Substance Use Disorder Symptoms and Signs
Substance use disorder, commonly called addiction, is continued use despite harm, with craving, loss of control over the amount used, and a brain reward system that has reorganised itself around the substance.
Also called: Addiction, Substance dependence, Drug addiction, Alcohol use disorder.
ICD-10 F10-F19 · ICD-11 6C40
Not weak will. A want that was taught.
Most people who drink, smoke or try a drug never develop a problem with it. Some people do. For them, using stops being a fresh choice each time. It becomes something that pulls at them.
A substance use disorder means using something even though it is causing real harm. The harm can be to health, work, money, or the people around you. It is common. It can be treated. And most people who have one eventually recover.
This is not a moral failing. It is what happens when the brain's learning system gets trained, over and over, by something very good at training it.
FROM INSIDE
What it is actually like
You promise yourself you will not do it tonight. By evening the thought is already there. A certain street, a certain time, a certain mood. The pull arrives before you have decided anything.
Using does not feel as good as it used to. Often it only makes you feel normal for a while. But not using feels worse than it used to. You feel flat, restless, anxious and unwell.
People around you ask why you do not just stop. You ask yourself the same thing, usually the next morning.
A path worn across grass
Walk the same shortcut every day and it becomes a bare track. Your feet find it without thinking. Grass grows back, but slowly, and only if other paths get walked.
WHAT IT DOES
Four common patterns
The substance changes. The pattern underneath is the same.
Losing control
The person uses more than they meant to, or for longer. They want to cut down and cannot manage it. The cravings are strong.
Life shrinking
Work, study, family and hobbies give way to getting the substance, using it, and recovering from it. Things that used to matter get dropped.
Carrying on despite harm
The person keeps going even though it is clearly damaging their health, their relationships or their safety. They know it is.
The body adapting
They need more to get the same effect, and they feel unwell without it. This is common. On its own, it is not enough for a diagnosis.
400M — ALCOHOL
64M — DRUGS
1 in 12 — TREATED
22M — RECOVERED
When it tends to begin
Peak age of onset: 20.
Median age of onset: 25.
Most substance use disorders start between the late teens and the mid twenties. The earlier someone starts using, the higher the risk. The teenage brain is still building its brakes. It can still begin at any age, including in later life.
How it is actually diagnosed
A pattern of use causing real problems, with at least two of these in the same year.
- Using more, or for longer, than intended, or failing to cut down
- Lots of time spent getting, using or recovering, and strong cravings
- Falling behind at work, school or home, or giving up other activities
- Carrying on despite problems with health, safety or relationships
- Needing more for the same effect, or withdrawal when stopping
Doctors count how many signs are present. Two or three is mild. Four or five is moderate. Six or more is severe. Needing more of a prescribed medicine, or feeling unwell when it stops, does not count on its own.
If it is worse than that right now
Stopping some substances suddenly can be dangerous. Alcohol and sleeping pills are the main ones. Get medical advice before you stop. If you use opioids, carry naloxone and never use alone. Remember that your tolerance drops fast after any break.
If someone is unresponsive or struggling to breathe, call emergency services now. If you are thinking about ending your life, contact a crisis line.