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Substance Use Disorders: Causes, Types & Treating SUDs

A substance use disorder can have a significant impact on many aspects your life and can drastically affect others around you. If you or someone you know is struggling with a substance use disorder, it is important to understand the potential consequences of the addiction as well as the benefits of seeking professional treatment. Treatment can help you begin the process of healing and recovery and allow you to regain control of your life.

American Addiction Centers offers addiction treatment for substance use disorders and other co-occurring disorders at each of our nationwide facilities. Call

What is a Substance Use Disorder (SUD)?

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 abusing 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.
  • 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 Abuse

The terms substance use disorder and substance abuse 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 abuse, 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 abuse isn’t a diagnosable disorder. However, chronic substance abuse 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

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Symptoms of Substance Use Disorders

The following are symptoms associated with a substance use disorder:2

The visible signs or symptoms of 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 abuse.
  • 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 abuse 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 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 of abuse) to help minimize withdrawal symptoms and prevent relapse.
  • Inpatient rehab. 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 abuse.
  • Motivational interviewing to help increase your motivation to stop substance abuse and make positive changes.
  • Contingency management to help you remain abstinent using positive reinforcement.

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  1. American Psychiatric Association. (2020, December). Help with addiction and substance use disorders.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. Substance Abuse and Mental Health Services Administration. (2020, April 30). Mental health and substance use disorders.
  4. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  5. McLellan, A. T. (2017). Substance misuse and substance use disorders: Why do they matter in healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112–130.
  6. National Institute on Drug Abuse. (2020, July). Drugs, brains, and behavior: The science of addiction: Drug misuse and addiction.
  7. National Institute on Alcohol Abuse and Alcoholism. (n.d.). What is alcohol use disorder (AUD)?
  8. National Institute on Alcohol Abuse and Alcoholism. (2021, April). Understanding alcohol use disorder.
  9. U.S. Department of Health & Human Services. (2019, March 22). Mental health and substance use disorders.
  10. American Psychiatric Association. (2020, December). What is a substance use disorder?
  11. Substance Abuse and Mental Health Services Administration. (2019, October). Treatment options.
  12. National Institute on Drug Abuse. (2019, January). Treatment approaches for drug addiction DrugFacts.
Last Updated on November 19, 2021
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