Substance Use Disorders: Signs, DSM-5 Criteria and Treatment

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Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

Substance Use Disorders (SUDs)

Substance use disorders (SUDs) represent a wide spectrum of addiction that profoundly impact individuals, families, and communities worldwide. Characterized by an uncontrollable urge to use substances despite harmful consequences, these disorders can disrupt daily life and lead to long-term health issues. This blog post aims to shed light on the various types of substance use disorders, exploring the diagnostic criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and examining the array of treatment options available. By gaining a deeper understanding of SUDs, we can foster a more empathetic and informed approach to addressing these challenging conditions, ultimately aiding those affected in their journey towards recovery and improved well-being.

Most common substance use disorders include:

Alcohol Use Disorder:

Characterized by excessive and problematic alcohol consumption, leading to negative physical, social, and psychological consequences.

Opioid Use Disorder:

Involves the misuse of prescription opioids or illegal opioids like heroin, fentanyl, oxycodone “oxy’s” and percoset “perc’s,” among others. These substances are associated with a strong physical and psychological dependence.

Cannabis Use Disorder:

Refers to the problematic use of marijuana or cannabis products, leading to impaired functioning and negative consequences.

Stimulant Use Disorder:

Includes the misuse of stimulant drugs such as cocaine, amphetamines, or methamphetamines, which can cause heightened energy, focus, and euphoria.

Sedative, Hypnotic or Anxiolytic Use Disorder:

Involves the misuse of prescription benzodiazepines like Xanax or Valium, leading to dependence and withdrawal symptoms.

Phencyclidine Use Disorder:

Involves misuse of PCP and ketamine, which can cause hallucinogenic and dissociative effects.

Other Hallucinogen Use Disorder:

Pertains to the misuse of hallucinogenic substances like LSD, MDMA (Ecstasy), or magic mushrooms, causing altered perceptions and experiences.

Tobacco Use Disorder:

Involves the addictive use of tobacco products, primarily cigarettes, leading to significant health risks and addiction.

Inhalant Use Disorder:

Involves the misuse of volatile substances such as aerosols, solvents, or gases, leading to mind-altering effects.

DSM-5 Criteria for Substance Use Disorders:

The DSM-5 outlines specific criteria to diagnose Substance Use Disorders, which include:

  • Taking the substance in larger amounts or over a longer period than intended.
  • Unsuccessful efforts to cut down or control substance use.
  • Spending a significant amount of time obtaining, using, or recovering from the effects of the substance.
  • Craving or a strong desire to use the substance.
  • Failure to fulfill major obligations at work, school, or home due to substance use.
  • Continued substance use despite social or interpersonal problems caused or worsened by its effects.
  • Giving up or reducing important social, occupational, or recreational activities because of substance use.
  • Using substances in situations where it’s physically hazardous.
  • Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  • Tolerance, defined by needing more of the substance to achieve the desired effect or experiencing reduced effects with the same amount.
  • Withdrawal, characterized by experiencing symptoms when reducing or stopping the substance.

Severity specifiers:

The more criteria that are met, the more severe the disorder is considered to be:

  • Mild: patient meets 2-3 criteria
  • Moderate: patient meets 4-5 criteria
  • Severe: patient meets 6+ criteria

Treatment Options for Substance Use Disorders:

1. Inpatient hospitalization:

Admission to an inpatient psychiatric unit for detox can be a very helpful first step to safely detox, with medical help on site and mental health providers who can help assist in a safe and less disruptive detox.

2. Rehabilitation (Rehab) Programs:

Inpatient rehab programs offer a structured environment for individuals to focus on their recovery. Medical detoxification may be provided to manage withdrawal symptoms safely. Residential treatment offers patients to live on site with other patients in recovery where many services are provided such as visits with a psychiatrist, therapy, education, and support to address the underlying causes of addiction.

3. Intensive Outpatient Programs (IOP):

IOPs offer a less restrictive option for individuals who need intensive treatment but don’t want to commit to losing autonomy or sleeping outside of their home. They involve group therapy, individual counseling, and education sessions.

4. 12-Step Programs (AA/NA Meetings):

Programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) provide a supportive community of individuals in recovery. The 12-step approach focuses on admitting powerlessness over addiction, seeking higher power, and making amends. Meetings occur daily all across the country. There are many different kinds of meetings, and often groups are specifically aimed towards a specific population, for example atheists or veterans.

5. Medications for Cravings and Substance Pleasure Reduction:

There are many medications to help with substance use disorder, some aimed towards harm reduction, while others are aimed towards reducing cravings and the pleasure derived from using the substance. For opiate use disorder, some examples of commonly used medications are methadone, buprenorphine, and naltrexone. For alcohol use disorder, some examples of commonly used medications include naltrexone, disulfiram (Antabuse), acamprosate (Campral) and gabapentin.

6. Medications for Co-Occurring Disorders:

Individuals with SUD often have co-occurring mental health issues like depression, anxiety, or PTSD. Medications like antidepressants or anti-anxiety drugs can help address these underlying conditions.

7. Therapies:

Motivational Enhancement Therapy (MET) helps individuals build motivation to change addictive behaviors. Contingency Management involves rewarding positive behaviors and abstinence. CBT and psychodynamic therapy are also viable options.

Recognizing the signs, seeking professional help, and exploring treatment options are crucial steps towards recovery. Whether it’s through rehab programs, support groups, medications, or therapies, there is a range of approaches available to help individuals break free from the cycle of addiction. By fostering understanding and compassion, we can create a supportive environment that empowers those struggling with SUD to embark on a journey towards lasting recovery and a brighter future.