Substance Use Disorder - Mental Health

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  1. Understanding substance use disorder
    1. Substance Use Disorder (SUD) — previously called substance abuse and/or addiction — occurs when a person’s use of alcohol or drugs contributes to health issues or interferes with work, school, or home life.
  2. Increased risk of suicide
    1. Misusing substances like alcohol and prescription drugs can cause symptoms of or worsen mental health conditions and increase risk for suicide.
  3. Empower viewers with accurate depictions in storytelling
    1. Portraying the risk and protective factors for substance misuse accurately can empower viewers to help themselves and their loved ones.

Storytelling Tips

Portray a Range of Mental Health Experiences
  • Show the connection between substance use disorder and other conditions like generalized anxiety disorder, post-traumatic stress disorder, and depression.
  • Understanding this connection could help individuals and families find the best treatment options. 
Diversify Representation
  • Help viewers understand that substance use disorders can impact anyone, regardless of race, socioeconomic status, and occupation. 
  • Depictions of addictive behaviors and substance misuse in film and television that reinforce stereotypes by race, socioeconomic status, and occupation can prevent people from seeing their own experiences represented and seeking help when they need it.
Depict Effective, Realistic Help-Seeking and Treatment
  • When depicting inpatient or residential treatment for these disorders, talk to advisors and those with lived experience to ensure you are accurately depicting the treatment process. 
  • Treatment for substance use disorder can be complicated, and many patients will try different treatment options and may relapse frequently. 
Represent the Complex Causes of Mental Health Challenges
  • Explore the factors that can contribute to substance use disorders, including drugs like opioids, which can cause physical dependence.
  • The perception that substance use disorder is entirely genetic, or that it’s completely a behavioral problem, can prevent people already struggling with these issues from identifying the right solutions.
Consider the Impact of Language
  • Be cautious of terminology that defines someone’s identity based on a mental health challenge like substance use disorder. 
  • The mental health field has shifted from using language like “addict” and “abuse,” in order to destigmatize substance use disorder and to encourage conversation and help-seeking.
  • Terms like “addict” are often still used in non-clinical settings and may be required for authenticity in your story, but also look for opportunities to use more up-to-date terminology like “he or she has a substance use disorder” rather than “he or she is an addict.”
Avoid Sharing Potentially Harmful Details
  • Avoid showing substance use unless necessary for your storyline, and consult with advisors to make sure you are doing it as safely as possible.
  • Depictions of drug usage can be triggering for people who are struggling with substance use disorder or are in recovery.
  • It’s also important to avoid narratives about how people obtain substances or hide their usage, which can create a blueprint for others experiencing issues related to substances or considering substance use. 
  • If your story visualizes seemingly “positive” impacts of substances (like calm or relaxed states), make sure to also visualize the negative impacts on health and quality of life.


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).

Need more guidance on depicting Substance Use Disorders? Browse the expert directory >

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