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Substance Use Disorder Defined

Substance use disorder is the term devised by the American Psychiatric Association (APA) that diagnostically replaces terms including substance addiction and substance abuse disorder. Since May 2013, doctors in the U.S. have started using this diagnostic term as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).1 An individual must meet a certain set of criteria in order to receive this diagnosis.

What Is Substance Use Disorder?

This diagnosis was specifically designed to allow doctors to simultaneously address both addictive and non-addictive dysfunctional substance use in clients. This replaces the DSM-4, the diagnostic manual previously used by the APA, which treated addiction and clinically significant abuse as separate distinct issues. Under the DSM-5, there are eight types of substance use disorders that doctors can diagnose. Caffeine is also listed as a substance-related disorder under DSM-5, however, it is not designated as a substance use disorder.2

  • 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

Regardless of the substance used, diagnosis is based on a pathological set of 11 behaviors that fall into four basic categories, with specific patterns in each category, as follows.2

Impaired control: Using for longer periods of time than intended, or using larger amounts than intended; 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 family/social obligations. This may include repeated work absences, poor school performance, child neglect or failure to meet household responsibilities.

Addiction may also be indicated when someone continues using substances despite having interpersonal problems caused by its use. This may include arguments with family members about the substance use, as well as losing important friendships because of continued use. Meaningful social and recreational activities may be abandoned or curtailed due to substance use.

Risky use: Addiction may be indicated when someone repeatedly uses substances 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 though they are aware it is causing or worsening physical and psychological 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 trying to avoid withdrawal symptoms or getting high. Withdrawal is the body’s response to the abrupt cessation of a drug after it has developed a tolerance to it. Withdrawal symptoms 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, however, only about 20% receive treatment.3 According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use results in 88,000 deaths a year.1
  • In the past year, 4.2 million people ages 12 and older met the criteria for cannabis use disorder based on marijuana use.1
  • About 246,000 Americans had a hallucinogen use disorder in 2014.1
  • In 2014, an estimated 546,000 people ages 12 and older were current users of inhalants. The precise number of people with clinically diagnosable inhalant use disorder is unknown.4
  • 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% among men and 400% among women.1 The potent interaction of opioids with alcohol and other sedative-hypnotic drugs can produce lethal interactions.5
  • According to the APA, 11% to 15% of all adults in the U.S. have a bottle of Xanax in their medicine cabinet.6 The exact incidence of sedative use disorder is unknown.
  • About 913,000 people ages 12 and older had a cocaine use disorder in 2014.4
  • Of the estimated 1.6 million people ages 12 and older who used stimulants for nonmedical purposes in 2014, 569,000 were methamphetamine users.4

Heavy Substance Intake

Heavy substance intake is a term used to define a level of substance use that is no longer safe and puts an individual at risk for overtly negative short- or long-term consequences. The Substance Abuse and Mental Health Services Administration defines heavy drinking as five or more drinks on the same occasion on each of five or more days in the past 30 days. Generally speaking, heavy users of any drug consume it on a regular basis and/or consume unusually large amounts either in isolated instances or habitually.7

The Potential Benefits of Diagnostic Simplification

A study published in the December 2013 issue of Alcohol and Alcoholism analyzed the potential benefits of replacing the more complex definition currently used with the single diagnostic criterion of heavy substance intake. Authors from institutions in Canada and nine European countries set out to determine if heavy substance intake alone could effectively replace the 11 symptoms currently used to diagnose substance use disorder. Some experts believe that a relatively complicated definition may not translate well from culture to culture. Others believe that the language currently used to define these disorders may have an unintentional stigmatizing effect on addicted individuals.8

The researchers conducted an extensive review of the current state of scientific knowledge regarding the effects of heavy substance use. They surmised that heavy substance intake is a key underlying factor in the brain changes that contribute to the onset of substance use disorder. They concluded that habitual heavy substance intake is a critical factor in both substance-related illnesses and fatalities, as well as a major contributing factor in most of the social problems associated with substance use.8

As a result of their findings, the study’s authors believe that the term heavy substance intake by itself sufficiently captures the most important elements that define substance use disorder. They also believe that adoption of a simple definition for diagnosing the condition would widen the usefulness of substance use disorder as a concept, while simultaneously lowering the risk that people diagnosed with this condition feel targeted or stigmatized.8

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.

  1. Substance Use Disorders. Substance Abuse and Mental Health Services Administration website. Updated October 27, 2015. Accessed July 28, 2016.
  2. The Diagnostic Criteria for Substance Use Disorders (Addiction). Mental Help website. Updated April 25, 2016. Accessed July 28, 2016.
  3. 10 percent of US adults have drug use disorder at some point in their lives. National Institutes of Health website. Published November 18, 2015. Accessed July 28, 2016.
  4. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration website. Published September 2015. Accessed July 28, 2016.
  5. Rates of nonmedical prescription opioid use and opioid use disorder double in 10 years. National Institutes of Health website. Published June 22, 2016. Accessed July 28, 2016.
  6. Is Xanax Dangerous? What’s Hype and What Are the Real Threats?’s_hype_and_what_are_the_real_threats Published February 15, 2012. Accessed July 28, 2016.
  7. Drinking Levels Defined. National Institute on Alcohol Abuse and Alcoholism website. Accessed July 28, 2016.
  8. Rehm J, Marmet S, Anderson P, Gual A, Kraus L, Nutt DJ, et al. Defining substance use disorders: Do we really need more than heavy use? Alcohol Alcohol. 2013 Nov-Dec;48(6):633-40. doi: 10.1093/alcalc/agt127. Epub 2013 Aug 7.

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