Substance Use Disorders
In the latest DSM-5 (2013) edition, there has been a major change in how alcohol and other drug addictions are classified. The terms abuse and dependence have been removed and they are now all defined in terms of ‘use’ disorders.
Signs & symptoms
There are a number of use disorders that have been classified as disorders, they all share a broad classification criteria noted below. The problem “pattern” of use results in “significant impairment or distress”, and includes at least 2 of the following within a 12 month period.
- The substance is regularly consumed in larger amounts, or over a longer period than was planned
- There is a wish to reduce or to be able to control substance use, or there have been failed attempts to do so
- Considerable time is spent in obtaining, using or recovering from the effects of the substance
- Experiences cravings, or has a strong urge to use the substance
- Repeated substance use causes significant impact on work, home or school as responsibilities in these areas are not able to be fulfilled
- Regardless of the personal or social difficulties caused or worsened by its effects, the substance use continues
- The substance use takes priority over important social, work, or leisure activities that are either cut down or stopped completely
- Substance use persists even when physically unsafe to do so
- Despite the awareness of ongoing or recurrent physical or psychological problems that are likely to be caused or worsened due to the substance, its use is continued
- The development of tolerance that can EITHER:
- 1) require “markedly” increased amounts of the substance to obtain “desired effect’ or to become intoxicated OR
- 2) reduced effect with use of the same amount of the substance.
- Withdrawal as indicated by EITHER:
- a) the substance-specific withdrawal symptoms OR
- b) The substance or a related substance is taken to reduce or avert withdrawal symptoms.
The Australian Department of Health reports that 7.7% of Australian adults have a substance use disorder with males at 11.1% were twice as likely as females at 4.5% to have a disorder. Alcohol use disorders were approximately three times as common as drug use disorders.
Treatment of substance use disorders usually involves both psychological and medical approaches.
There are a number of health issues around withdrawal that require medical involvement and medication can lessen the risk and unpleasant physiological withdrawal symptoms. The combined approach of medical and psychological treatments has been found to be most effective. The psychological treatments take a number of different approaches, but there is also some evidence that suggests including broader aspects beyond the substance use and also dealing with issues such as relationships, social and community connectedness is also important. Research has also supported the 12-step treatment program used for example in Alcoholics Anonymous.