What are substance use disorders?

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Millions of Americans admit to drinking alcohol occasionally or trying illicit drugs at least once in their lifetime. However, substance use disorders go beyond a single glass of wine on a Friday evening or having experimented with marijuana a single time as a teenager.

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Substance use disorders (SUDs) are complex mental health conditions where there is a pattern of uncontrolled use of a substance despite this having harmful consequences to physical health, mental well-being, and quality of life.

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The results from the 2023 National Survey on Drug Use and Health reveal that 48.5 million people aged 12 or older in the U.S. had a substance use disorder within the previous 12 months.

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Substance use disorders have a significant impact on individuals and their families as well as the wider community and society as a whole. If you or a loved one are dealing with a suspected or known substance use disorder, the good news is that they are treatable. Nearly three-quarters of those who say they ever had a SUD consider themselves in recovery or recovered.

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In this article, we look at substance use disorders in more depth, explaining the types of SUD, their signs and symptoms, and how they can be treated.

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Key takeaways

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• Substance use disorder (SUD) is a diagnosable mental health condition that involves the compulsive use of substances despite harmful consequences to health, relationships, and daily functioning.

• SUD exists on a spectrum, from mild to severe, and can involve legal or illegal substances, including alcohol, opioids, prescription medications, and more.

• Risk factors for developing a SUD include genetic predisposition, mental health challenges, social environment, and early exposure to substance use.

• Treatment options are available and effective, ranging from detox and medication to talking therapies and peer support, with many people achieving long-term recovery.

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What is substance use disorder?

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Substance use disorder, which has previously been referred to as drug or alcohol addiction, abuse, or dependence, is a mental health condition where an individual has continued uncontrollable use of a legal or illegal drug or medicine.

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Previously, substance use disorder was correlated to perceived character flaws or moral deficiencies, with those affected heavily stigmatized. However, advances in neuroscience have led to a deeper understanding of the condition. It’s been realized that over time, the use of substances alters mechanisms in the brain including:

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• Reward

• Executive function

• Stress reactivity

• Mood

• Self-awareness

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These changes drive the use pattern, even though it causes impairment and/or distress, leading to a decline in health, social functioning, and quality of life.

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SUD is a progressive, chronic, relapsing disorder that exists on a spectrum from mild to moderate or severe. While sometimes life-threatening, substance use disorder can be overcome with treatment and recovery pathways.

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Types of substance use disorders

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There are many different types of substance use disorder according to the National Survey on Drug Use and Health (NSDUH) and the Diagnostic and Statistical Manual of Mental Disorders. These include:

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• Alcohol use disorder

• Caffeine use disorder

• Cocaine use disorder

• Hallucinogens use disorder

• Heroin use disorder

• Inhalants use disorder

• Marijuana use disorder

• Methamphetamine use disorder

• Nicotine use disorder

• Opioid use disorder

• Prescription pain reliever use disorder

• Sedatives use disorder

• Stimulants use disorder

• Tobacco use disorder

• Tranquilizer use disorder

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This list is not exhaustive, however, as both the DSM-V and NSDUH include a category for the use of any other drug or substance. The NSDUH also recognizes polysubstance use, which is the use of multiple substances such as combining alcohol and illegal drugs or using several prescription painkillers concurrently.

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Alcohol use disorder is the most common form of substance use disorder in America, with 28.9 million people stating they had alcohol use disorder in the last year. However, drug use disorder is a close second, with 27.2 million people affected in the previous 12 months.

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Signs of substance use disorder

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It isn’t always easy to spot the signs of substance use disorder but they can lead to changes in the way someone looks, acts, or feels The signs of substance use disorder include:

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• Having an intense urge to use the substance.

• Being unsuccessful in attempts to stop using or cut down on the use of the substance.

• Developing a tolerance for the substance and needing to use more and more to get the same effects.

• Spending a lot of time in finding, using, or recovering from using the substance.

• Using for longer than you’re meant to or at higher dosages than required if it’s a prescription medication.

• Struggling to fulfill work, school, or home responsibilities due to substance use.

• Continued substance use even though it is damaging your relationships with other people.

• Using the substance repeatedly even though it puts you in danger.

• Disinterest in social, recreational, or work activities because of your substance use.

• Continuing to use the substance even though it has adverse effects on your physical or psychological health.

• Experiencing symptoms of substance use withdrawal which can be relieved by using the substance again.

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Substance use disorder symptoms

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The effects of substance use disorder vary according to which substance is being used and whether it is active in your body or not.

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Intoxication refers to the immediate and short-term effects that a substance has on the body. Symptoms of substance intoxication include:

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• Calmness

• Excitedness

• Euphoria

• Intense emotions

• Sleepiness

• Impaired judgment and decision-making

• Decreased inhibition

• Decreased coordination

• Slowed reaction time

• Paranoia

• Altered sensations

• Extreme agitation

• Hallucinations

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Withdrawal occurs when the short-term effects dissipate as a substance begins to leave the body. Symptoms of substance withdrawal include:

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• Sleep problems

• Restlessness

• Sweats and chills

• Appetite changes

• Feeling anxious or depressed

• Headaches

• Muscle tension

• Diarrhea

• Vomiting

• Aches and pains

• Increased heart rate or blood pressure

• Excessive sweating

• Paranoia

• Irritability and agitation

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The most severe substance use disorder withdrawal symptoms are known as delirium tremens (DTs). The main symptoms of DTs are visual and/or auditory hallucinations and seizures. These require swift medical attention as they are life-threatening and can result in serious long-term complications.

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Causes of substance use disorders

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While the exact mechanisms aren’t fully understood, it is known that substance use disorder is a physiological condition where the way the brain works is altered, creating a harmful pattern of substance use.

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However, there are factors, such as social pressure, emotional escape, and even curiosity that may contribute to developing a SUD. Further, the development of substance use disorder often follows a progressive pathway:

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• Experimental or prescription use: Trying a substance once or taking a substance as prescribed.

• Occasional use: Using a substance socially or disregarding directions of prescription medication when taking it.

• Heavy use: Using a substance regularly, with little or no breaks between days of use.

• Substance use disorder: Taking the substance daily or multiple times a day with the use feeling uncontrollable.

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It is important to note though that everyone's experience of substance use disorder is different and differs according to age, gender, severity, socioeconomic status, and many other factors.

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What are the risk factors for substance use disorders?

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As is the case with many other chronic conditions, the likelihood of developing a SUD is heavily based on genetics, with 40-70% of a person’s risk based on this factor. However, numerous environmental and external factors can also elevate an individual's risk including:

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• Being raised in a home where another family member has a substance use disorder

• Living in a neighborhood and/or going to school with a high prevalence of substance use

• Easy access to inexpensive alcohol and other substances

• Heavy advertising of alcohol

• Low parental monitoring

• High levels of family conflict

• Mental health problems

• Low school involvement

• A history of abuse or neglect

• Limited access to healthy social and recreational activities

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What are the complications of substance use disorders?

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One of the most common complications of substance use disorders is overdose, with over 107,000 drug overdose deaths reported in 2022. This is a medical emergency caused when someone takes too much of a substance.

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There are many other health issues linked to substance abuse disorder. These include:

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Injury and physical trauma as a result of violence, falls, burns, and vehicular crashes

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• Arrhythmia

• Hypertension

• Cardiomyopathy

• Aortic dissection

• Sudden cardiac death

• Respiratory infection

• Sudden sniffing death syndrome

• Respiratory depression

• Urinary retention

• Acute kidney failure

• Sexual dysfunction

• Tooth decay

• Periodontal disease

• Bruxism

• Loss of vision

• Perforation of the nasal septum

• Bloodborne diseases

• Bacterial and fungal skin infections

• Ulcers

• Abscesses

• Deep vein thrombosis

• Cancer

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How are substance use disorders treated?

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As substance use disorder is such an individualized experience, so is treatment. You may utilize one or more different treatment options at different points of the process, and it may require a combination of inpatient and outpatient support.

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Detoxification

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Detoxification, or 'detox', is the process of clearing substances from the body, often under medical supervision. It helps individuals safely manage the physical symptoms of withdrawal, which can sometimes be severe or even life-threatening. Detox is usually the first step in treatment, rather than a standalone cure. Ongoing support is essential after detox to address the psychological aspects of substance use.

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Talking therapies

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Talking therapies, such as cognitive behavioral therapy (CBT), contingency management, and dialectical behavior therapy (DBT) play a key role in treating substance use disorders. They help individuals explore the underlying reasons for their substance use, develop healthier coping mechanisms, and build motivation to change.

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Therapy can be delivered one-on-one, in groups, or with family involvement, depending on the needs of the person. Long-term engagement with talking therapies can support sustained recovery and prevent relapse.

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Medicine

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Medications may be used to manage withdrawal symptoms, reduce cravings, or discourage substance use. For example:

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• Methadone or buprenorphine can help people with opioid use disorder.

• Naltrexone may be used for alcohol use disorder.

• Nicotine patches or nasal spray can be used for tobacco use disorder.

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These treatments are often most effective when combined with psychological support. Medicine is typically prescribed and monitored by a healthcare professional as part of a wider recovery plan.

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Self-help

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Self-help approaches, such as mutual aid groups and peer support networks, offer valuable community-based support. Groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) provide structured programs and shared experiences that can help individuals feel less isolated.

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These spaces encourage accountability, offer emotional support, and can complement professional treatment. Many people find long-term recovery is strengthened through regular involvement in self-help communities.

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Recovering from a substance use disorder is a deeply personal journey, and there’s no one-size-fits-all approach. However, help is available, and recovery is possible. The most important step is reaching out and starting the conversation. If you’d like to learn more about mental health conditions and explore practical ways to support yourself or someone you care about, take a look around our blog for more expert insights and guidance.

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References

• Drug Abuse Statistics
• Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and Health | SAMHSA (July 2024)
• Substance use, abuse, and addiction
• Substance Use Disorder (SUD): Symptoms & Treatment (September 2024)
• Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (May 2023)
• Substance Use Disorders - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health - NCBI Bookshelf (June 2016)
• Signs and Symptoms of Drug Misuse - Overdose Prevention
• Drug withdrawal: symptoms, timeline and management - Priory (September 2024)
• Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? - PMC (2017)
• Drug Overdose Deaths: Facts and Figures | National Institute on Drug Abuse (NIDA) (August 2024)

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