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What Is a Substance Use Disorder?

When people talk about the compulsive use of drugs or alcohol combined with an inability to stop, they usually use the term “addiction.” While this is the more commonly used term, treatment professionals use the terminology of “substance use disorder” (SUD) when diagnosing someone.1

According to the American Psychological Association, an SUD is marked by a set of symptoms that indicates that a person has lost the ability to control their substance use despite the problems it causes in various areas of their life. Diagnostic criteria include cognitive, physiological, and behavioral symptoms. Professionals may determine the severity of a person’s disorder based on how many symptoms they are experiencing (e.g., meeting 2 to 3 of the 11 criteria would result in a diagnosis of mild SUD).1

This article will review some of the most common signs that suggest that an individual may have a substance use disorder. If you believe you are suffering or you’ve noticed concerning signs in someone you love, Greenhouse Treatment Center can help. Our program includes a full continuum of care with treatment options ranging from outpatient therapy to inpatient rehabilitation.

DSM-5 Criteria for Substance Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria for diagnosis of specific substance use disorders. While there is some variation in the diagnostic language between different substances, the criteria are generally very similar and reflect a loss of control over drug or alcohol use. Signs that an individual may have an SUD include:1

Girl suffering from addiction

  • Taking the substance for longer or in larger amounts than intended.
  • Failing in attempts to cut back or quit using the substance.
  • Expending a great deal of time and energy in getting, using, and recovering from the substance.
  • Craving the substance.
  • Failing to attend to personal, professional, or domestic obligations due to substance use.
  • Giving up important hobbies or social/occupational activities in favor of substance use.
  • Regularly using substances in situations where doing so could by physically hazardous.
  • Continuing to use substances when doing so causes or worsens health problems (physical or psychological).
  • Experiencing increased relationship conflicts due to use but continuing to use anyway.
  • Tolerance (needing to take more of the substance to experience the desired effects).
  • Withdrawal symptoms arise when attempts are made to cut down or quit.

Other Potential Signs of Substance Abuse

Other signs that may be indicative of substance abuse include:2,3

  • Impaired judgment/increased risk-taking.
  • Legal woes related to substance use.
  • Financial distress/frequent requests for money.
  • Lack of motivation.
  • Neglect of personal appearance or hygiene.
  • Frequently slurred speech.
  • Changes in pupil size (appearing abnormally large or small on a regular basis) or bloodshot appearance to the eyes.
  • Unusual clumsiness/lack of coordination.
  • Changing sleep patterns.
  • Unusual smells on the clothing, breath, or body.
  • Calling in sick to work more often (or missing classes if in school).
  • Personality changes and/or drastic mood swings.
  • Seeming “spaced out” or not engaged with others/aware of surroundings.
  • Appearing more anxious than normal or becoming paranoid for no reason.
  • Changing friend/social groups.
  • Acting more secretive than usual/engaging in suspicious behaviors.

Is Addiction a Disease or a Choice?

Pill bottle with handcuffs

There has been a longstanding debate over whether addiction is a disease or a choice. Historically, many people viewed addiction as a moral failing or weakness; however, years of research have led to a much greater understanding of just how significantly drug use impacts the brain and the complex factors that may make a person susceptible to a substance use disorder.

Many professional organizations such as the National Institute on Drug Abuse now discuss addiction as a chronic and relapsing brain disease with risk factors that include:4,5

  • Biology/genetics. Some people are genetically predisposed to develop substance use disorders. Ethnicity, gender, and biological factors such as differences in brain inhibitory circuitry can influence a person’s risk.
  • Family life, parental support, friends, and economic status can all influence whether a person will develop an SUD.
  • Developmental stage. The brain is not fully developed at birth; this takes time. Adolescents are still developing critical areas of the brain responsible for self-control, judgment, and critical thinking—functions that, when intact, might otherwise protect against certain addictive behaviors. The earlier drug experimentation begins, the more likely an addiction will develop.

Certain addiction-related brain changes are in-line with the now commonly accepted concept of the condition as a brain disease. According to NIDA, many drugs of abuse influence our brain’s reward circuits and, eventually, natural rewards may take a backseat to drug-associated rewards. Eventually, though, the euphoria associated with a drug will lessen as tolerance grows, and the individual will have to keep increasing their dose to try and chase the feeling they got when they first began to use. As they need more and more of the drug to feel good and as their ability to derive pleasure from daily life diminishes, they may compulsively seek out the drugs over and over despite experiencing numerous negative consequences of such escalating use. Drug use can also alter a person’s ability to control their impulses and to resist cravings, so quitting becomes that much more difficult.4

According to the American Society of Addiction Medicine, talking about addiction as a moral failing “takes us back to an earlier, more ignorant time.”5 For years, many people thought that addiction recovery meant little more than making the choice to stop. However, we now know that quitting is a difficult process that often requires some form of professional treatment, and not just good intentions or a desire to get sober.4

Fortunately, treatment for substance use disorders can work, and many people have recovered from addiction to lead happy, healthy, successful lives. Treatment for addiction may include:

Greenhouse Treatment Center offers a comprehensive treatment program that includes all of the above and more. If you’re struggling with substance abuse, know that you can recover. Suffering from an SUD can make you feel hopeless and alone, but we are here for you and can work with you every step of the way to provide you the support and treatment you need to live a life no longer ruled by substance use.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  2. U.S. Department of Health and Human Services. (2019). Mental Health and Substance Use Disorders.
  3. Tennessee Department of Mental Health & Substance Abuse Services. (n.d.). Warning Signs of Drug Abuse.
  4. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction.
  5. American Society of Addiction Medicine. (2014). Addiction: Character Defect or Chronic Disease?
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More