Substance Use Disorder:

Aspects of Recovery

What is a Substance Use Disorder?

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

DSM-5 is a manual used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental/behavioral disorders.

The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: 

  1. Alcohol
  2. Caffeine
  3. Cannabis
  4. Hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD)
  5. Inhalants
  6. Opioids
  7. Sedatives
  8. Hypnotics, or anxiolytics
  9. Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
  10. Tobacco, and other or unknown substances.

While some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.

The activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.

The pharmacological mechanisms for each class of drug are different. But the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

Not all people are automatically or equally vulnerable to developing substance-related disorders. Factors for developing a substance use disorder include biological, environmental and methods of use. 

There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders.

  • Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result

  • Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorders.

Criteria for Substance Use Disorders span a wide variety of problems arising from substance use, and cover 11 different aspects:

  1. Taking the substance in larger amounts or for longer than you’re meant to. You meet your friends after work for a cocktail. You tell yourself you are only going to have one or two because you need to get home.  Before you know it, it’s a few hours later and you have four or five drinks.

  2. Wanting to cut down or stop using the substance but not managing to.  You wake up the next morning and feel like crap.  You tell yourself that you are not going to do that again!  Back at work, your friends from the night before tell you what a great time they had, and ‘won’t you join them again tonight?’  You do.  This becomes a pattern.

  3. Spending a lot of time getting, using, or recovering from use of the substance.  You spend most of Sunday recovering from the night before.  In fact, most mornings after drinking, you feel sick.  Hint:  A hangover is recovering from use of the substance.

  4. Cravings and urges to use the substance.  You begin to really look forward to the after work drinks; in fact, the drinking becomes how to relax and undo the day.  This is when you feel like you.  The drink becomes your coping mechanism.

  5. Not managing to do what you should at work, home, or school because of substance use.  Maybe your dishes start to pile up.  Or the outfits you used to iron and prepare for the next day or week becomes a scramble the next morning.  Assignments get rushed or postponed or missed.  

  6. Continuing to use, even when it causes problems in relationships.  Your significant other may complain about you going out; a friend stops answering your late night drunk calls.  Your boss is on your back about tardiness,  

  7. Giving up important social, occupational, or recreational activities because of substance use.  You stop attending events where alcohol isn’t served; you aren’t jogging anymore, or attending those cooking classes you enrolled in.  Non drinking family events feel like a burden, so you cut them short or just don’t show. 

  8. Using substances again and again, even when it puts you in danger.  Maybe you got stopped by the police, maybe given a ticket or even a DUII.  You ‘forgot’ where you parked and wandered the dark streets late night trying to find it.  You left the bar with someone you didn’t even know.  

  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.  Your doctor tells you your pancreas or kidneys or liver is in bad shape.  You are pre-diabetic.  You are diabetic.  Yet you continue to drink.

  10. Needing more of the substance to get the effect you want (tolerance).  One beer doesn’t do anything for you.  One margarita used to give you a buzz, but not so much anymore.  Maybe you switch to martinis or alcohol on the rocks.  Shots.  You tell yourself that you are saving calories.  You stop eating before you go out because that interferes with the buzz.  

  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.  Maybe you feel pretty shaky in the morning, and have a bloody mary or a mimosa.  That takes the edge off, doesn’t it?  Your head or hands shake a bit-but when you have a drink or two, that stops it.  You get an anxiety attack mid day, and have a glass of wine, or two, and are suddenly calmed down.  

 

Two or more substance use disorder criteria within a 12-month period indicate a potential diagnosis for a Substance Use Disorder. 

Severity of Substance Use Disorders

The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. 

  • Two or three symptoms indicate a mild substance use disorder

  • Four or five symptoms indicate a moderate substance use disorder, and 

  • six or more symptoms indicate a severe substance use disorder.

Clinicians can also add 

  • “in early remission” 

  • “in sustained remission” 

  • “on maintenance therapy” for certain substances, and 

  • “in a controlled environment” (Incarcerated, in residential treatment, in hospital)

These further describe the current state of the substance use disorder.

Diagnosing drug addiction (substance use disorder) requires a thorough evaluation and often includes an in-depth bio-psycho-social assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine or other lab tests are used to assess drug use, but they’re not a diagnostic test for addiction.  There are additional tools used to obtain a diagnosis-these include:

AUDIT Tests:  “The  Alcohol Use Disorders Identification Test” is a guideline by the World Health Organization (WHO) Department of Mental Health and Substance Dependence used by clinicians and physicians worldwide in the diagnosis of Alcohol Use Disorders.  You can download the manual and tests (including the self test) from the Recovery Tools Page.

For reference, scoring is as follows:  

  • Risk Level Intervention AUDIT score* Zone I Alcohol Education 0-7

  • Zone II Simple Advice 8-15 Zone III Simple Advice plus Brief Counseling and Continued Monitoring 

  • 16-19 Zone IV Referral to Specialist for Diagnostic 

  • 20-40 Evaluation and Treatment                                                                                                

Another test used is the MAST.  The Michigan Alcohol Screening Test (MAST) was developed in 1971, and is one of the oldest and most accurate alcohol screening tests available, effective in identifying dependent drinkers with up to 98 percent accuracy. Questions on the MAST test relate to the patient’s self-appraisal of social, vocational, and family problems frequently associated with heavy drinking. The test was developed to screen for alcohol problems in the general population. You can download a PDF of this below.  

IMPORTANT:  The tests are structured to be administered by professionals trained in Substance Use Disorders and are presented here for reference and information only.  Always seek medical advice for diagnoses.

Substance/Medication-Induced Mental Disorders

Substance/medication-induced mental disorders are mental problems that develop in people who did not have mental health problems before using substances. They include:

  • Substance-induced psychotic disorder

Substance-induced psychotic disorder is a condition that causes symptoms like hallucinations and delusions and that is triggered by misuse of drugs or alcohol. In most cases the psychosis is short-term, but in rare cases, heavy and long-term use of a drug can cause psychosis that lasts for months or years.

  • Substance-induced bipolar and related disorders

For the substance/medication-induced bipolar, the clinical picture is delineated by an elevated, expansive, or irritable mood, with or without depressed mood, or markedly diminished interest or pleasure in all spheres of life

  • Substance-induced depressive disorders

Substance/medication-induced depressive disorder is characterized by a prominent and persistent change in mood, exhibiting clear signs of depression or a marked decrease in interest or pleasure in daily activities and hobbies, and these symptoms start during or soon after a certain substance/medication has been taken

  • Substance-induced anxiety disorders

Substance or medication-induced anxiety disorder is the diagnostic name for anxiety or panic attacks that are caused by alcohol, drugs, or medications. While it is normal to have some feelings of anxiety in stressful situations, and even the transient feelings of anxiety or panic that can happen spontaneously during intoxication or withdrawal from alcohol or drugs, substance-induced anxiety disorder causes clinically significant distress or functional impairments.

  • Substance-induced obsessive-compulsive and related disorders

Substance/medication-induced obsessive-compulsive or related disorder is diagnosed in patients with obsessions and compulsions characteristic of OCD, but that develop during or after substance intoxication or withdrawal or after exposure to medications.                       

  • Substance-induced sleep disorders

Substance or medication-induced sleep disorder is the official diagnostic name for insomnia and other sleep problems which are caused by the use of alcohol, drugs, or taking certain medications. Roughly translated, that means that one of the effects of drinking alcohol, using a drug, or taking a medication, is having a problem with getting to sleep at the time you want to sleep, staying asleep at the time you want to sleep, excessive sleepiness during the day, or unusual behaviors when you do sleep

  • Substance-induced sexual dysfunctions

Medication-induced sexual dysfunction occurs when there is a problem that leads to frustration with sexual activity or performance. Symptoms of sexual dysfunction for males may include: Loss of sexual interest or desire. Not being able to obtain or maintain an erection.

  • Substance-induced delirium

Substance intoxication delirium is the diagnostic name for alcohol or drug-induced delirium. 1 The condition is caused by intoxication from a psychoactive substance. Disturbances in focus and attention are normal when people are under the influence of alcohol or drugs, and even when they are overtired.

  • Substance-induced neuro-cognitive disorders

Substance-induced neuro-cognitive disorders: Disturbance of cognitive function, such as memory impairment, aphasia or the loss of ability to understand speech; or apraxia, the inability to perform purposeful actions, that is induced by substance use and that is not typically present when substances are not being used

Substance/medication induced disorders closely resemble the mental health disorder they represent; as a result, many hospitals, emergency care facilities and detoxification facilities treat the substance use in an attempt to ‘rule-out’ substance inducement.  

It is imperative that if you or someone you love is exhibiting any of these symptoms, seek medical support and advice immediately.  

For more information:  

https://www.verywellmind.com

https://www.ncbi.nlm.nih.gov

A Substance Use Disorder professional facilitates a bio-psychosocial assessment to obtain a diagnosis; the answers are ‘weighed’ to the DSM V to obtain the diagnosis; the assessment encompasses all aspects of your life, and form the basis for treatment.  

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