Specialties
Substance Use Disorder
According to the American Psychiatric Association, substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance — such as alcohol, tobacco, or illicit drugs — to the point where the person's ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing, or will cause, problems. The most severe SUDs are sometimes called addictions.
People with a substance use disorder may have distorted thinking and behaviors. Changes in the brain's structure and function are what cause people to have intense cravings, changes in personality, abnormal movements, and other behaviors. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavioral control.
Repeated substance use can cause changes in how the brain functions. These changes can last long after the immediate effects of the substance wear off — in other words, after the period of intoxication. Intoxication is the intense pleasure, euphoria, calm, increased perception and sensation, and other feelings caused by the substance. Intoxication symptoms are different for each substance.
When someone has a substance use disorder, they usually build up a tolerance to the substance, meaning they need larger amounts to feel the effects.
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:
- To feel good — a feeling of pleasure, "high," or intoxication
- To feel better — to relieve stress, forget problems, or feel numb
- To do better — to improve performance or thinking
- Curiosity, peer pressure, or experimenting
People with substance use and behavioral addictions may be aware of their problem but not be able to stop, even if they want to and try to. The addiction may cause physical and psychological problems, as well as interpersonal problems with family members and friends or at work. Alcohol and drug use is one of the leading causes of preventable illness and premature death nationwide.
Symptoms of substance use disorder are grouped into four categories:
- Impaired control: a craving or strong urge to use the substance; a desire or failed attempts to cut down or control use
- Social problems: substance use causes a failure to complete major tasks at work, school, or home; social, work, or leisure activities are given up or cut back
- Risky use: the substance is used in risky settings; use continues despite known problems
- Drug effects: tolerance (needing larger amounts for the same effect); withdrawal symptoms (different for each substance)
Many people experience substance use disorder alongside another psychiatric disorder. Often another psychiatric disorder precedes substance use disorder, or the use of a substance may trigger or worsen another psychiatric disorder.
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