Substance Use Disorder

Substance use disorder (SUD) is a medical condition characterized by the misuse of substances such as alcohol, drugs, or medications, leading to significant impairment or distress.

Definition and Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines substance use disorder as a pattern of substance use that leads to significant impairment or distress, as manifested by at least two of the following criteria within a 12-month period:

• Using the substance in larger amounts or over a longer period than intended
• Persistent desire or unsuccessful efforts to cut down or control substance use
• Spending a great deal of time in activities necessary to obtain or use the substance
• Craving, or a strong desire or urge to use the substance
• Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home
• Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the substance
• Giving up or reducing important social, occupational, or recreational activities because of substance use
• Using the substance in situations where it is physically hazardous
• Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
• Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve intoxication or desired effect or a markedly diminished effect with continued use of the same amount of the substance
• Withdrawal, as manifested by either the characteristic withdrawal syndrome for the substance or the substance is taken to relieve or avoid withdrawal symptoms

Types of Substance Use Disorders

Substance use disorders can be classified based on the type of substance used, including:

• Alcohol use disorder
• Opioid use disorder (including prescription opioids and heroin)
• Cannabis use disorder
• Stimulant use disorder (including cocaine and amphetamines)
• Sedative, hypnotic, or anxiolytic use disorder (including benzodiazepines)
• Tobacco use disorder
• Other substance use disorders (including hallucinogens, inhalants, and other substances)

Risk Factors and Causes

The development of a substance use disorder is influenced by a combination of genetic, environmental, and psychological factors, including:

• Genetic predisposition
• Family history of substance use disorders
• Mental health conditions (such as depression, anxiety, or trauma)
• Social and environmental factors (such as peer pressure, stress, or lack of social support)
• Brain chemistry and function

Treatment and Management

Treatment for substance use disorder typically involves a combination of medications, behavioral therapies, and supportive services, including:

• Medication-assisted treatment (MAT) with medications such as methadone, buprenorphine, or naltrexone
• Behavioral therapies such as cognitive-behavioral therapy (CBT), contingency management, and motivational interviewing
• Support groups such as 12-step programs or peer support groups
• Counseling and case management services

Prevention and Early Intervention

Prevention and early intervention efforts can help reduce the risk of developing a substance use disorder, including:

• Education and awareness about the risks of substance use
• Screening and brief interventions in primary care settings
• Family-based prevention programs
• Community-based initiatives to reduce substance availability and promote healthy behaviors