Substance Use Disorders and What They May Entail
By Gina Cipriano
The American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) explains that substance use disorders are characterized by some of the following:
- Taking more of the substance than was initially intended
- Inability or difficulties stopping use of the substance
- Decreasing amount of time engaging in activities unrelated to the substance (i.e., giving up recreational activities)
- Relational difficulties as a result of the substance use
- Craving the substance
- Having to increase the amount of the substance than originally used to get the same high
- Depending on the substance abused, symptoms of withdrawal may include some of the following: headaches, irritability, nausea, fatigue, issues sleeping, changes in appetite and/or sleep
Often, substance use does not occur in isolation and a dual diagnosis of a substance use disorder and mental health issue is warranted. It is not always clear what comes first (the substance use or the mental health issue). Using substances can serve as a means for someone to manage their symptoms of a mental health issue. However, substances can induce mental health problems such as “psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders” (APA, 2013, p.481). Some factors to consider that demonstrate the commonness of a substance use disorder and mental health illness include the following:
- “Separately, eating disorders and substance use disorders have the highest and second-highest mortality rates of all psychological disorders” (Claudat et al., 2020p.143). Ultimately, a co-occurring diagnosis can be extremely dangerous.
- Almost half of people diagnosed with schizophrenia also have a substance use disorder (Khokhar et al., 2018)
- Substance use disorders often occur with severe depression and anxiety (Mohamed et al., 2020)
Treatment should generally entail addressing BOTH the substance use disorder and mental health issue concurrently rather than one after the other. People can potentially engage in symptom substitution if mental health issues and substance issues are treated separately (Bahji et al.,2019). Ultimately, this would mean that a person increases the symptoms of one issue while another one is being treated. For instance, if someone has a co-occurring eating disorder and substance use disorder (and their eating disorder was being treated separately), they may reduce the amount of time they spend engaging restricting food but increase the number of substances they use to deal with the distress of not restricting food (Bahji et al.,2019). Treating issues concurrently may include a plethora of interventions. Firstly, a person must be physically and biologically stabilized due the negative effects of a substance and impacts of withdrawal on a person. After this, treatment can entail medication, group therapy, individual therapy, family therapy, and psychoeducation.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry Research, 273, 58-66. https://doi.org/10.1016/j.psychres.2019.01.007
Claudat, K., Brown, T. A., Anderson, L., Bongiorno, G., Berner, L. A., Reilly, E., Luo, T., Orloff, N., & Kaye, W. H. (2020). Correlates of co-occurring eating disorders and substance use disorders: a case for dialectical behavior therapy. Eating Disorders, 28(2), 142–156. https://doi.org/10.1080/10640266.2020.1740913
Khokhar, J. Y., Dwiel, L. L., Henricks, A. M., Doucette, W. T., & Green, A. I. (2018). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia Research, 194, 78–85. https://doi.org/10.1016/j.schres.2017.04.016
Mohamed, I. I., Ahmad, H. E., Hassaan, S. H., & Hassan, S. M. (2020). Assessment of anxiety and depression among substance use disorder patients: A case-control study. Middle East Current Psychiatry, 27(1). https://doi.org/10.1186/s43045-020-00029-w
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