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Defining Substance Abuse and Substance Use Disorder

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 disorders. Each specific type of substance — such as opioids, alcohol, or hallucinogens — is classified and described separately.

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

  • Alcohol: 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.
  • Opioids: 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, 33,091 Americans died of opioid overdoses in 2015. According to the 2015 National Survey on Drug Use and Health, 3.8 million Americans ages 12 and older have reported misuse of prescription pain relievers, based on data of reported misuse of prescription pain relievers. Opioids include prescription drugs such as hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®), codeine, morphine, as well as illegal substances like heroin. Misusing opioids can lead to physical dependence, severe respiratory depression, and even death.
  • Stimulants: Stimulants increase alertness, breathing, blood pressure, and heart rate and include amphetamines, methamphetamines, and cocaine. Misuse can lead to overly elevated body temperature, seizures, and heart failure as well as psychological symptoms like hostility and psychotic symptoms.
  • Hallucinogens: 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: 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: 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). For more information please see RHIhub's Rural Tobacco Toolkit.

Resources to Learn More

Substance-Related and Addictive Disorders
Document
Describes changes in classification of substance use disorder 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 use disorders, identifies commonly misused substances, gives an overview of treatment options for addiction, and touches on prevention methods and programs.
Organization(s): American Psychiatric Association