more about substance abuse disorders
What is a substance use disorder?
The American Psychiatric Association classifies a substance use disorder as a mental disorder. A substance use disorder is usually indicated when a person is unable to control their use of a mood-altering substance, they experience cravings for the substance, and they continue to use the substance despite repeated use-related consequences. The person might have repeated disputes with their spouse or parents, perform poorly at work or school, or repeatedly place themselves in life-endangering situations. Still, they continue to use the substance with seeming disregard for the risk of additional consequences.
The mental processes underlying the development of a substance use disorder are complex. Mood-altering substances act on the brain's reward system, resulting in intense feelings of pleasure and reinforcing the use of the substance. With continued use of the substance, the brain's circuitry is altered and the individual begins to prioritize the use of the substance over other important activities. Normal activities which had activated the reward system in the past, such as enjoying a meal or spending time with family, no longer produce the same sense of enjoyment. Instead, the pursuit of the pleasure produced by the substance begins to overshadow many basic needs, such as eating, sleeping, having sex, or maintaining emotional bonds with family members. Additionally, the pursuit of the pleasure persists long after the substance has stopped producing the desired effect.
The substance-induced changes in brain circuitry persist beyond the initial weeks and months of abstinence, making the person susceptible for relapse. Brain imaging research has shown that the brain can take up to 18 to 24 months to heal from the effects of active addiction. In addition to the reduced sense of pleasure from normal activities, the individual may experience anxiety, depression, irritability, and insomnia. These uncomfortable physical and emotional states - sometimes called post-acute withdrawal syndrome - place the person at risk for relapse. Therefore, it is important for them to receive adequate support during this critical stage of recovery.
The diagnostic criteria for a substance use disorder include the following:
- Using larger amounts of the substance than intended, or for a longer period of time than intended
- Wanting to cut down or control the use of the substance, or attempting to cut down or control the use without success
- Spending a great deal of time in obtaining, using, or recovering from the effects of the substance
- Having cravings for the substance
- Being unable to fulfill major role obligations due to the use of the substance (e.g., being insufficiently engaged with the family, failing to meet deadlines at work or school)
- Continuing to use the substance despite the fact that it has caused or could be exacerbating social or interpersonal problems (e.g., repeated legal problems, ongoing arguments with spouse or parents)
- Giving up or cutting back on important social, occupational, or recreational activities due to the use of the substance (e.g., giving up family outings or business networking opportunities)
- Repeatedly placing self at risk of harm while using or after using the substance (e.g., operating a vehicle, working on a construction site)
- Continuing to use the substance despite the fact that it has caused or could be exacerbating a physical or psychological problem (e.g., contributing to diabetes or depression, or making them more difficult to treat)
- Developing tolerance (i.e., having to use more of the substance to achieve the desired effect, or discovering that using the same amount has a notably decreased effect)
- Experiencing withdrawal (i.e., having withdrawal symptoms after discontinuing the use of the substance, or using the substance or a similar substance to relieve or avoid withdrawal symptoms)
A substance use disorder can be diagnosed when a person meets two or more of these diagnostic criteria within the same one-year period. The disorder is described as mild, moderate, or severe, depending on the number of diagnostic criteria met. A mild disorder is indicated by two to three criteria, a moderate disorder is indicated by four to five criteria, and a severe disorder is indicated by six or more criteria. Neither tolerance nor withdrawal is required for the diagnosis of the disorder, although a history of withdrawal is indicative of a more advanced stage of addictive disease.
Regardless of the severity of the substance use disorder, many effective treatments are available. For a mild to moderate diagnosis, outpatient counseling and self-help groups would likely be sufficient, whereas a moderate to severe diagnosis would likely require a more structured program, including medical care.