Substance Use Disorder – The New Terminology

In recent years, the terminology surrounding alcoholism and addiction has evolved significantly, reflecting a deeper understanding of these conditions. Previously, terms like “alcoholism” and “addiction” were commonly used, often carrying stigmatizing connotations and lacking specificity. The shift to using “substance use disorders” (SUDs) represents a more precise and medically accurate approach. This change aligns with the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which categorizes these conditions under various specific diagnoses, such as Alcohol Use Disorder (AUD), Opioid Use Disorder (OUD), and others. By adopting this language, healthcare professionals emphasize that these disorders are chronic diseases, similar to diabetes or hypertension, requiring appropriate medical treatment and intervention.

Who Made The Change

The change from using the term “addiction” to “substance use disorder” was primarily driven by advancements in medical and psychological research, as well as the efforts of leading health organizations. The American Psychiatric Association (APA) played a crucial role in this shift. In 2013, the APA published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which introduced “Substance Use Disorder” (SUD) as a comprehensive term that includes various substance-related conditions, such as Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD). This new terminology aimed to provide a more precise, clinical framework for diagnosing and treating these disorders.

In addition to the APA, other influential bodies like the National Institute on Drug Abuse (NIDA) and the World Health Organization (WHO) have supported and promoted the use of “substance use disorder.” These organizations recognized the importance of adopting language that reflects the complex nature of these conditions as chronic medical illnesses rather than moral failings or character flaws. This change in terminology has been part of a broader effort to reduce stigma, improve public understanding, and enhance the effectiveness of treatment and policy interventions for individuals affected by substance use disorders.

This shift in terminology also aims to reduce stigma and promote a more compassionate understanding of individuals affected by these conditions. Using specific terms like AUD or OUD helps to highlight the unique aspects and needs of each disorder, facilitating more targeted and effective treatment plans. Additionally, it underscores the idea that these disorders are part of a spectrum, recognizing varying levels of severity and the importance of personalized care. The change in language is part of a broader movement within the medical and public health communities to approach substance use disorders with a focus on health and recovery, rather than moral judgment or blame. This evolving terminology reflects ongoing advancements in the field and supports efforts to improve outcomes for individuals struggling with substance use disorders.

With a wide range of substances involved, each with unique characteristics and potential harms, the complexity of SUD presents significant challenges in prevention, diagnosis, and treatment. This comprehensive guide aims to demystify SUD, offering insights into its various facets, including the major substances involved, and the criteria used for diagnosis and determination of severity based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

SUD is a complex, multifaceted issue that spans various types of substances, each with unique challenges in terms of prevention, diagnosis, and treatment. The standardization of SUD terminology and criteria, as stipulated by the DSM-5, allows for more precise diagnosis and treatment plans. However, more research, advocacy, and treatment options are needed to effectively address this pervasive public health issue.

Definition

It’s characterized by a pattern of continued substance use despite causing significant problems or distress, often resulting in health issues, disability, and failure to meet responsibilities at work, school, or home.

Major Substances 

Several substances fall under the umbrella of SUD, each carrying distinct properties and impacts:

• Alcohol: A legal substance that can cause significant health issues such as liver disease, cardiovascular problems, and neurological damage when consumed excessively or chronically.
• Tobacco/Nicotine: Also legal, tobacco is highly addictive and is a major risk factor for lung diseases, heart disease, and various types of cancer.
• Opioids: This category includes both legal prescription drugs like morphine, oxycodone, and hydrocodone, as well as illegal drugs like heroin. Opioids are highly addictive and can lead to fatal overdoses.
• Stimulants: This includes illicit drugs like cocaine and methamphetamine, as well as prescription drugs like amphetamines (Adderall) used to treat ADHD. These can lead to heart problems, psychosis, and severe physical dependence.
• Cannabis: Although legal in certain areas, cannabis can lead to a disorder characterized by cravings, withdrawal symptoms, and negative impacts on personal and professional life.
• Hallucinogens: These include drugs like LSD, peyote, and psilocybin (“magic mushrooms”). Chronic use can lead to persistent psychosis and hallucinogen persisting perception disorder (HPPD).
• Inhalants: These are volatile substances found in many household and industrial products that can be misused for their mind-altering effects. Long-term use can lead to brain damage and organ failure.
• Sedatives, Hypnotics, and Anxiolytics: This category includes prescription drugs such as benzodiazepines. Misuse can lead to physical dependence, overdose, and death.

Criteria for Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides standardized criteria for diagnosing SUD. It stipulates that the individual must exhibit a problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following within a 12-month period:

• Substance is often taken in larger amounts or over a longer period than intended.
• Persistent attempts or one or more unsuccessful efforts to cut down or control substance use.
• A great deal of time is spent in activities necessary to obtain, use, or recover from the substance’s effects.
• Craving or a strong desire or urge to use the substance.
• Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home.
• Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
• Important social, occupational, or recreational activities are given up or reduced because of substance use.
• Recurrent substance use in situations where it is physically hazardous.
• Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
• Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve intoxication or the desired effect, or markedly diminished effect with continued use of the same amount of the substance.
• Withdrawal, as manifested by either the characteristic withdrawal syndrome for the substance, or the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

The severity is determined as follows:

• Mild: Presence of 2-3 symptoms
• Moderate: Presence of 4-5 symptoms
• Severe: Presence of 6 or more symptoms

Risk Factors

The onset of Substance Use Disorder (SUD) can be influenced by a variety of factors. Here are some notable ones:

• Genetic Factors: Certain individuals may be genetically predisposed to develop SUD due to inherited characteristics.
• Early Drug Use: Using drugs at an early age can interfere with normal brain development and increase the risk of addiction.
• Mental Health Disorders: Individuals with mental health disorders, such as depression or anxiety, are more likely to develop SUD.
• Environmental Influences: Factors like peer pressure, family environment, socio-economic status, and availability of drugs can contribute to SUD onset.
• Lack of Family Supervision: In younger individuals, lack of parental supervision can increase the likelihood of initial substance use, which can potentially lead to SUD.

Myths and Misconceptions

Debunking common myths about SUD can combat stigma and promote understanding. For example:

• Myth: You can’t get addicted to prescription medication.
• Fact: Prescription medications, particularly opioids, can be highly addictive even when used as directed.
• Myth: Addiction is a choice.
• Fact: While the initial decision to use substances is often voluntary, addiction is a complex disease of the brain that affects behavior.

The Impact on Society

SUD affects not just the individual and their family but also society at large:

• Healthcare Costs: SUD can lead to long-term health complications, driving up healthcare costs.
• Productivity Loss: SUD often leads to decreased productivity at work, job loss, and financial instability.
• Criminal Justice System: Substance use is a significant factor in crime, both directly and indirectly.

Here’s a list of the 50 most addictive drugs