Recent estimates indicate that nearly 21 million adults in the United States have a substance-related addictive disorder. Substance-related disorders are categorized by 10 separate classes of substances: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other (or unknown) substances. These drugs all activate the reward system in the brain, which produces feelings of pleasure in the user.
Substance-related disorders are diagnosed when use of any substance, whether recreational or prescribed, becomes excessive and leads to significant impairment or distress. A formal diagnosis of substance-use disorder can be applied for all classes of the substances listed above, with the exception of caffeine. Caffeine is on the list because it is so readily available and can cause both a form of intoxication and withdrawal symptoms. As a result, its use is being investigated as a substance-related disorder.
Substance-related disorders are generally divided into two groups: substances-induced disorders and substance-use disorders. Substance-induced conditions include intoxication, withdrawal, and other mental disorders that can be caused by substances, such as psychotic disorders and sleep disorders. All substance-use disorders are characterized by the continued use of substances, despite their causing significant problems in important areas of an individual's life, such as family, school, and work. These disorders cause an underlying change in the brain of the user that may persist beyond detoxification. The behavioral consequences of these changes in the brain can be seen in the repeated relapses and intense drug craving experienced by many users.
While there does not appear to be a single cause, some people are more predisposed than others to developing substance-use disorders. This predisposition is largely based on genetic, environmental, social, and biological factors that vary from person to person. Many people with substance-use disorders have cross addiction and mental health issues. Children of parents with substance abuse disorders are at higher than average risk of developing the disorders themselves. Substance-use disorders and withdrawal symptoms can also be caused by the addictive nature of the substance itself.
Substance-related addiction disorders are treated like any chronic disease that may be managed or go into remission but always with a chance that relapse could occur. While medical attention is not generally required for some of the substance-related disorders, such as those that involve overuse of tobacco, cannabis, or caffeine, medication or behavioral interventions, including recovery programs (such as harm reduction) and support groups (such as AA) can help diminish cravings and other symptoms of withdrawal and improve the likelihood of quitting substance use once and for all.
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
Hartz SM, Pato CN, Medeiros H et al. Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry. 2014;71(3):248-254.
Last reviewed 03/06/2018