Snapshot

The DSM-5, the authoritative guide used to diagnose psychiatric disorders, uses the term “substance use disorder” in place of “substance abuse.” Accordingly, the mental health field has moved away from stigmatizing language such as “abuse” and “addict,” to terms like “substance use disorder” and what’s known as person-first language like “person with addiction.” There is also an additional category in the Addictive Disorders section of the DSM-5 labeled “Non-Substance-Related Disorders,” which currently only refers to gambling use disorder.

There are nine substances associated with substance use disorder: alcohol, caffeine, cannabis, phencyclidine (PCP) inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, and a category of unknown substances. 

While some people may see the causes of substance use disorder as primarily genetic or biological, and others may see them as behavioral, the reality is that SUD is caused by a combination of biological and environmental factors. While genetics and life experiences can make individuals more predisposed to this disorder, certain substances (like opioids) are more likely to cause physical dependence, which can create uncomfortable symptoms when a person stops using that substance. Physical dependence is not the same thing as a substance use disorder. 

Facts & Stats

Alcohol and tobacco are the most commonly used substances, followed by cannabis. 

Over 20% of Americans used illicit drugs in 2019. 

Approximately 20% of Americans experience substance use disorder in a given year, but only 10% of those will seek treatment.

Use of substances can cause or worsen other mental health conditions. Approximately 38% of people with substance use disorder are also experiencing another condition like depression or an anxiety disorder. 

Alcohol causes more deaths than all drugs combined and alcohol misuse contributes to 88,000 deaths in the United States each year. 1 in 10 deaths among working adults is due to alcohol misuse.

After tobacco and alcohol, the deadliest drugs (in order of most deaths to least deaths) are fentanyl, heroin, prescription opioids, cocaine, methamphetamines, and benzodiazepines.

Types of Substances

• Alcohol creates feelings of euphoria and lowers inhibitions, but it also severely impairs judgment, perception, and reaction times. Alcohol is a central nervous system depressant, but it causes the most severe long-term damage to the liver.
• Cannabis (also known as marijuana) is a chemical that creates feelings of elation (being high), but can negatively impact cognitive function, memory formation, the perception of time, and reaction time. Cannabis is the most commonly used substance behind alcohol. 
• Hallucinogens, like LSD and psilocybin (magic mushrooms), alter a person’s perception of reality (casually known as “tripping”) and can cause auditory and visual hallucinations. 
• Inhalants are chemicals (paint thinner, nail polish remover) that people breathe in (also called “huffing”), which can produce a brief period of feeling high. While not as addictive as other substances, they can pose an acute risk of cardiac arrest or suffocation. 
• Opioids, or opiates, interact with neurotransmitters in the brain to reduce pain. They can also cause feelings of intense pleasure. These drugs — like oxycodone,heroin, and fentanyl — are extremely addictive and cause the most drug overdose deaths. 
• Sedatives are a type of prescription medication that slows down brain activity and are often used to induce relaxation or sleep. These drugs include Xanax and Ambien and can cause addiction. 
• Stimulants, also known as “uppers,” are used to improve concentration, increase energy and keep people awake. While these drugs — like cocaine and meth — may create a “rush” and achieve these goals, they are also very addictive and can have serious health consequences. 

Symptoms & Warning Signs

While different substances can cause different symptoms, these are the defining factors of substance use disorder:

• Taking the substance in larger amounts or for longer than intended
• Wanting to cut down or stop, but not being able to 
• Spending a lot of time and resources getting or using substances 
• Cravings and urges to use the substance
• Substance use interfering with work, school, or home life
• Continuing to use, even when it causes problems in relationships
• Giving up important social, occupational, or recreational activities because of substance use
• Increased tolerance or needing to use more of the substance to get the desired effect
• Development of withdrawal symptoms when not using the substance 

Treatment Options

• Behavioral counseling can be provided through outpatient or inpatient services. More severe substance use disorders often require inpatient treatment to manage withdrawal and create a safe environment so underlying problems related to the disorder can be identified and treated. 
• Medication is not available for all SUDs, but it is used to treat tobacco use disorder, alcohol use disorder, and opioid use disorder. Types of medications used and their function differ by substance or drug category. 
• Support groups and peer support are frequently used as part of a substance use disorder treatment plan (like Alcoholics Anonymous and Narcotics Anonymous).