What Is a Substance Use Disorder?

by Amanda Lautieri  |  Updated: June 12, 2020 

Drug and alcohol addictions are commonly diagnosed as substance use disorders (SUDs). Substance use disorders comprise a grouping of conditions characterized by several potential mental, behavioral, and physiological signs and symptoms that may arise when an individual continues to drink or use drugs despite them causing a range of considerable problems in their lives.¹

Clinicians may diagnose an SUD using a set of several criteria that, depending on the number of them present, may serve as some indication of the severity of an individual’s addiction.

How Is a Substance Use Disorder Diagnosed?

When clinicians diagnosis a substance use disorder, they do so with a set of 11 criteria. When 2 or more of the criteria are present within a 12-month period, an individual may be diagnosed with an SUD. The criteria are:¹

1. Using a substance more often or in larger amounts than you originally set out to.

2. Making repeated failed attempts to cut back or stop using a substance.

3. Expending a lot of time trying to get, use, or recover from substance use.

4. Craving or strongly desiring to drink or use drugs.

5. Neglecting to keep up with your obligations at home, work, or school because substance use has gotten in the way.

6. Abandoning social, professional, or recreational activities due to your substance use.

7. Continuing to drink alcohol and/or use a drug even when doing so is causing problems in your interpersonal relationships.

8. Endangering yourself or others by using substances in hazardous scenarios e.g., driving while intoxicated.

9. Continuing to use a substance even when you know it has caused or worsened a physical or psychological health problem.

10. Developing a growing tolerance to a drugs or alcohol, indicated by:

• Needing more and more to achieve the desired effect.
• Feeling diminished effects at the same dose.

11. Experiencing withdrawal upon attempting to reduce or end use, manifested by:

• Having the characteristic withdrawal syndrome of the substance being used.
• Needing to continue use of a substance or similar substances to avoid withdrawal.

Meeting fewer criteria (2-3) may indicate a mild disorder, while meeting more (4+) will indicate a more serious problem that might require a higher level of treatment.¹ 

Signs and Symptoms of Drug and Alcohol Abuse

There are many other physical and behavioral signs and symptoms that someone may be struggling with drug abuse and/or substance addiction. Some potential signs and symptoms of various types of problematic substance use may include:^2–5

• Dilated or pinpoint pupils.
• Bloodshot eyes.
• Red/raw nostrils.
• Runny nose.
• Scratching or picking at the skin.
• Shaking/tremors.
• Slurred speech.
• Wearing long sleeves in warm weather (an attempt to cover injection marks).
• Possessing/hiding drug paraphernalia (e.g., tin foil, pipes, balloons, needles, mirrors, etc.)
• Quickly fatigued/appearing drowsy often.
• Displaying uncharacteristic personality changes.
• Suddenly becoming withdrawn.
• Showing signs of depression or unstable mood.
• Acting hostile, agitated, or even violent.
• Becoming less communicative.
• Lying more often or being increasingly secretive.
• Frequent or sudden changes in friends/social groups.
• Showing signs of apathy or decreasing motivation.
• Sleeping more or less than usual.
• Changing eating habits.
• Neglect of hygiene or personal appearance.
• Missing school or work.
• Engaging in risky sexual behaviors.
• Blacking out.
• Stealing.
• Getting in trouble with the law.

These signs don’t necessarily mean a person has a substance use disorder, but they are red flags to look out for if you suspect someone you care about has a problem with drugs or alcohol.

Is Dependence the Same as Addiction?

Even though the concepts of dependence and addiction commonly overlap, they are not always entirely interchangeable. In some instances, a person can be develop physical dependence to a drug and not have a substance use disorder. Conversely, with some substances a person can meet the criteria for a substance use disorder without having developed considerable physical dependence.⁶

Dependence refers to a physical adaptation to drugs and alcohol. As the brain grows accustomed to the chemical influence of a drug, some degree of tolerance will often develop, and the person will need more of the substance in question to feel the effects they want. As use escalates, the likelihood of developing physiological dependence grows.

At that point, with many kinds of substances, should the dose be reduced—or the drug stopped entirely—a withdrawal syndrome may emerge. This may involve physical and/or mental health symptoms.

Some degree of tolerance and dependence may develop even in those who are taking medications as prescribed. In isolation, they may not indicate a drug problem. However, dependence and tolerance often accompany the development of substance use disorders.⁶

Something to keep in mind when considering the difference between physiological dependence and addiction is that dependence is purely a physical phenomenon. An addiction, or substance use disorder, is a larger issue. It involves a cluster of symptoms, sometimes including dependence and tolerance, that together may indicate the development of compulsive patterns of substance use despite the adverse consequences.⁶

In addition to the reinforcing or rewarding properties of abused substances, physical dependence can make it even more challenging to stop using drugs or alcohol, especially if the accompanying withdrawal syndrome is very severe. For example, withdrawal from opioids can make a person extremely sick, and that person may keep using opioids past the point that it is enjoyable simply to avoid the symptoms of withdrawal.

Some types of withdrawal may even be life-threatening, such as that of alcohol withdrawal, which can bring on very serious symptoms such as agitation, delirium, dangerously elevated heart rate, and tremors/seizures.⁷ Someone abusing or addicted to a drug, especially when taking it often and/or in large amounts, can more easily become dependent on it; and, many substances of abuse (both prescription and illicit) have an accompanying withdrawal syndrome once dependence develops.

This is why many rehabilitation programs have a medical detox component to help dependent patients safely and comfortably manage their withdrawal prior to initiating therapy to address the larger substance use disorder and the underlying reasons for the patient’s drug use.

Risk Factors for Substance Use Disorders

Some people may be particularly vulnerable to developing a substance use disorder at some point in their lives due to having one or more of the following risk factors:^8–11

• Family history of addiction and/or mental health problems.
• History of abuse or neglect.
• Aggressive behavior in early childhood.
• Conflict or violence in the family unit.
• Little involvement in school.
• Environmental stress such as poverty or violence in the neighborhood.
• Easy access to drugs.
• Peer pressure.
• Existence of a current mental health issue.

While there are many risk factors for addiction, there are a number of protective factors, or those that reduce your likelihood of this disease. These include:^8,9

• Healthy parental involvement.
• Intervention for issues impacting both parents and children, such as mental health or substance abuse treatment or counseling for adverse childhood experiences (e.g., divorce, abuse, or parental death).
• Development of good coping skills and ability to regulate emotions.
• Involvement in school.
• Involvement in positive recreational and social activities.
• Strong sense of community.
• Anti-drug policies/limited access to substances.

Types of Treatment

Getting help for a substance use disorder doesn’t always mean going into a residential drug rehab. There are many different forms of treatment and many paths to recovery that may be successful for you. If you’ve tried one path before and you’ve relapsed, you might need to adjust your plan slightly. A doctor or addiction therapist can help you determine what might be right for you at this moment.

Forms of treatment for substance use disorders include:

• Inpatient or outpatient medical detox. This will involve regular medical supervision and the use of medications to help ease you through the withdrawal process. A period of additional rehabilitation or substance use disorder treatment may be initiated once you’re feeling well enough.
• Inpatient or residential rehabilitation. A live-in, drug-free environment where you’ll have 24/7 care and structured days, an inpatient or residential rehab is a great option for those who need the extra support in early recovery. During your time, you’ll work on your aftercare plan for when you return home.
• Partial hospitalization program (PHP). In this intensive program, you’ll spend the majority of your days in therapy but will have the freedom to return to your residence in the evenings.
• Intensive outpatient program (IOP). This outpatient level of care offers many weekly hours of therapy, though not as many as a PHP.
• Outpatient therapy. Generally, standard outpatient programming includes 1-2 hours of therapy per week and is often a step-down treatment for someone who has already completed a higher level of care.

Not all rehabilitation approaches will be a good fit for everyone, as individual treatment needs will naturally vary. A good treatment facility will allow you to adjust your care plan as needed. Many people will move through different levels of care as they progress or regress in their recovery.

Finding a rehab facility that provides individualized assessments and tailored treatment plans can help to ensure you get care that meets your unique needs. If you also struggle with another mental health disorder such as depression or bipolar disorder , you can seek out programs that treat co-occurring disorders. If you’re unsure, you can always ask a facility whether they provide this type of treatment.

How to Get Help

A substance use disorder can be devastating, but treatment can give you your life back. For help, call us today. If you feel you’re ready to seek professional help for a co-occurring mental health and substance use disorder, American Addiction Centers (AAC) can help. AAC is a nationwide provider of treatment facilities and is committed to making recovery accessible to everyone in need. Call our 24/7 hotline now to discuss your treatment options with one of our friendly admissions navigators today!

Sources:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

2. National Institute on Drug Abuse. (2014). What are signs of drug use in adolescents, and what role can parents play in getting treatment?

3. Ali, S., Mouton, C. P., Jabeen, S., Ofoemezie, E. K., Bailey, R. K., Shahid, M., & Zeng, Q. (2011). Early detection of illicit drug use in teenagers. Innovations in clinical neuroscience, 8(12), 24–28.

4. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.

5. U.S. Department of Health and Human Services. (2019). Mental Health and Substance Use Disorders.

6. National Institute on Drug Abuse. (2018). Is there a difference between physical dependence and addiction?

7. Michael James Burns, MD, FACEP, FACP, FIDSA. (2019). Delirium Tremens (DTs). Medscape.

8. McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112–130.

9. Substance Abuse and Mental Health Services Administration. (n.d.). Risk and Protective Factors.

10. National Institute on Drug Abuse. (2003). What are risk and protective factors?

11. Fresno County Department of Public Health. (n.d.). Substance Use Disorder Information for Parents/Caregivers.

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