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Defining Substance Abuse

The World Health Organization (WHO) defines substance abuse as:

“...the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.”

In 2013, the American Psychiatric Association updated the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to define substance abuse within a new category, substance-related and addictive disorders. Each specific type of substance — such as opioids, alcohol, or hallucinogens — is classified and described separately.

The most common types of substance abuse in the U.S. include:

  • Alcohol abuse: Excessive alcohol consumption increases the risk of serious health conditions such as heart disease, brain and liver damage, and hypertension and can cause health issues related to intoxication behaviors and withdrawal. Criteria for diagnosis include an inability to control alcohol intake, developing a tolerance, and/or developing withdrawal symptoms.
  • Opioid abuse: In recent years, the U.S. has seen a dramatic increase in the use of opioids, which are substances used to relieve pain in healthcare settings. Opioids work by binding to receptors in the brain or body to reduce pain signals going to the brain. According to the Centers for Disease Control and Prevention, over 28,000 Americans died of opioid overdoses in 2014. According to the 2014 National Survey on Drug Use and Health, 1.9 million Americans ages 12 and older have prescription pain relievers abuse, based on data of reported use of prescription pain relievers. Opioids include prescription drugs such as hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®), codeine, morphine, as well as illegal substances like heroin. Abuse of opioids can lead to physical dependence, addiction, severe respiratory depression, and even death.
  • Stimulant abuse: Stimulants increase alertness, breathing, blood pressure, and heart rate and include amphetamines, methamphetamines, and cocaine. Abuse can lead to overly elevated body temperature, seizures, and heart failure as well as psychological symptoms like hostility and psychotic symptoms.
  • Hallucinogen abuse: Hallucinogens are substances that distort perceptions of reality and cause hallucinations. Hallucinogenic substances include chemically synthesized substances like MDMA (also known as Ecstasy), phencyclidine (PCP) and lysergic acid diethylamide (LSD) as well as naturally occurring substances like psilocybin mushrooms, peyote, or mescaline.
  • Cannabis abuse: Excessive use of cannabis or marijuana can lead to problems with memory, learning, and perception, as well as loss of motor coordination and difficulty with thinking and problem-solving skills. Excessive use of cannabis in youth can also increase risk for cognitive difficulties and mental illness.
  • Tobacco abuse: Tobacco is a leafy plant that contains the addictive substance nicotine and is typically smoked through cigarettes, cigars, and pipes. Tobacco is the leading cause of preventable disease and death in the U.S. and increases one's risk of cancer, coronary heart disease, and chronic obstructive pulmonary disease (COPD). Smoking in pregnancy can lead to infant tissue and lung damage, as well as greater risk of preterm birth, low birthweight, and death from Sudden Infant Death Syndrome (SIDS).

Resources to Learn More

The Diagnostic Criteria for Substance Use Disorders (Addiction)
Website
Explains the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for substance abuse, including impaired control, social impairment, risky use, and pharmacological indicators.
Author(s): Horvath, A., Misra, K., Epner, A., and Cooper, G.
Organization(s): Aroostook Mental Health Center

Substance-Related and Addictive Disorders
Document
Describes changes in classification of substance abuse in the DSM-5, including combining the DSM-IV categories of substance abuse and dependence into one category and classifying each substance (opioids, alcohol, etc.) as a separate issue.
Organization(s): American Psychiatric Association

What is Addiction?
Website
Defines substance abuse (addiction), describes commonly abused substances, gives an overview of treatment options for substance abuse, and touches on prevention methods and programs.
Organization(s): American Psychiatric Association