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Defining Substance Use Disorders

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

“...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 encompass both the use of illicit, or illegal, substances and the misuse of legal substances like alcohol, nicotine, and prescription drugs. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) outlines eleven defining behaviors and patterns associated with SUDs:

  1. Having a persistent desire to stop using the substance and/or continuously trying to reduce or control substance use.
  2. Continuing to use the substance despite knowing that it is likely causing or worsening a physical or psychological health issue.
  3. Using the substance in larger amounts or over a longer 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 its effects.
  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 the desired effect.
  8. Having a strong urge to use the substance.
  9. Continuing to use even when it leads to difficulties in fulfilling work, school, or home responsibilities.
  10. Continuing to use the substance despite causing or worsening interpersonal problems.
  11. Continuing to use the substance in risky or physically dangerous situations.

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 can increase the risk of serious health conditions such as heart disease, brain and liver damage, and hypertension, as well as issues related to intoxication and withdrawal. Criteria for diagnosis include an inability to control intake, developing tolerance, and/or experiencing withdrawal symptoms.
  • 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 increase risk for cognitive difficulties and mental health issues. Synthetic cannabinoids are lab-made substances that can produce effects different from those of the cannabis plant and are linked with serious health risks.
  • Hallucinogens – Psychedelic and dissociative drugs, also known as hallucinogens, distort perceptions of reality and cause hallucinations. Hallucinogenic substances include chemically synthesized substances like MDMA (Ecstasy), phencyclidine (PCP), and lysergic acid diethylamide (LSD), as well as naturally occurring substances like psilocybin mushrooms, peyote, or mescaline.
  • Opioids – Over the past 25 years, the U.S. has seen a dramatic increase in opioid use, including prescription medications such as hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®), codeine, morphine, as well as illegal substances like heroin. Recent trends highlight the rise of fentanyl and other synthetic opioids, which have contributed to the increase in overdose deaths. Misusing opioids can lead to physical dependence, severe respiratory depression, and even death.
  • Stimulants – Stimulants include amphetamines, methamphetamines, and cocaine. Stimulants elevate alertness, breathing, blood pressure, and heart rate. Misuse can lead to dangerously high body temperature, seizures, heart failure, and psychological symptoms like hostility and psychosis.
  • Tobacco and Vaping – Tobacco and vaping devices, which contain the addictive substance nicotine, raise the risk of cancer, coronary heart disease, and chronic obstructive pulmonary disease (COPD). Cigarette smoking is the leading cause of preventable disease and death in the U.S. Smoking while pregnant can result in serious risks, including infant tissue and lung damage, preterm birth, low birthweight, and Sudden Infant Death Syndrome (SIDS). The growing use of vaping and e-cigarettes, especially among young people, presents new challenges for nicotine addiction. Many vaping products have high levels of nicotine and cancer-causing chemicals.

Resources to Learn More

Co-Occurring Disorders and Other Health Conditions
Website
Defines co-occurring disorders as the co-existence of substance use and mental health disorder. Identifies common mental health disorders and types of substances misused by patients.
Organization(s): Substance Abuse and Mental Health Services Administration

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, 69(12), 317–323
Date: 3/2020

Treatment of Substance Use Disorders
Website
Defines SUDs, identifies commonly misused substances, provides an overview of treatment options for SUD, and offers a list of resources to find treatment services and learn more about recovery.
Organization(s): Centers for Disease Control and Prevention