Last reviewed:
Apr 3rd 2023
LSW
There are several different kinds of substances, both legal and illegal, that have the potential to cause addiction, abuse, and dependency. If someone develops a physical or mental dependence on one of these substances, they may be diagnosed with a substance use disorder. Treatment can include medication and therapeutic intervention.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), substance use disorders can include the use of 10 types of legal and illegal substances [1][2]:
Symptoms of substance use disorders may vary slightly depending on the substance and severity, but can include [3][4][5]:
Many people with a substance use disorder also have a co-existing mental health condition, such as depression, anxiety, or posttraumatic stress disorder (PTSD) [6].
In some cases, the mental illness leads to substance use, and in others, the substance use leads to the development of a mental illness. Some people may have genetic or environmental risk factors that increase their risk of both substance use disorders and mental illness [7].
Depression, anxiety, and psychosis are common conditions that can be caused by the use or withdrawal of certain substances [8]. For example, substance-induced psychosis is a known disorder that is often caused by excessive or early cannabis use [6].
Diagnostic criteria for substance-induced conditions includes [1][8]:
There are several mental health conditions that commonly co-occur with substance use disorders that are thought to precede or cause substance abuse, including [6][7]:
Research indicates that around a quarter of people with a serious mental illness, such as schizophrenia and bipolar disorder, also have a substance use disorder. People diagnosed with schizophrenia are significantly more likely than those without a mental health diagnosis to excessively use tobacco, alcohol, and illicit drugs [6].
Mental illness has also been shown to significantly increase the risk of prescription medication abuse, potentially leading to addiction. There is also research to suggest that those with a mental disorder in childhood are at increased risk of developing a substance use disorder [5][6].
Risk factors may be linked, such as genetic or environmental factors increasing the risk of mental illness as well as the risk of substance use disorder [5][7].
Many people with a mental health condition use substances as a way to temporarily avoid or alter their mental state, such as creating a euphoric feeling, numbing thoughts and feelings, or reducing agitation. However, substance use commonly worsens symptoms in the long-term and can create further mental and physical health issues [7][8].
A diagnosis of substance use disorder may occur if the individual seeks professional support in reducing their use, if a family member expresses concern, or if a doctor notices concerning signs at a routine appointment that cause them to suspect a substance use disorder, such as poor hygiene, weight loss, red eyes, needle marks, or changes in mood or behavior [8].
Criteria in the DSM-5 for a diagnosis of substance use disorder involve aspects such as level of control over use, level of impairment, risky behaviors, and physiological signs of dependence [1][2].
For a diagnosis of substance use disorder, at least 2 of the following criteria must be met [1]:
The severity of the diagnosis depends on the number of criteria that are met. Substance use disorder can be classified as mild with 2-3 criteria, moderate with 4-5 criteria, and severe with 6 or more criteria being met [1][5].
The treatment for a substance use disorder will vary depending on the substance that is being used and the severity of the condition. Several treatment options are available.
Certain medications can be prescribed in order to help reduce withdrawal symptoms, detoxify, or replace a substance [9][10]:
Antidepressants are also sometimes prescribed while treating substance use disorders, to help reduce emotional distress that can occur alongside withdrawal or in the context of co-occurring conditions [9].
Other substance use disorders, such as cocaine and methamphetamine, do not yet have approved medicinal treatments but there is ongoing research into the use of certain medications and their effectiveness [10].
There are several types of therapy that can be useful in treating substance use disorders, particularly those that co-occur with other mental health conditions, such as [2][6][7]:
Many communities offer support groups that help people overcome their own addiction and maintain abstinence or offer guidance to those dealing with the effects of someone else’s addiction, by sharing experiences and support. Examples of this include:
Some people choose or are advised to utilize a facility to help them detoxify from a substance, with the help of professional support. This can involve several weeks of staying at a residential facility or hospital, in which individual and group therapy will be offered, along with any required medicine and support to aid with the withdrawal and detoxification process. Treatment may begin with a medical detox program, followed by a transition into a residential treatment program, where the person participates in ongoing therapy and other addiction treatment services [2][10].
If there is an underlying mental health condition contributing to the use of substances, the individual will likely be referred to a mental health specialist to treat this condition with the use of combined therapy and medication, alongside treatment for substance use disorder [7].
If there is a physical health condition, such as overdose, organ damage or failure, vitamin deficiency, or infection, the individual will be provided with appropriate treatment to manage this condition [2].
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