What is a Substance Use Disorder (SUD)?

What is a Substance Use Disorder (SUD)?

A Substance Use Disorder (SUD) is a medical condition that is defined by the inability to control the use of a particular substance (or substances) despite harmful consequences.¹ In other words, SUDs occur when an individual compulsively misuses drugs or alcohol and continues using the substance despite knowing the negative impact it has on their life.^2,3 

SUDs may range from mild to severe, with severity depending on the number of diagnostic criteria a person meets. When someone is diagnosed with mild SUD, this means a person displays 2-3 symptoms, moderate means they display 4-5 symptoms, and severe means they display 6 or more.²

The American Psychiatric Association (APA) has developed 11 criteria for SUD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).²

The DSM-5 Criteria for Substance Use Disorders includes:²

• Taking the substance for long periods of time or in larger amounts than intended.
• Being unable to cut down or stop substance use.
• Spending a lot of time obtaining, using, and recovering from the effects of the substance.
• Experiencing cravings, or intense desires or urges for the substance.
• Failing to fulfill obligations at home, work, or school due to substance use.
• Continuing substance use despite having interpersonal or social problems that are caused or worsened by substance use.
• Giving up social, recreational, or occupational activities due to substance use.
• Using the substance in risky or dangerous situations.
• Continuing substance use despite having a physical or mental problem that is probably due to substance use.
• Tolerance, or needing more of the substance to achieve previous effects.
• Withdrawal, meaning that unpleasant symptoms occur when you stop using your substance of choice.

Substance Use Disorder Statistics

The National Survey on Drug Use and Health (NSDUH) provides statistics on substance use and substance use disorders across the US. The most recent NSDUH (2019) results show the prevalence of SUDs in general and specific types of the following: SUDs in the US in people aged 12 and older over the previous year.

• 4 million people had an SUD.⁴ 
• 5 million had an alcohol use disorder.⁴
• 6 million had a marijuana use disorder.⁴
• 1 million had a cocaine use disorder.⁴
• 438,000 had a heroin use disorder.⁴
• 1 million had a methamphetamine use disorder.⁴
• 558,000 had a prescription stimulant use disorder.⁴
• 681,000 had a prescription tranquilizer or sedative use disorder.⁴
• 4 million had a prescription pain reliever disorder.⁴
• 6 million had an opioid use disorder.⁴

The NSDUH also collects data about receipt of and need for substance use treatment.⁴

• 1 million people aged 12 and older with a SUD received treatment in the past year.
• 9 million aged 12 or older had a past year SUD but did not receive treatment at a specialty facility.
• 1 million of these people felt they didn’t need treatment.
• 236,000 felt they needed treatment and made an effort to get it.
• 577,00 felt they needed treatment but didn’t make an effort to get it.

Substance Use Disorder vs. Substance Use

The terms substance use disorder and substance use are often used interchangeably, however they hold very different meanings. SUD, also known as addiction, is a diagnosable medical condition that requires a person meets at least 2 of the 11 DSM criteria.² On the other hand, substance use, or substance misuse, are terms that are used when a person uses a substance inappropriately or in ways that cause harm to themselves and the people around them.⁵ Unlike SUDs, substance use isn’t a diagnosable disorder. However, chronic substance use can potentially lead to the development of an SUD.⁵

Types of Substance Use Disorders

The DSM provides diagnostic criteria for 10 classes of SUD, which, excluding caffeine and tobacco, includes:²

• Alcohol use disorder.
• Cannabis use disorder, also known as marijuana use disorder.
• Phencyclidine use disorder, a type of hallucinogen.
• Other hallucinogen-use disorder, which includes hallucinogens other than phencyclidine.
• Inhalant use disorder.
• Opioid use disorder.
• Sedative, Hypnotic, or Anxiolytic use disorder, which includes substances like benzodiazepines, benzodiazepine-like drugs such as zolpidem (Ambien), carbamates, and barbiturates.
• Stimulant use disorder, which includes substances like cocaine or methamphetamine.

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Symptoms of Substance Use Disorders

The visible signs or symptoms of a SUD can vary by specific substance but can include physical, behavioral, and social changes such as:⁹

• Skipping school or missing work.
• Having frequent fights, accidents, or legal trouble.
• Secretive or suspicious behavior.
• Appetite or sleep changes.
• Personality or attitude changes.
• Mood swings or irritability.
• Unusual hyperactivity or energy.
• Lack of motivation.
• Bloodshot eyes or small pupils.
• Sudden weight changes.
• Poor physical appearance.
• Smelly breath or clothing.
• Tremors, slurred speech, or impaired coordination.
• Changes in social circle.
• Asking for money.

Risk Factors for Substance Use Disorders

Your vulnerability to substance misuse involves a complex interplay of different factors. Risk factors include:⁵

• Genetics, such as a family history of substance use.
• Starting substance use at an early age.
• Easy access to drugs or alcohol, especially at a young age.
• Exposure to heavy advertising of substances (like alcohol).
• A current mental health diagnosis.
• Low parental monitoring.
• A high amount of family conflict.
• A history of abuse or neglect.
• Family conflict or violence.

How Are SUDs Diagnosed?

SUDs can only be diagnosed by medical professionals.¹⁰ They will conduct a formal assessment that takes into account a person’s symptoms and needs (such as medical, social, or psychiatric concerns), to determine whether you have a SUD based on DSM-5 criteria.¹⁰

Substance Use Disorder Treatments

Unfortunately, many people with SUDs don’t seek help. Even someone with a mild SUD can benefit from treatment.¹⁰ If substance use is affecting your life and you think you may have a SUD, then it’s time to seek help. You can call a drug addiction helpline to find treatment facilities near you, or use the Substance Abuse and Mental Health Services Administration’s FindTreatment.gov website.

Treatment types can include:^10,11

• Drug detox. This is the first step in recovery. Medically-supervised detox helps you safely and comfortably withdraw from the substance so you can become stable and enter treatment. During detox, you may receive medications (depending on the substance used) to help minimize withdrawal symptoms and prevent relapse.
• Inpatient rehabilitation. You live at a treatment facility and receive round-the-clock care and monitoring, as well as different forms of therapy and medication if appropriate. Inpatient rehab can take place in different settings, such as hospitals or residential facilities.
• Outpatient rehab. You live at home but travel to a facility for treatment. Intensive forms of outpatient rehab include partial hospitalization or intensive outpatient programs, which require treatment for several hours per day, most days a week, or less intense settings where you may only attend treatment once a week.
• Co-occurring mental health disorder This involves treating the mental health condition as well as the SUD. It’s important to address both issues as they can affect each other.

Behavioral therapies are often used to address SUDs. This includes:¹²

• Cognitive-behavioral therapy (CBT) to help change thoughts and behavioral patterns that contribute to substance use.
• Motivational interviewing to help increase your motivation to stop substance use and make positive changes.
• Contingency management to help you remain abstinent using positive reinforcement.

The Cost of Substance Use Treatment

The cost of rehab for substance use disorders can vary by the treatment center, the level of care needed, and whether your insurance may be able to cover the cost of rehab. Find out if your insurance provider can help you with affording rehab and verify your insurance by filling out the confidential online form below.