Substance Use Disorder Defined

Substance use disorder includes substance addiction and substance abuse. An individual must meet a certain set of criteria in order to receive this diagnosis.

What Is Substance Use Disorder?

This diagnosis was designed to allow doctors to address both addictive and non-addictive substance use in clients. The previous version treated addiction and abuse as two separate issues. Under the new version, DSM-5, there are eight types of substance use disorders that doctors can diagnose, including:

• Alcohol
• Cannabis (e.g. marijuana)
• Hallucinogens (e.g. LSD, peyote)
• Inhalants
• Opioid (e.g., heroin)
• Sedatives, hypnotics, or anxiolytics (e.g. Valium, Xanax)
• Stimulants (cocaine, methamphetamine)
• Tobacco

Diagnosis is based on a set of 11 behaviors. Each fall into four basic categories, as follows.

Impaired control: Impaired control includes using a substance for longer periods of time than intended. This may also include using larger amounts than intended. A few examples include:

• Wanting to reduce use, yet being unsuccessful in doing so
• Spending excessive time getting/using/recovering
• Cravings that are so intense it is difficult to think about anything else

Social impairment: People may continue to use despite problems with work, school or social obligations. This may include:

• Repeated work absences
• Poor school performance
• Child neglect
• Failure to meet household responsibilities.

People may continue to use despite having personal problems caused by its use. This may include arguments with family members about the substance use. Many people will lose important friendships because of continued use. Meaningful activities may be abandoned or due to substance use.

Risky use: This is repeated use in physically dangerous situations. This may include using alcohol or other drugs while operating machinery or driving a car. Some people continue to use addictive substances even when they know it is causing physical and mental problems. An example is a person who continues to drink alcohol despite having liver failure.

Pharmacological indicators (tolerance and withdrawal): Tolerance occurs when a person needs to increase the amount of a substance to achieve the same desired effect. The “desired effect” could be to avoid withdrawal symptoms or to get high. Withdrawal is the body’s response to the abrupt cessation of a drug after it has developed a tolerance to it. Multiple factors may play a role in the level of withdrawal symptoms. These symptoms mainly depend on the type of drug and duration of use.

Substance Use Disorder Statistics

• There are an estimated 17.6 million Americans with alcohol use disorder. Only about 20 percent receive treatment. According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use results in 88,000 deaths a year.
• In the past year, 4.2 million people ages 12 and older met the criteria for cannabis use disorder.
• About 246,000 Americans had a hallucinogen use disorder in 2014.
• In 2014, an estimated 546,000 people ages 12 and older were current users of inhalants.
• In 2014, an estimated 1.9 million people had an opioid use disorder related to prescription pain relievers and about 586,000 had an opioid use disorder related to heroin use. Since 1999, opiate-related overdose deaths have increased 265 percent among men and 400 percent among women. The potent interaction of opioids with alcohol and other sedative-hypnotic drugs can produce lethal interactions.
• According to the APA, 11 to 15 percent of all adults in the U.S. have a bottle of Xanax in their medicine cabinet.
• About 913,000 people ages 12 and older had a cocaine use disorder in 2014.
• Of the estimated 1.6 million people ages 12 and older who used stimulants for nonmedical purposes in 2014, 569,000 were methamphetamine users.

Heavy Substance Intake

Heavy substance intake is a level of substance use that is no longer safe. It puts an individual at risk for negative consequences. This is usually defined as five or more drinks on the same occasion, for five or more days in the past 30 days. Heavy users consume their drug on a regular basis. They may consume unusually large amounts.⁷

Regardless of the term used, if you or a loved one is struggling with heavy substance use, dependence or addiction, contact Promises today. Our compassionate, highly trained addiction counselors are here to help you overcome these addictions.