used before detoxing.
Substance Use Disorder Categories
Depending on the substance and symptoms, people can fall into different substance use categories. These include:
- Mild substance use disorder: Meeting two to three of the above criteria
- Moderate substance use disorder: Meeting four to five of the above criteria
- Severe substance use disorder: Meeting six or more of the above criteria
Substance use disorders can also be identified by the substance of choice. For example:
- If the substance of choice is alcohol, the diagnosis would be mild, moderate, or severe alcohol use disorder.
- If the substance of choice is opioids, the diagnosis would be mild, moderate, or severe opioid use disorder.
Other defining factors that are taken into account when assigning a substance use disorder include where a person is at on the continuum of recovery. These include:
- Early remission: This is when a person no longer meets the DSM-5 criteria for having a substance use disorder for at least three months but less than a year.
- Sustained remission: This is after a person has not met the DSM-5 criteria for having a substance use disorder for greater than a year.
- Maintenance therapy: This applies when someone is taking a prescribed replacement medication such as methadone or buprenorphine for an opiate use disorder.
How Maintenance Therapy Is Used
In maintenance therapy, a prescribed medication (like methadone) is substituted for a highly addictive drug (like heroin) to prevent withdrawal and cravings, and as part of a harm-reduction strategy.
Causes of Substance Use Disorder
There is no known cause of substance use disorder, but several risks have been identified, A person may be more likely to develop a substance use disorder if one of several factors are present, including:
- Biological factors: A person’s genes, ethnicity, gender, and the presence of mental health disorders may all increase the risk of developing an addiction. In fact, according to the Cleveland Clinic, nearly two-thirds of people in treatment programs for addiction are men.
- Environment: A person’s environment—such as experiencing abuse or neglect during childhood, peer pressure during adolescence, or intense stress levels at any age—can raise the risk of the likeliness of developing a substance use disorder.
- Age: There are specific ages that make a person more likely to develop a substance use problem. Adolescence is a particularly risky time due to changes in the brain that lend themselves to a lack of self-control, poor decision making, and a lack of judgment skills. In addition, when drugs are introduced during the time a teenager’s brain is developing, it can cause addiction to be more likely to occur.
Types of Substance Use Disorders
There are many different types of substance use disorders, including:
- Alcohol
- Stimulants (such as cocaine and methamphetamine)
- Cannabis (marijuana)
- Inhalants (such as solvents, aerosol sprays, nitrites, and gases)
- Hallucinogens (such as LSD, mescaline, PCP, and DMT)
- Club drugs (such as ketamine, ecstasy, GHB, and flunitrazepam)
- Opioids (such as heroin, oxycodone, codeine, morphine, and other types of prescription pain killers)
- Prescription drugs and cold medicines (such as cough syrups with dextromethorphan)
- Sedatives, anti-anxiety drugs, and hypnotics
- Anabolic steroids
- Synthetic cathinone (bath salts)
- Nicotine (from tobacco or e-cigarette/vaping sources)
While different types of substances can cause various signs and symptoms, being addicted to any type of substance results in the same action on the addiction center in the brain.
Treatment
There are several levels of intensity of substance use treatment based on each individual’s situation. These include:
- Medically managed intensive inpatient (detoxification centers): A medically staffed program aimed at helping a person during the initial withdrawal phase of substance use
- Residential/inpatient treatment: A hospital or other inpatient setting where people diagnosed with substance use disorder live 24/7. Inpatient treatment centers include daily talk therapy, support groups, education on addiction and substance use, family therapy, and more. They also provide a safe milieu for those who are highly likely to relapse when living in their using environment.
- Intensive outpatient treatment: An intensive treatment program offering group and individual therapy, an educational component, and other modalities during a day treatment center in which participants attend for a specific number of hours and days per week
- Outpatient: A less intensive type of outpatient program which usually involves fewer hours and days per week. This program serves as a follow-up treatment, designed to offer a longer-term structure to those who have completed inpatient or intensive outpatient programs.
Treatment Modalities
Common treatment modalities for substance use disorders include:
- Individual and/or group therapy
- An educational component to learn about the nature of addiction, denial, and relapse prevention
- Behavior therapy such as cognitive behavioral therapy
Medications
Many different types of medications are commonly prescribed to help treat substance use. The type of drug prescribed depends on many factors, including the phase of treatment a person is in.
Examples of medications for substance use disorders include those that treat the various stages of recovery.
Medication for Detoxification/Withdrawal
Several different medications are given while a person is going through detox; these drugs help safely manage a person’s withdrawal symptoms. The exact type of medication given during detox depends on the recovering person’s drug of choice.
Medications for Substance Use Disorder After Detox
Many types of medications are given to decrease a person’s cravings for a substance, block the ability to get high from a drug, or otherwise help reduce drug-seeking behavior, while helping to stabilize normal brain function. These include:
- Methadone (Dolophine), naltrexone (Vivitrol), and buprenorphine/naloxone (suboxone) or Subutex treat opioid addictions. Naltrexone helps to block the effects of opioids in the brain and is used only after a person has been detoxified.
- Naltrexone blocks nerve receptors involved in the rewarding effects of drinking alcohol. It also helps reduce cravings for alcohol.
- Acamprosate (Campral) is thought to reduce long-term symptoms of withdrawal (such as anxiety and insomnia) and potentially reduce the risk of returning to drinking.
- Disulfiram (Antabuse) is a drug that has long been used for alcohol use. It works by causing an unpleasant effect (such as flushing, nausea, and vomiting) when a person drinks alcohol.
- There are many different types of drugs prescribed for those with co-occurring disorders; the exact type of drug depends on the mental health condition being treated.
Coping
Maintaining sobriety after treatment for substance use is no small undertaking. It’s a lifelong journey involving continually learning how to apply new coping skills to everyday life.
Some principles lend themselves to helping a person cope with the many factors involved in recovering from an addiction. These factors apply to a spouse, caregiver, and other family members as well. They include:
- Getting involved in counseling or therapy with a professional therapist or licensed drug and alcohol counselor
- Continuing to participate in therapy until your counselor or therapist advises that you are ready to complete the program
- Seeking an evaluation from a mental health professional if you have signs of mental health problems (dual diagnosis)
- Getting involved with a support group (such as Alcoholics Anonymous or Narcotics Anonymous) and committing to regular ongoing meetings
- Sharing your experiences with other recovering alcoholics or addicts
- Balancing your schedule to avoid excess amounts of idle time
- Establishing a regular exercise routine (with the approval of your healthcare provider). Exercise has been shown in some studies to be effective for improving depression; it was also found to be an effective add-on treatment for those taking anti-depressant medications.
- Adopting a stress-reduction program—such as yoga—aimed at helping to cope with daily stressors
