Substance use disorder

This is a serious condition in which the use of alcohol or drugs, or both, leads to physical and psychological problems that affect the individual’s working or home life for the worse.

What is it?

Also known as drug use disorder or substance abuse, this condition can cause wide-ranging impairments and psychological distress. Symptoms and signs of substance abuse (whether alcohol or drugs) include taking drugs regularly, maybe daily, to function; taking drugs even when alone; continuing to use drugs even when the person knows it is harming their own health, family, or work; making excuses to use drugs and reacting with aggression to inquiries about their substance use; being secretive about using drugs; losing interest in other activities; impaired ability to work; neglecting to eat or attend to physical appearance; confusion; lethargy; depression; financial problems; and criminal activity such as stealing money. In the longer term, overconsumption of alcohol can
cause weight gain and high blood pressure and increase the risk of depression , liver damage, problems with the immune system, and some cancers. Drugs can be associated with mental health issues such as depression, schizophrenia , and personality disorders . Alcohol or drug abuse usually begins as a voluntary
behavior, encouraged or tolerated within the person’s social and cultural climate. Peer pressure, stress, and family dysfunction can escalate the problem. A child with a family member who has chemical-dependency issues may be at a higher risk of the disorder for either environmental or genetic reasons or both.

How is it diagnosed?

Diagnosis begins with the person recognizing that they have a problem; denial is a common symptom of addiction. Empathy and respect are more likely to induce a person to accept that they have substance use disorder than orders and confrontation. The GP or specialist grades the person’s behavior (below) while the individual is using the substance.

Behavior patterns

The diagnosis of this disorder, whatever the substance, is based on a set of 11 behaviors related to its use. The severity of the disorder is based on how many of these behaviors are present: 0–1 = no diagnosis; 2–3 = mild substance use disorder; 4–5 = moderate substance use disorder; 6+ = severe substance use disorder.

Impaired control

• ❯ 1. Uses substance for longer and/or in larger amounts than originally intended.
• ❯ 2. Wants to cut down, but cannot do so.
• ❯ 3. Spends longer and longer getting, using, and recovering from using the substance.
• ❯ 4. Has intense cravings for the substance, which makes it difficult for the person to think about anything else.

Social impairment

• ❯ 5. Continues to use despite knowing the problems it causes with life at home or work.❯ 6. Continues to use despite arguments with family or the loss of friendships it causes.
• ❯ 7. Gives up social and recreational activities as a result, so spends less time with friends and family, and becomes increasingly isolated.

Risky use

• ❯ 8. While under theinfluence, engages in risky sexual behavior or puts themselves or others in danger, for example, by driving, operating machinery, or swimming.
• ❯ 9. Continues to use while aware that the substance is making psychological or physical problems worse (for example, drinking even when liver damage has been diagnosed).

Pharmacological criteria

• ❯ 10. Becomes tolerant to the substance, so needs increasing amounts to achieve the same effects. Different drugs vary in terms of how quickly tolerance develops.
• ❯ 11. Suffers withdrawal such as nausea, sweating, and shaking if the intake is stopped.

29.5million people in the world have
drug use disorder

United Nations Office on Drugs and Crime, World Drug Report 2017