substance use disorder

Here's most everything you need to know about Substance Use Disorder in one handy-dandy place.

Some folks call it Substance Use Disorder. Others say Substance Abuse Disorder. Still others drop the Disorder entirely. They insist that Substance Abuse is Substance Abuse. Period. But the ABC's are the same, whatever name you choose to use -- or abuse.

In the considered opinion of the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) however, the malady is called Substance Use Disorder (SUD). So that's the name we'll choose.

The DSM-5 is the latest version of the American Psychiatric Association’s gold-standard text on the names, symptoms, and diagnostic features of every recognized mental illness -- including addictions. There are 11 criteria for Substance Use Disorders, from "Taking the substance in larger amounts or for longer than you're meant to" to "Development of withdrawal symptoms, which can be relieved by taking more of the substance." There are also various levels of severity, and those are configured by symptom amount.

The Verywell Folks

While we're discussing particulars, this piece echoes one written by Sherry Christiansen. Christiansen's article appeared in Verywell Health, and it's as comprehensible as it is extensive. Perhaps that's because it was medically reviewed by Harvard Medical School's board-certified Steven Gans, MD, who also happens to be an attending psychiatrist at McLean Hospital. Or maybe she's just astute like that. We're thinkin' it's both, plus a good bit of what Gans says here:

I am thrilled to be involved with Verywell in their mission to bring accurate and accessible information regarding health issues to everyone. This is an especially crucial time that the information available to the public in understanding their health is factual, clear, and contextually useful.

If that's not refreshing to you, well, you're in the wrong place. The fact of the matter is Verywell is very much concerned with the facts of what matters. So much so that they've even appointed an in-house Medical Review Board of equally concerned professionals tasked with ensuring their facts are exceedingly accurate. Verywell is also very much concerned with digestibility. And there they also do very well indeed.

(Insert applause here.)

Anyway, here the facts cover Symptoms, Diagnosis and Treatment. Ready?

Substance Use Disorder Symptoms

Symptoms are similar, whether you're drinking or drugging. So are signs. The key is being able to recognize them. Here are some of the most glaring:

  • Getting into physical altercations
  • Having accidents
  • Having legal problems
  • Experiencing a decline in attendance or performance at school or work
  • Disappearing from home for long periods
  • Exhibiting suspicious behavior
  • Experiencing a change in appetite or sleep cycle
  • Having personality or attitude changes
  • Experiencing mood swings
  • Exhibiting anger, irritability, hyperactivity, agitation, or emotional outbursts
  • Having a lack of motivation
  • Feeling paranoia or fearfulness
  • Having a sudden weight gain or weight loss
  • Exhibiting a decline in physical appearance and or personal hygiene

There are more of course, much more. (Aren't there always?) But these represent the most prevalent.

SUD Diagnosis

SUD's diagnostic criteria are like signs and symptoms on steroids. In other words, they don't represent a "maybe;" they represent an "is."

  • Ingesting ever larger quantities of alcohol or drugs
  • Inability to quit using or reduce the amount of use
  • Devoting considerable time and resources into obtaining the substance
  • Indefatigable desire and cravings to drink and/or drug
  • Consistently unable to meet obligations at work, school, or at home
  • No desire to stop recurring or ongoing substance-related social problems
  • Uninterested in hobbies, social engagements and/or leisure activities
  • Increasing and continued hazardous behavior (i.e. drinking and driving)

Addiction professionals also consider ignoring inherent harm, increasing tolerance and intense withdrawal symptoms in their criteria.

Substance Use Disorder Categories

The three SUD categories are Mild (meeting two to three of the above criteria), Moderate (four to five of the above) and Severe (six or more).

Substance Use Disorders can also be identified by the substance of choice (i.e. Alcohol Use Disorder or Opioid Use Disorder).

With regards to recovery, there's Early and Sustained Remission for those who no longer meet the respective DSM-5 criteria for either 3-12 months or a year or more. (That means complete sobriety.) There's also Medication-Assisted Treatment (MAT) for those who choose to treat Opioid Use Disorder with methadone or buprenorphine.

Substance Use Disorder Treatment

There are various levels of Substance Use Disorder treatment, including Detox, PHP, IOP, OP and Aftercare. Here's a quick breakdown of each:

Detox

Detox duration is entirely dependent upon the substance of choice. Alcohol, cocaine and opioid detox is generally accomplished within a week. Sleeping pills and benzos may take up to two weeks. Whichever the substance, detox must be conducted by a medical professional. Only qualified physicians have the capacity to prescribe the necessary medications. And you most definitely don't want to detox without. At the very least cold turkey is severely unpleasant. It can also be fatal.

Partial Hospitalization Program (PHP)

Partial Hospitalization Programs generally last 30 days but can extend longer. During PHP clients continue meeting with medical staff until mental health conditions or biomedical conditions present as stabilized. Clients also have a minimum one hour individual therapy and 30+ hours of group therapy per week. Therapy can include Twelve Step facilitation, psychoeducational information, spirituality, life skills training, as well as health and fitness activities.

PHP clients additionally live onsite and are usually required to attend seven AA meetings per week.

Intensive Outpatient Programs (IOP)

Intensive Outpatient Programs generally run 30-90 days and take place onsite within a structured sober living environment. Also like PHP, clients receive close oversight. Some facilities insist on immediately reengaging withing the community (i.e. jobs). And all consist of intensive classes and workshops.

IOP is considered the most crucial time in recovery. Between resuming social and/or occupational responsibilities, attending multiple meetings, and closely communicating with staff and sponsor, it's the first time a client handles his- or herself sober.

Outpatient / Aftercare

Aftercare / Outpatient Programs generally last from 3-6 months and can occur within or outside a sober living facility. Most people prefer the added support provided by a sober home, at least for the first 90 days. Aftercare / Outpatient clients continue learning and implementing sober coping and behavioral skills. They also continue utilizing their sponsor and therapist.

Aftercare / Outpatient clients identify and accomplish healthy recovery goals, of housing, employment and educational varieties. They also begin to re-establish ties to the community. In other words, the emphasis is on purpose, meaning, and connection.

More Applause Please

Recovery Boot Camp applauds the good folks at Verywell Health for providing such comprehensive -- and easily comprehended -- addiction information. Like we said, few folks manage to do one, let alone both. When one does both -- and both so strikingly -- well, applause is definitely in order. We'd also like to applaud each and every one who's decided to take on Substance Use Disorder. Whether afflicted or comforter, the fight is a fight for very lives. So anyone who's stepped up to do battle deserves resounding acclaim.

What about you? Are you afflicted? Or are you comforting and fighting for the afflicted? If you're the former, please don't hesitate to reach out. Help is out there. In varieties you can't even imagine. Each more than ready, willing and eager to assist. No foolin.'

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