Defining Substance Abuse and Substance Use Disorders

The Substance Abuse and Mental Health Services Administration defines substance use disorders (SUDs) as occurring when:

“the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”

SUDs describes both the use of illicit, or illegal, substances and the misuse of legal substances like alcohol, nicotine, or prescription drugs. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines eleven symptoms of SUDs:

1. Having a persistent wish to stop using the substance and/or continuously trying to reduce or control substance use
2. Continuing to use the substance despite knowing that a physical or psychological health issue was likely caused or worsened by the substance
3. Using the substance in larger amounts or over a long time period than originally intended
4. Exhibiting withdrawal symptoms when not using the substance
5. Spending a significant amount of time trying to obtain the substance, use it, or recover from using it
6. Stopping or decreasing social, work-related, or recreational activities due to substance use
7. Building up a tolerance, where a larger amount of the substance is needed to experience an effect
8. Having a strong urge to use the substance
9. Continuing to use even when it causes an inability to fulfill work, school, or home-related responsibilities
10. Continuing to use the substance even when it causes interpersonal problems or makes them worse
11. Continuing to use the substance even in situations that are risky or physically dangerous

The most common types of SUDs in the U.S. involve the use of one or more of the following substances:

• 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. 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 include amphetamines, methamphetamines, and cocaine. Stimulants increase alertness, breathing, blood pressure, and heart rate. Misuse can lead to overly elevated body temperature, seizures, and heart failure, as well as psychological symptoms like hostility and psychosis.
• 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 use 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 while pregnant 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 Control and Prevention Toolkit.

Resources to Learn More

Mental Health and Substance Use Disorders
Website
Defines and describes several types of SUDs, including opioid use disorder and stimulant use disorder.
Organization(s): Substance Abuse and Mental Health Services Administration

Pain in the Nation Update: Alcohol, Drug, and Suicide Deaths in 2018
Document
Outlines changes and trends in annual deaths from alcohol, drugs, and suicide in the U.S from 1999 to 2018. Highlights policies, programs, and research to reduce and prevent deaths due to alcohol, drugs, and suicide.
Organization(s): Trust for America's Health
Date: 5/2020

Patterns and Characteristics of Methamphetamine Use Among Adults – United States, 2015-2018
Document
Examines methamphetamine use rates in the United States and characteristics associated with past-year methamphetamine use using data estimates from the 2015–2018 National Surveys on Drug Use and Health (NSDUHs).
Author(s): Jones, C., Compton, W., & Mustaquim, D.
Citation: Morbidity and Mortality Weekly Report (MMWR), 69(12), 317–323
Date: 3/2020

Substance-Related and Addictive Disorders
Document
Describes the changes in the DSM-5 manual combining DSM-IV categories of substance use disorder (SUD) into a single disorder measured on a continuum from mild to severe.
Organization(s): American Psychiatric Association
Date: 2013

What is Addiction?
Website
Defines SUDs, identifies commonly misused substances, provides an overview of treatment options for addiction, and touches on prevention methods and programs.
Organization(s): American Psychiatric Association