Substance Use Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, criteria for substance use disorder covers multiple symptoms that fall under four categories, including the following.

Social issues

Social issue symptoms may include the following: 

• Use of the substance creates impairment that affects function at work, school, or home
• The individual gives up previously enjoyed leisure activities because of substance use
• Use adversely interferes with social connections

Drug effects

Drug effect symptoms may include: 

• Tolerance² to the substance (the individual must take more to get the same effect)
• Symptoms of withdrawal,³ which can vary depending on the substance, the amount used, and the frequency of use

Impairment of control

Impairment of control can be defined with the following two symptoms: 

• Unsuccessful attempts to cease use of the substance
• Strong cravings for the substance

Risky use

Risky use of substances can include the following symptoms: 

• Continuing to use a substance despite knowing that the use causes adverse symptoms, such as physical health challenges 
• Continued use of a substance even though using puts the individual in risky situations or settings

When a health professional diagnoses an SUD, they may classify it as mild, moderate, or severe. Two or three symptoms in the individual are considered mild, four or five are moderate, while six or more symptoms indicate a severe SUD. 

There is no one accepted cause for an SUD. Rather, researchers have identified several risk factors that may contribute to a susceptibility to experiencing these conditions, including but not limited to the following. 

Genetics

Individuals with a family history of SUDs may be more likely to develop one themselves. Recent research has identified a series of common genetic markers related to dopamine messages that may be responsible, which can be viewed in the research section of this article. 

Environment

Those who experience trauma in developmental years, such as mental, physical, or sexual abuse, can have an increased chance of experiencing an SUD.

Other mental health disorders

The presence of another mental health disorder, such as depression, anxiety, or bipolar disorder, among others, may indicate a higher risk of developing an SUD. In some cases, people may self-medicate the symptoms of another mental illness. In addition, substances can sometimes change brain structure and function, making a person more likely to develop a mental illness. 

The first step in getting treatment for an SUD may be admitting that there is a problem, which could be difficult for someone who is currently experiencing one of these conditions. Treatment can depend on many factors, including the type of substance, length of time it has been used, and whether there is a co-occurring mental health condition present. 

Medications

Depending on the substance or substances the individual has been using, certain prescription medications may be given to help them manage overdoses, withdrawal symptoms, cravings, and substance effects. They might also help maintain long-term sobriety by managing mental illness and other mental health conditions.

• Naltrexone - Used for Alcohol, opioid, and other disorders.
• Methadone - Used for opioid use disorder. 
• Naloxone - Used for reversing opioid overdose.
• Disulfiram - Used for alcohol use disorder.
• Acamprosate - Used for alcohol use disorder. 
• Varenicline - Used for nicotine use disorder. 

Antidepressants or anti-anxiety medications may also be prescribed for individuals struggling with depression or other mood disorders. 

Other treatments

For some severe substance use disorders, a medical professional may order medically supervised detox, which involves administering medications during this period to help recovery. They may also recommend residential or outpatient treatment, partial hospitalization (day treatment programs), or sober living communities. 

In addition to individual therapy, some professionals may recommend group programs. These may be traditional 12-step or community support programs that offer socialization with other former users in an environment of support and understanding. 

Self-care

A therapist working with a person in recovery from an SUD may recommend healthy lifestyle habits to support living without substances long-term. to help clients manage stress and regulate mood. Some of these habits may include the following:

• Avoiding individuals and situations that were formerly associated with their substance use
• Eating a balanced, nutritious diet and hydrating regularly
• Participating in consistent, moderate-intensity physical activity 
• Maintaining a strong social circle and participating in hobbies and social activities with friends and family members regularly
• Learning and implementing relaxation techniques such as meditation, breathing exercises, or visualization
• Getting sufficient sleep through the implementation of healthy sleep habits

Support can be a vital factor in recovery from an SUD. Therapy, especially in the form of CBT and CM, may be helpful in training new positive behaviors and increasing self-esteem. In addition to shifting patterns of thought and behavior, CBT also offers positive coping skills and reinforcement of healthy lifestyle habits. 

There may be a disparity of treatment in some geographical areas for specialized treatment like CBT or CM for SUDs. Not every area is equipped with licensed therapists who specialize in this area or may have limited options. Online therapy addresses this barrier by offering care to anyone with internet. 

Online therapy platforms like BetterHelp match individuals with a licensed therapist through the completion of an online survey and allow a change of therapist with no financial penalty. Therapy appointments are held via video, phone, or live chat following the client’s preferences. 

Below are a few other resources for anyone seeking more information about SUDs and how to get help:

• The Substance Abuse and Mental Health Services Administration (SAMHSA)’s Find Treatment Tool
• SAMHSA National Helpline
• 988 Suicide and Crisis Lifeline 
• The National Institute on Drug Abuse

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact Substance Abuse and Mental Health Services Association (SAMHSA) National Helpline at 1-800-662-HELP (4357).

A meta-analysis of over one million subjects published in 2023 identified genes commonly inherited across SUDs, regardless of which substance was misused. The dataset showed that the genes associated with these disorders were linked to dopamine signaling in the body, reinforcing the role of dopamine in addiction. Researchers hope to use this information to find new treatment targets for SUD, especially for individuals who have been diagnosed with more than one. 

According to a 2020 report by the CDC, 13% of Americans reported that they either started or increased substance use as a coping mechanism during the COVID-19 pandemic. Researchers also found during this time that overdoses during the pandemic increased as well, with an 18% increase starting in 2019 that continued trending throughout 2020. 

A 2023 report found significant disparities in treatment for opioid use disorder in the United States. Only one in five people with OUD received medical treatment, with certain groups identified as substantially less likely to receive treatment, including women, Black adults, unemployed individuals, and those living in metropolitan areas.

Below are several statistics on SUDs: 

• Of individuals aged 12 and over in the United States, 16.5% (or 46.3 million) met DSM-5 criteria for a substance use disorder, with 29.5 million living with alcohol use disorder and 24 million living with a drug use disorder. 
• The highest percentage of the US population that met the criteria for substance use disorder was found between ages 18 and 25.
• Studies have found that internet-based therapy for people with substance use disorders may sometimes be more effective than in-person modalities and has been associated with more cost-effectiveness and convenience.