July 10th, 2020

What Is Substance Use Disorder?

A first-person photograph of a person submerged under water, reaching up for the surface — a metaphor for substance use disorder.

Substance use disorder is a disease that impacts a person’s ability to control their use of a drug. This includes legal and illegal drugs — medications, marijuana, nicotine, alcohol, and so on. A person experiencing substance use disorder may be unable to complete daily tasks, could cause harm to others, and may potentially get into legal trouble over their behavior.

Drug use has been on the rise, and substance use disorder is a common disease that impacts millions of Americans each year. According to the 2018 National Survey on Drug Use and Health, just over 8% of all US adults had a substance use disorder, accounting for 18.7 million individuals.

Substance use itself may not be a problem, but if it begins to affect an individual’s health or ability to function in life, that person may have a substance use disorder. Note that, while the term “substance use disorder” is often used interchangeably with “substance abuse,” “dependence,” or “addiction,” there are distinctions between these concepts.

Given the above statistics, it’s important to understand the nature of this disease. This guide will provide the diagnostic criteria for substance use disorder so that readers can see these differences clearly and understand the ramifications it can have on a person’s life.

Substance use disorder criteria

In order for a doctor to diagnose a case of substance use disorder, the patient’s condition must meet certain criteria. These are laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This manual recognizes substance use disorders that involve the following classes of drugs:

Alcohol Opioids
Caffeine Sedatives
Cannabis Hypnotics
Hallucinogens Stimulants
Inhalants Tobacco

If an individual is struggling with moderating their use of any of the above substances, they may fall into the criteria for substance use disorder. These criteria are outlined in the DSM-5, which includes:

  • Experiencing persistent cravings to use the substance
  • Having a desire to reduce substance use, but being unable to do so.
  • Exhibiting withdrawal symptoms
  • Developing a tolerance for the substance, requiring more and more of it over time
  • Spending an excessive amount of time procuring, using, and recovering from the use of the substance
  • Taking the substance for longer (or in larger amounts) than intended
  • Being unable to meet work-, home-, or school-related obligations due to substance use
  • Continuing to use after being made aware of existing physical/psychological conditions that are being worsened by the substance

Depending on the number of criteria that an individual meets, their condition may be classified as mild, moderate, or severe substance use disorder. The severity of the diagnosis may impact the specifics of their treatment plan.

The exact cause of substance use disorder is not yet known, and research on what causes drug and alcohol addiction is ongoing. However, some major contributors to developing a substance use disorder, including individual and environmental factors, have been identified:

  • A history of addiction in the family, which may indicate a genetic disposition to substance use disorder
  • A dysfunctional caregiving environment during childhood
  • Existing mental illnesses, such as anxiety disorders, depression, or bipolar disorder
  • Existing physical conditions that cause chronic pain
  • Severe sources of stress, such as the loss of a loved one, relationship problems, or financial difficulties
  • Social pressures to engage in substance misuse from friends, family, social media (particularly for teens), and more

Substance use disorder symptoms

The symptoms of substance use disorder can vary greatly depending on the substance being used. For example, withdrawal from alcohol looks and feels different from withdrawal from marijuana. However, there are some symptoms that occur in most cases of substance use disorder:

  • A decrease in performance or attendance at work or school
  • Using the substance in risky situations, such as while driving
  • Experiencing sudden mood swings or changes in personality
  • Unexplained deterioration of physical appearance
  • Impaired coordination or slurred speech
  • Changes in friendship groups, hobbies, or favorite places
  • Changes to existing relationships, including new patterns of behavior involving manipulation and abuse — these may deteriorate into toxic relationships
  • Sudden financial problems due to substance-related expenses

Substance use disorder treatment options

If a substance use disorder is not treated, continued addictive use will likely result in negative consequences for the individual and their loved ones. The impact of a substance use disorder can include legal problems, decreased job performance, health problems, or serious physical injury — potentially death — as a result of the risky behavior often associated with using. Without treatment and a support network, the individual will continue to be at risk of relapse, which can bring a great deal of volatility and instability into their lives.

Regardless of your or your loved one’s condition, know that substance use disorder is treatable. Whether they need help with managing withdrawal symptoms, understanding their condition, and finding appropriate coping mechanisms, there are treatment options and strategies to help.

Quitting a substance without medical supervision can be dangerous — particularly in cases involving excessive amounts of alcohol or opioids. Most treatment plans first focus on managing withdrawal symptoms, as this step is required before further treatment can take place.

As noted above, withdrawal symptoms and severity can vary greatly depending on the type of substance being used. An outpatient treatment program can dramatically improve patient outcomes, while some patients may prefer treatment at an inpatient treatment facility, depending on their symptoms.

The FDA has approved several medications for use in substance use disorders. For instance, the FDA has approved three medications for opioid use disorder: buprenorphine, methadone, and naltrexone. These have been proven to improve patient outcomes, though doctors must take care to re-evaluate continuing medication-assisted treatments on a regular basis. Depending on the patient’s circumstances, this treatment may be temporary or go on indefinitely.


Counseling and behavioral therapy can help individuals process traumatic events from their past and develop healthy coping mechanisms going forward. This can include cognitive behavioral therapy to help patients recognize cravings and change risky behavior. It can include dialectical behavior therapy to help them regulate their emotions.

Substance use disorder support groups

A recovery support network is a vital resource for people undergoing treatment for a substance use disorder. There are a variety of support groups you can find in-person or online, and many are designed to help individuals undergoing treatment for the misuse of specific types of drugs. Examples of well-known support groups include:

  • SMART Recovery: Self-Management and Recovery Training (SMART) is a global community of support groups in which individuals aim to help each other cope with substance use disorders. You can find local meetings and online meetings through this organization.
  • Alcoholics Anonymous: For people struggling with alcohol misuse, Alcoholics Anonymous can provide helpful resources and support group meetings all across the US. On this page, you can locate nearby meetings and access state-specific resources.
  • Narcotics Anonymous: Withdrawal from narcotics can cause intense symptoms, and support groups can help people work through these difficult times. Individuals with substance use disorder related to narcotics can find local Narcotics Anonymous helplines, websites, and support groups here.
  • Marijuana Anonymous: Although many people do not regard marijuana as addictive, some people do struggle when trying to quit using marijuana. Local support groups for those looking to quit marijuana use can be found at Marijuana Anonymous.
  • Pills Anonymous: Prescription pills may not be illegal, but they can still be debilitating when misused. If you are struggling with a use disorder related to prescription pills, you can find a local or online support group here.

If you are interested in finding help for yourself or a loved one, you can locate additional support groups and information by contacting the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357.

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